Do Accountable Care Organizations Improve Patient Experience?

January 11, 2016 - Accountable Care Organizations (ACOs) are designed to generate revenue by keeping patients happy. When ACOs were a tad newer, beneficiaries reportedly confirmed they were indeed satisfied with the level of care received from an ACO. But the push from fee-for-service to value-based care continues. As healthcare consumers become increasingly accountable for their health outcomes, new focus on how to improve the patient experience is imperative.

How satisfied are patients with their ACO experience now that nearly a decade has passed since talk of ACOs first started trending?

The healthcare industry is indeed interesting in exploring this ACO-patient experience connection further via new means of data collection. According to past studies to be discussed below, ACOs may promote happier and healthier patients. New research is underway to provide more answers.

To help clarify confusion about the Consumer Assessment of Health Plan survey (CAHPS) for ACOs from the Centers for Medicare & Medicaid Services (CMS), Press Ganey has released a new set of Frequently Asked Questions this week.

Press Ganey expects CMS to randomly choose up to 860 Medicare beneficiaries to sample per ACO. CMS will manifest scores based on Medicare pay-for-performance over the first 3 years of an ACO’s contract with CMS.

The ACO CAHPS survey, to be administered annually over a 2-month timeframe, plans to measure the patient’s experience with ACO-tied primary physicians, says Press Ganey.

The survey will be used for public ACOs, including the Pioneer ACO model and the Medicare Shared Savings Program (MSSP).

The Pioneer ACO model was created for healthcare organizations and providers with prior experience coordinating care for patients across multiple settings. It aims to expedite the switch from a shared savings payment model to a population-based payment model, independent of the Medicare Shared Savings Program.

The MSSP is a primary piece of many Medicare delivery efforts stemming from the Affordable Care Act (ACA). Created by Congress to help advance healthcare providers’ coordination and cooperation efforts, it helps providers improve the quality of care for Medicare Fee-For-Service beneficiaries and slash revenue cycle waste.

CMS has yet to indicate the CAHPS for ACO Survey version for 2016, says Press Ganey. There were 2 survey versions of the survey in 2015 – ACO-12 and ACO-9. ACO-9 focused on a variety of topics, including provider communication and how providers were rated by patients. ACO-12 focused on topics such as care coordination. Survey participants reflected on their care experience from the past 6 months.

Patients who have been assigned to the ACO can expect 2016 performance year collection beginning this November.

How can ACOs achieve top survey scores?

“In addition to submitting the small number of responses needed for the official CMS survey, Press Ganey recommends surveying continuously using our visit-specific survey to capture patient feedback by individual physician.”

“This continuous, visit-specific methodology allows you to pinpoint areas for improvement and identify best practices. We recommend using a multimode approach of mail combined with eSurvey to maximize the number of surveys that can be sent and correspondingly received, allowing for significant sample sizes and impactful results that will allow you to improve and score higher on the official ACO CAHPS survey.”

Will the patient experience past dictate the ACO future?

As RevCycleIntelligence.com reported in 2014, according to an earlier ACO CAHPS assessment by researchers at Harvard Medical School, ACO-based patient experiences remained strong not too long ago.

“As payment moves away from fee-for-service toward incentives to limit healthcare spending, we found no evidence of deteriorating patient experiences in ACOs. In fact, ACOs achieved meaningful improvements for patients in some key areas,” said J. Michael McWilliams, Associate Professor of Healthcare Policy and Medicine at HMS and Brigham and Women’s Hospital.

“The improvements that we found in patient experiences constitute important initial progress in fostering high-quality, patient-centered care in Medicare.”

“There is a pressing need for regulatory and legislative changes to strengthen ACO incentives, expand provider participation in new payment models and address potential downsides of provider integration, such as higher prices,” McWilliams said.

There was, however, little improvement regarding how ACO patients rated individual physicians’ communication skills. Perhaps such can be addressed soon with CMS’s CAHPS initiatives.