Meaningful Consumer Engagement

Diverse and meaningful consumer engagement is integral to the design, implementation and oversight of Medicaid ACO programs. While transitioning to value-based payment methods, consumers and their advocates and caregivers must have a voice in their health care so community members can improve their health. We focus on opportunities to engage consumers and advocate at two levels: engagement with state policymakers, and engagement with organizational leadership of the Accountable Care Organizations. At both levels, it is crucial to engage a diverse group of consumers who represent the community served by the ACO, including people with disabilities, people with substance use disorders and mental illness, and people with complex health and social needs. For more examples, see Consumer Engagement in Medicaid Accountable Care Organizations: A Review of Practices in Six States.

At the state level, does your state do the following? 

  • Ensure regular public- and consumer-advocate representation on implementation and oversight committees. Committee members should be provided with ongoing and appropriate training and support, so they may participate meaningfully.

  • Monitor consumer engagement in Medicaid ACOs. This could be done within the ACO evaluation process.

    • Oregon requires that members of their Consumer Advisory Council be surveyed annually to assess their satisfaction with the level and quality of their engagement.

  • Explain what ACOs are in a consumer-friendly way and provide user-friendly materials for consumers to access so they understand how their care will change under and ACO model.

    • Oregon issued a user-friendly video  that explains how their version of an ACO, the Coordinated Care Organization (CCO), provides value-based care to Medicaid beneficiaries.

  • Include payment, incentive and penalties review, as part of the state’s oversight of the ACO.

  • Ensure that information about public meetings and public reports are easily accessible to the public and shared in a timely manner.

At the organizational level, does your state require Medicaid ACOs to do the following?

  • Include consumers, consumer advocates or caregivers on ACO governing boards to help ensure that the ACO’s decisions are made in the best interest of the community. Governing board membership should reflect the demographics of the community it serves and should include adequate member representation. Member representation needs to be diverse, as individual consumers cannot represent the views of an entire community. The ratio of member representation to provider representation should be at least equal. Consumer members could be consumer advocates and/or consumers enrolled in the ACO or a family member or caregiver.

    • Maine requires at least two MaineCare members on each ACO governing board.

    • Oregon requires at least one member from the Community Advisory Council and at least two members from the community at large on their CCO governing boards.

  • Create consumer advisory councils (CACs) or patient family advisory councils (PFACs). Provide ongoing training and funding for consumers to participate so that the opportunity is accessible to all interested members.

    • In Massachusetts, ACOs are required to have at least one patient or consumer advocate within their governance structure and establish a Patient and Family Advisory Committee.

    • In Oregon, the Oregon Health Authority Transformation Center supports the CACs through resources, meetings, and funding to attend conferences.

  • Solicit beneficiary feedback using a variety of methods such as focus groups, member meetings, PFACs and surveys.

  • Offer a “ladder of engagement” so consumers can engage with the ACO in increasingly active ways, such as by moving from focus group participant to advisory council member.

  • Create partnerships with community-based organizations (CBOs). CBOs can provide valuable input on the needs and preferences of the communities being served. They can also help recruit, train, and support the consumers who participate in governance or advisory roles.

    • In Massachusetts, Health Care for All (HCFA) operates a helpline that consumers can call for questions related to their health insurance. HCFA then uses this information to advocate to the ACO different solutions to addressing consumers’ needs.

  • Partner with consumer advocacy organizations to create and maintain an infrastructure for consumer and community engagement.

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