A deeper analysis by some of the nation’s top consumer, aging, civil rights, patient, disease and other advocacy groups finds support for the final rule on Accountable Care Organizations (ACOs) released by the U.S. Department of Health and Human Services late last week. The groups are members of the Campaign for Better Care’s consumer coalition, which is working to ensure that the nation’s oldest and sickest patients get high-quality, well-coordinated care.

The Campaign for Better Care analysis singled out the following provisions for praise:

• Patient-Centered Criteria. The final rule includes key elements the Campaign has identified as being critical to patient-centered care including: care coordination across all settings, a foundation of primary care, new systems to identify high risk patients, and ways to measure the quality of care beneficiaries receive.
• Patient Experience. The final rule requires ACOs to report on patient experience of care including in areas especially important to patients like shared decision making, and how well doctors communicate.
• Patient Engagement. The final rule requires ACOs to promote greater patient engagement in their care by: communicating with beneficiaries in ways they understand, promoting shared decision making that takes into account beneficiaries’ unique needs and preferences, and making it easier for beneficiaries to access their own medical records.
• Maintains Beneficiary Choice of Provider. The final rule does not “lock in” beneficiaries but allows them to seek care from physicians outside the ACO.

“We applaud the effort to incentivize better primary care, increase coordination, and improve patient care,” said Campaign for Better Care leader Debra L. Ness, who is president of the National Partnership for Women & Families. “We are very pleased that this final rule will require ACOs to adhere to strong patient-centered criteria, use beneficiary experience of care measures to evaluate performance, and ensure choice of provider for beneficiaries. These provisions are all essential to realizing the promise of successful ACOs. While not perfect, the final rule provides a path toward a system that offers the higher quality, better coordinated and more patient-centered care America needs.”

“Without engaged patients and families, ACOs will not best serve the needs of our most vulnerable Medicare beneficiaries: people with multiple chronic conditions and those with disabilities,” said Rob Restuccia, Executive Director of Community Catalyst, a Campaign for Better Care partner. “We call on providers thinking about creating ACOs to work with local patients and family members to design programs that best meet their needs and to create formal structures through which they regularly seek feedback on ACO operations.”

“Achieving equity in health and health care is in the national interest,” said Wade Henderson, president and CEO of The Leadership Conference on Civil and Human Rights, a Campaign for Better Care coalition partner. “But today, many vulnerable populations face barriers to high quality health care that meets their individual needs. The revised ACO regulations are a step in the right direction, but we expect the Centers for Medicare and Medicaid Services (CMS) to closely monitor and ensure that ACOs contribute to reducing health and health care disparities as well as meet the unique needs of minority and other vulnerable populations, including the need to provide culturally and linguistically appropriate care and services.”

“Finding better ways to provide care is critical for our clients and to preserving the long-term health of Medicare,” said Emily Spitzer, Executive Director of NHeLP, the National Health Law Program and a Campaign for Better Care partner. “ACOs present one opportunity for improving quality and efficiency, as long as the core protections and access to care that are the hallmarks of Medicare and Medicaid are preserved. NHeLP supports the consumer protections included in the final ACO regulations, and will continue to advocate for even stronger protections over time.”
“The National Council on Aging (NCOA) commends CMS for producing ACO regulations that are patient-centered and responsive to the needs of health care consumers,” said Vice President for Health Promotion, Wendy Zenker, from NCOA’s Center for Healthy Aging. “We particularly applaud CMS for retaining all of the performance measures in the Patient/Caregiver Experience domain as well as the Care Coordination and Patient Safety measures. These measures will surely move us in the direction of improving the lives of older Americans, particularly those living with multiple health problems.”

Rev. Heyward Wiggins, Steering Committee Co-Chair of the PICO National Network said, “These rules create stronger incentives for hospitals and doctors to join together to accomplish the double bottom line of better care at lower cost. Now health care providers need to work together to improve the delivery of health care in the United States. The true measure of ACOs is whether these entities can improve care for the most vulnerable patients in the most vulnerable communities. PICO will be monitoring the development of ACOs at the local level through our 10-city Bring Health Reform Home initiative to assure that any new ACOs are developed in partnership with the community and meet the needs of the highest risk patients.”

Campaign for Better Care coalition members said they hoped the following provisions of the new rule would be strengthened over time:

• Governance. The Campaign strongly advocated for required beneficiary representation on governing boards, but the final rule gives ACOs greater leeway. While those ACOs that do not include beneficiaries on governing boards must describe in their applications why not, and specify how they will provide beneficiaries with meaningful participation in governance, it will be incumbent upon the Centers for Medicare and Medicaid Services to carefully monitor whether beneficiaries are being given a role in governance, and whether ACOs are operating in the public interest and reflecting the needs and perspectives of the communities they serve. Consumers and patients hope and expect that these provisions will be strengthened down the road if needed.
• Translation and Cultural/Linguistic Appropriateness. The Campaign called for ACOs to demonstrate that they provide care that is culturally and linguistically appropriate; and require patient experience surveys to be translated into languages at least 5 percent of patients in the ACO speak. The Campaign also recommended ACOs consider patient experience data stratified by age, race, ethnicity, gender, language and disability status. Unfortunately, the ACO final rule does not include these recommendations.
• EHR Requirements. The final rule no longer aligns ACO and electronic health record requirements.