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Six Medicaid ACOs Vary in Consumer Engagement Success

Public and private payers need to consider consumer engagement in their strive to compete effectively in the health insurance market.

By Vera Gruessner

Consumer engagement in a number of Medicaid accountable care organizations (ACOs) tend to vary significantly, according to a September 2016 report from the Center for Consumer Engagement in Health Innovation. With providers being incentivized to reduce costs of care, public and private payers will need to incorporate consumer engagement more effectively in order to keep quality of care sufficient while cutting down on unnecessary healthcare services and spending.

Patient Engagement

Within the Medicaid ACOs analyzed in the report, health plan member participation in stakeholder committees or governing bodies was not sufficient to advance consumer engagement on a more significant level. Medicaid ACOs across the states of Colorado, Maine, Minnesota, New Jersey, Oregon, and Vermont were reviewed to identify their structures for consumer engagement. Consumer engagement within the six states is outlined below.


In the state of Colorado, the Medicaid ACO connected its members to a medical home. The Regional Care Collaborative Organization in Colorado has a local advisory committee that incorporates member voice in their healthcare program. Members, families, advocates, and providers all contribute and are represented by the advisory committees. Public meetings are held at least every three months, the report found.


In Maine, its Medicaid ACO began in 2011 and has included a Member Standing Committee since its founding days. The accountable care governance structure in Maine provides access for all interested parties to the Medicaid ACO decisions and actions. However, only two members are required to be on their committee.


State held public stakeholder meetings were held with regard to the Medicaid ACO operating in Minnesota. The meeting revolved around discussion of the State Innovation Model (SIM) grant application. The Health Care Financing Task Force included consumer advocates who advised on improving access and quality of medical care.

New Jersey

READ MORE: Org Offers 25-Point Plan for NJ Medicaid Program Improvement

In the state of New Jersey, the  Medical Assistance Advisory Council (MAAC) holds quarterly public meetings regarding Medicaid issues. It includes both consumers and consumer advocates. Every ACO governing board in New Jersey is required to have at least two consumer advocacy groups represented.


In Oregon, its Care Collaborative Organization has a governance board that includes at least two members of the community. This is meant to help align values of the Medicaid ACO with the community’s needs. Additionally, a Consumer Advisory Council is required to meet at least once every three months. Consumers make up the majority of the membership of these advisory councils.


In the state of Vermont, every Medicaid ACO governing board is required to include a minimum of one Medicaid beneficiary and two consumer members who have either volunteered, have a professional background in consumer advocacy, or personal experience.

Essentially, the report found that consumer engagement varies significantly among the states and suggests for policy makers to create a better support system through more funding and training to boost consumer participation in policy decisions.

“There is also a need for better tools to monitor and assess the effectiveness of consumer engagement, so that states can measure how successful ACOs are in engaging consumers,” the report stated.

READ MORE: WI Improperly Claimed $3M in Medicaid Drug Reimbursement

“The Financial Alignment Demonstrations, for example, include a quality measure of whether a plan established a consumer advisory board or included consumers on their governance board, consistent with contract requirements.40 However, additional measures are needed to assess more than whether or not an engagement structure was established. There is a need to further assess whether strong consumer engagement structures produce meaningful consumer engagement, and in turn, whether this engagement ultimately results in better health outcomes over time.”

Commercial healthcare payers can also address these concerns by making a stronger effort in improving consumer satisfaction. A HealthEdge survey had found that 88 percent of health plan consumers would prefer their payer to provide complete data on their financial responsibility. Additionally, 27 percent of 2,500 polled consumers stated having difficulty with getting a claim issue solved.

“Poor member service has a significant impact on a health plan’s bottom line, where a bad experience could very well mean a lost customer,” HealthEdge CEO Steve Krupa told “As our data shows, improving a health plan’s customer service representative’s ability to effectively research and answer simple member questions in a timely manner, or enabling a member to have accurate and user-friendly self-service options to seek answers to questions will have an immense impact on wasteful costs in the system.

“As a result, health plans are at a critical juncture, where they must improve upon their ability to communicate with members to increase satisfaction and remain viable in this era where their members have the ability to ‘shop’ for coverage,” Krupa explained.

The report suggests that payers will need to improve consumer engagement as well as the communication channels used in their customer service protocols. For example, payers would benefit by aligning customer service with the tech-savviness of their consumer base.

READ MORE: MA Medicaid Wrongly Paid $193M in Fee-for-Service Claims

Both public and private payers operating accountable care organizations will need to ensure their protocols include sufficient consumer engagement strategies in order to keep the quality of their medical services and customer support superior.

Image Credits: Center for Consumer Engagement in Health Innovation


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