Medicaid ACOs: 3 ways to improve consumer engagement

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A review of Medicaid accountable care organizations in six states shows they all actively engage consumers, but because these efforts vary in format and effectiveness, there is some opportunity for improvement.

The review, which the Center for Consumer Engagement in Health Innovation at Community Catalyst details in a new report (.pdf), says engaging consumers in the design, implementation and oversight of Medicaid ACOs is critical to ensure they achieve their goal of providing “coordinated, person-centered care.”

To gauge how states are tackling this challenge, the report reviews six states’ Medicaid ACO programs--Colorado, Maine, Minnesota, New Jersey, Oregon and Vermont. In the design phase, these programs used existing Medicaid structures to solicit public input, and in the implementation phase, they held public forums, regular stakeholder meetings, and workgroups and councils. In terms of oversight, they included consumers in ACO governance structures and created consumer advisory councils to provide feedback.

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Some states, the report notes, had unique structures for consumer engagement. In Colorado’s Accountable Care Collaborative program, a consumer advocate chairs the Program Improvement Advisory Committee and helped develop its bylaws. And in Oregon, each Coordinated Care Organization’s Consumer Advisory Council is required to oversee the Community Health Needs Assessment and the development of the Community Health Improvement Plan.

For their part, the report notes, consumer advocates pushed to have consumers and advocates serve on ACO boards and provide input on ACOs’ financial incentive models; encouraged ACOs to consider consumer advisory council members for potential board members; and helped ACO initiatives achieve bipartisan support by promoting their potential advantages from a variety of perspectives.

Even with all of these efforts, though, the review highlights ways that healthcare organization leaders and policymakers could improve consumer engagement in Medicaid ACOs. They include:

Make it convenient. Be mindful about meeting times and locations, and accommodate transportation and childcare needs. In addition, provide adequate time before meetings for consumers and consumer advocates to review materials, and give consumers opportunities to offer input outside of in-person meetings.

Make it inclusive. Ensure that consumers and consumer advocates receive adequate training and funding; give consumer advocates the resources to solicit broader consumer input; engage a range of consumers who are fully representative of the ACO’s Medicaid beneficiaries; and change the dynamic of meetings to make language more inclusive and spend more time addressing issues relevant to consumers.

Make it effective. Ensure that consumer recommendations have impact by tracking the effect of their input on outcomes and providing pathways to increased leadership authority in governance structures. Also, require a “critical mass” of consumers on governance boards.