- A three-step strategy for beneficiary outreach can help to raise the level of patient engagement in an accountable care organization (ACO) environment, according to a study published this month in the American Journal of Managed Care.
Effective population health management starts by understanding the patient pool, says the study funded by the Agency for Healthcare Quality and Research (AHRQ), by choosing a meaningful beneficiary representative, and continues when providers make an effort to foster more robust relationships and evaluating the impact of their accountable care programs.
Accountable care organizations are typically financially and clinically responsible for a certain population of patients, attributed based on geography, demographics, chronic disease status, or some other defining characteristic. In order to effectively manage attributed patients, providers within the ACO need to know who those patients are and what their primary needs may be.
Many accountable care organizations function in a multi-faceted environment, say the authors from Johns Hopkins University, cutting across multiple health systems, communities, providers, and payers. This makes patient engagement more difficult than it would be for an individual clinic or hospital only responsible for the patients who choose to seek care at their facilities.
“Because an essential part of the ACO concept incorporates payment reform (via complex analytics, benchmark expenditures, quality and cost metrics, etc), knowledge barriers may get in the way of involving patients in decision making,” the study says. “Because patients may not enroll in the ACO per se (eg, in a Medicare ACO) but instead become involved in the ACO by virtue of where they receive primary care, patients may not associate or identify with ‘their’ ACO itself.”
The first step to devising an effective patient engagement strategy in an ACO operating under the Medicare Shared Savings Program (MSSP) is choosing a beneficiary representative that understands the needs and desires of the patient population as a whole, says the report. While an ACO may not be able to hold elections to choose a patient representative, the process by which the decision is made should be transparent, publicly justified, and open to necessary change.
The representative must be able to appropriately advocate for minority groups within the patient population – for ACOs with particularly diverse beneficiaries, a panel or group of representatives may be a wiser choice to ensure that care strategies and population health management programs are vetted by knowledgeable members of the patient community.
After identifying impactful representatives, and ACO must foster patient engagement relationships by offering opportunities for feedback from beneficiaries and their caregivers.
“For example, dedicating time on the meeting agenda for patient-level input, or having the board chair regularly solicit the views of patient beneficiary members, could empower representatives to express their opinions,” the authors write. “Providing beneficiary representatives with background knowledge and accessible informational materials about ACOs (along with adequate time to review materials and ask questions about them) could help inform their input into decision making. Finally, offering financial support—even for small expenses, like parking—could ease potential obstacles to beneficiaries getting involved.”
ACO leaders may also wish to leverage social media and other online resources to provide feedback opportunities for patients who wish to provide their opinions without attending in-person events, although providers must remain aware that many vulnerable groups, including elderly, technically challenged, and low-income patients, may not be able to take full advantage of these tools.
Lastly, accountable care organizations must be self-critical, evaluating the effectiveness of their patient engagement strategies with an objective, analytical eye. While the study notes that there are few industry-wide quality metrics to measure the success of system-level patient engagement, customer satisfaction surveys fielded to beneficiaries can provide a certain understanding of how effective an ACO’s outreach has been.
“Patient focus groups could also provide rich information about how to connect patients with their representative(s) and extend system-level engagement directly to more of an ACO’s patients,” the study suggests. “Specific attention should be given to documenting the impact of engagement on how ACOs craft policies and care programs, including those areas where engagement is needed or could be improved. A comprehensive, iterative evaluation process could build trust in the ACO and facilitate dissemination of effective strategies among ACOs.”
An accountable care organization relies on regularly assessing patient engagement and satisfaction to ensure that it is providing effective, high-quality care that will produce the outcomes upon which value-based reimbursement depend. By focusing on identifying the best possible representatives for the patient community, offering sufficient feedback opportunities, and measuring the effectiveness of patient programs, providers may be able to provide tailored, effective care to its community of attributed lives.