Since it began three years ago, Medicare's test of accountable care hasn't asked beneficiaries who are not assigned to an accountable care organization whether they want to voluntarily enroll. That will change next year when some Pioneer ACOs will give beneficiaries that option.
The CMS Innovation Center is testing whether seniors will elect to enroll in an ACO, and whether those who agree to enroll are more likely to stay within the ACO's provider network for their care.
The track record for patients staying within the ACO network has been spotty. Unlike Medicare Advantage plans, patients in Medicare ACOs can seek treatment anywhere with no financial penalty, and often wander outside the network. That undermines ACO efforts to manage quality and costs and weakens incentives for ACOs to invest in services and programs, experts say.
Until this year, patients were enrolled in Medicare ACOs because their doctor was participating, and they were informed by letter. That will continue next year. But in 2015, additional patients will be able to choose to enroll.
The CMS Innovation Center said five Pioneer ACOs will solicit Medicare patients to sign up. Invitations will go to patients not included in an ACO in 2015, based on their 2014 primary-care doctor, but who previously were included.
Signing up may make patients more conscious of the quality-of-care benefits of ACO enrollment, and may nudge them to stay within the provider network, said Colin LeClair, executive director of Monarch HealthCare, an ACO that is inviting patients to enroll.
Irvine, Calif.-based Monarch mailed invitations to nearly 10,000 Medicare patients and 2,100 responded. Of those, about 100 declined. Monarch used letters drafted by the Innovation Center, which worked with a behavioral economist to draft four letters to see which version gained the highest response from Medicare patients.
But it's uncertain whether seniors will change their old healthcare patterns simply because they signed up for an ACO, said Dr. J. Michael McWilliams, an associate professor of health policy at Harvard University who has studied managed care and accountable care.
In Minneapolis, the Park Nicollet Pioneer ACO worried that inviting seniors to enroll would confuse them, and that it ultimately would do little to change patients' provider choices, said Donna Zimmerman, a senior vice president at HealthPartners, which includes Park Nicollet. Her ACO will wait to see whether Monarch's invitations are effective in getting patients to stay within the ACO network.