The White House is looking to bolster Medicare's accountable care programs by promoting ACOs to the 8.9 million beneficiaries who may be covered by the organizations, but may not know it.
The number of Medicare ACOs climbed to 447 this month as the program entered its fourth year and expanded to include four models. Medicare launched ACOs under the Affordable Care Act and growth of the program has been rapid, but rocky. In the program, hospitals and doctors agree to lower costs and improve the healthcare of patients. Under the model, Medicare pays ACOs based on the level of care, and ACOs with high quality scores that also happen to save Medicare money share in the savings. Those with poorer outcomes and higher costs may lose money.
Medicare beneficiaries are enrolled in ACOs by CMS, but participation is voluntary and the agency is working out how to best communicate about the benefits of the programs.
“A beneficiary may not know they are in an ACO, so the real challenge for this model is how does the ACO and CMS communicate what is the value of an ACO?” said Jane Andrews, a health insurance specialist in the seamless care models group at CMS said January 13 during a meeting of HHS' Advisory Panel on Outreach and Education (APOE).
“Because beneficiaries do not enroll into ACOs, they may have less or no knowledge about them,” added Karin Bleeg, another health insurance specialist in the seamless care models group. “We continue to struggle at times with messaging about ACOs,” she said.
To enhance communications around the model, the agency began to perform market research and focus groups last year to figure out outreach messaging according to Andrews. Results from the talks will be in in the next few months she said.
Beneficiaries opting out the ACOs don't appear to be a motivator in the agency seeking to increase communication about the care programs. ACOs have reported data sharing opt-out rates around 2% according to Jeffery Spight, president of Collaborative Health Systems, which operates 24 Medicare ACOs.
Instead the motivation appears to be ensuring that enrollees are getting the highest quality of coordinated care by being more aware of its benefits Spight said. His programs have been participating in the focus groups.
“We have lots room to improve communication and get information out,” Spight said. “This is all new ground.”
Members of APOE, a committee composed of patient advocates, payers, researchers and providers that advises HHS on outreach and implementation around the agency's various programs, had a few ideas for the CMS.
First and foremost the agency should focus on conveying the benefits of coordinated care versus attempting to explain what an ACO is. A way to do this would be sharing individual beneficiary stories via outreach materials panel members said.
Providers should also be incentivize in some way to promote the models, said Dr. Alvia Siddiqi, president of the Illinois Academy of Family Physicians.
Having ACOs succeed is crucial to the Obama administration. By the end of this year, HHS wants 30% of all traditional Medicare payments to come from ACOs, bundled payments or other alternative payment models. That number will increase to 50% by 2018.