Can Next Generation ACO Drive Patient Engagement?
By - The Centers for Medicare and Medicaid Services (CMS) Innovation Center recently revealed plans for a new payment initiative – the Next Generation Accountable Care Organization (ACO) Model – which focuses on a unique accountable care opportunity designed to achieve the utmost quality care standards.
The Next Generation ACO Model of payment and care delivery stems from involvement with the Pioneer ACO Model and the Medicare Shared Savings Program (Shared Savings Program). It involves three initial performance years and two optional one-year extensions, says CMS.
The model supports patient-centered care by allowing beneficiaries to confirm a care relationship with ACO providers and encourages direct communication regarding care preferences. It is designed to achieve the utmost quality care standards.
Attorney Matthew R. Fisher, Co-Chair of Mirick O’Connell’s Health Law Group, spoke with RevCycleIntelligence.com this week to provide an enhanced perspective about the new ACO model’s implications and outcomes.
Regarding participants rewarding beneficiaries for seeking care within the ACO network, a limit of fifty dollars in annual coordinated care rewards for beneficiaries may not be enough to effectively drive active patient engagement, says Fisher.
“The whole patient engagement side is a missing factor in the ACO Model,” Fisher states. “Everyone has to buy into the process. There are some provisions within the Next Generation ACO Model that are trying to get individuals more engaged and tied into the process. It is a good start to addressing the issue, but there’s still work to be done.”
Fisher states the consideration should be given to incorporating leeway and change, although amendments are not likely to be implemented.
“If you’re dealing with an environment that’s trying to shift away from fee-for-service, it might lessen the traditional concerns that the government had about paying patients to come in for more services or other actions that could result in more expense to a federal healthcare program,” Fisher explains.
Fisher adds that it makes sense and an incentive may be needed to encourage behavioral change.
A primary challenge of accountable care and the shift towards value-based goals is that a great deal of alignment and sharing of information and financial considerations among providers is needed to ensure success, he says. Many goals are arguably at odds with applicable referral based regulations, he continues.
“If you’re dealing in a capitated system, you know the full scope of money involved and there is a lesser concern about seeking to perform more services to earn more money,” Fisher maintains. “You’ve got everyone trying to figure out how to work with a defined pot of money. By its nature, that type of shift in the system will help drive alignment and help drive strategies to get people working together.”
If layers of complexity are added on top of something that’s already complex to begin with, this entanglement of functionality could hinder the needed meeting of objectives, Fisher explains.
Further, as everyone gets more experience within a value-based system, the provision of care and control of cost should become better managed, he adds.
“There’s the defensive practice in medicine which is kind of allowed by a fee-for-service system. You don’t necessarily mind if you’re billing these extra services that may or may not be needed,” Fisher explains. “
According to Fisher, the result is a more conscientious provision of care since the focus is about what is absolutely medically necessary.
This idea directly correlates with patient engagement, reveals Fisher.
“Patients are more directly financially responsible for some of the costs for their care. That’s driving conversations about what’s needed and when,” Fisher says.
