National Partnership for Women & Families

Leading Advocates Say Meaningful Information and Consumer Engagement Are Essential to Realizing Promise of Next Generation ACOs

A Dozen Diverse Consumer Groups Send Comments to CMS
WASHINGTON, D.C. — May 19, 2015 —

The National Partnership for Women & Families and 11 other leading consumer advocacy groups today submitted a letter urging the Centers for Medicare & Medicaid Services (CMS) to ensure that the Next Generation Affordable Care Organization (ACO) Model delivers on higher quality, well-coordinated care.

In the letter, the groups note that ACOs present a promising model for improving the quality of health care, reducing costs and enhancing patient experience of care by aligning payment with value and quality and encouraging delivery of better coordinated care. But achieving the promise of ACOs will require continuous improvement that can best be achieved through meaningful collaboration with patients and family caregivers in care design, in policy and governance, and at the community level. The signers support an emphasis on effective care coordination, team-based care and connections to community resources. They say their recommendations for Next Generation ACOs can help put patients and family caregivers at the center of care design and delivery. 

In addition to the National Partnership, the letter was signed by the American Association on Health and Disability; American Cancer Society Cancer Action Network; Center for Medicare Advocacy; Community Catalyst; Families USA; Family Caregiver Advocacy; Family Caregiver Alliance; Medicare Rights Center; NHeLP; The Empowered Patient Coalition; and Well Spouse Association.

The letter is critical of the financial rewards CMS proposed in its Next Generation ACO Model Request for Applications. It says, in part: “Any use of financial incentives must be limited to and focused on removing barriers to care, building strong relationships between providers and beneficiaries, and engaging patients in their care. Waiving or reducing copays for office visits to ACO providers or for medications related to chronic care management may have potential to improve beneficiary access to care by removing financial barriers. We do not believe, however, that the currently proposed semi-annual monetary reward will achieve our shared goals of strengthened relationships between patients and their providers and enhanced patient engagement in their health and health care.”

“The most successful ACOs will be grounded in comprehensive, well-coordinated primary care,” said National Partnership for Women & Families President Debra L. Ness. “The success of Next Generation ACOs will rest, in part, on their ability to improve the patient experience of care, and that will only happen through partnerships with patients and families at all levels. ACOs must also be built on a strong foundation of robust consumer protections that ensure beneficiary rights are safeguarded and that access to care is not impeded. We are looking for improvements in cost-sharing that remove barriers that prevent patients from getting the care they need and that help them interact effectively with providers. Patients also need full transparency about their providers and about the financial structure of their ACOs, and assurances that quality metrics are being used.”

The letter offers strong support for CMS’ proposal to require Next Generation ACOs to provide beneficiaries with access to their own medical records in order to foster patient engagement and better two-way communication between patients and providers. It encourages CMS to add an explicit reference to electronic access to health records and clinical information (a 2014 survey commissioned by the National Partnership showed patients overwhelmingly use online access when available).

The letter is available here.

The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to promoting fairness in the workplace, reproductive health and rights, access to quality, affordable health care and policies that help women and men meet the dual demands of work and family. More information is available at www.NationalPartnership.org.

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