Medicaid accountable care organizations are beginning to gain traction in many states, but their development relies on gathering meaningful feedback from constituents, many of whom require complex care.
In a comparative study of six states with Medicaid ACOs — Colorado, Maine, Minnesota, New Jersey, Oregon and Vermont — the Center for Consumer Engagement in Health Innovation focuses on how ACOs can leverage consumer participation and feedback to fine tune the design, implementation and oversight of Medicaid ACOs.
In interviews with 14 consumer advocates across the six states, researchers identified the following five factors that can create or hinder meaningful consumer engagement.
1. Funding for training and transportation. To get meaningful feedback on ACO progress some funding is needed. Consumer advocates need to be trained to solicit information and reimbursed for their time. Consumers themselves may also require some form of reimbursement to help incent participation. For low income consumers, or those who live in rural areas or are disabled, providing a transportation voucher or other mode of transportation could make participation possible, for example.
2. Representative recruitment. Consumer advocates on stakeholder committees should reflect the actual members of the Medicaid ACO, rather than be family members of elected officials, for example.
3. Bandwidth and scheduling. The report recommends state agencies coordinate requests for consumer input so they can be spread out over time. Otherwise, an ACO workgroup could be held monthly for two to three hours at a time during the work day, and require advance preparation, according to the report. Such a time commitment could be discouraging or prohibitive to participation, particularly if participants are employed or have young children.
4. Educational support. Consumer advocates voiced concerns about the difficulty associated with learning the various acronyms and policies concerning ACOs. The jargon often keeps people from participating fully in discussion at workgroups or may make issues seem distant from everyday issues. Interviewees suggested consumers and consumer representatives be offered educational sessions to help prepare them to participate meaningfully in meetings.
5. Influence. Some consumers felt their participation had little impact on ACO policy. Advocates suggested offering consumers who participate often the ability to become increasingly active and even move into leadership positions on advisory councils.
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