- The Centers for Medicare and Medicaid Services Innovation Center will test whether or not seniors will voluntarily enroll in a Pioneer ACO if given the option, and if they do enroll, if they are more likely to seek care within the ACO's provider network.
- Up until now, patients were "attributed" to a Medicare ACO because their physician was a part of the network. Patients could opt out of allowing the ACO to share their medical data, but their information was still included in cost and quality metrics and performance results for the organization.
- This strategy will continue to be in place in 2015, but in addition, five Pioneer ACOs will also solicit enrollment. CA-based Monarch HealthCare has mailed invitations to almost 10,000 Medicare beneficiaries and has received 2,100 responses. About 100 declined.
A third of ACO enrollees turn over each year because they seek too much care outside of the organization's provider network. Still, the organizations are still on the hook for either rewards or penalties for these people—the assessment strategy looks at patients who were attributed at the start of each year. And providers have no way to create incentives to retain these patients: Unlike Medicare Advantage plans, ACOs can't use deductibles or other financial penalties to encourage patients to stay in-network.
Monarch executive director Colin LeClair thinks voluntary enrollment will make patients more conscious of the high quality care they can receive by staying in the ACO's network and therefore less likely wander to other providers. If he's right, this could be a big step in the right direction for the Pioneer program, which has been struggling.
Still, there are some critics of the new enrollment tactics. Some believe that simply choosing to enroll is not a strong enough incentive to keep patients in-network: "It's not clear that would necessarily change the care patterns," said Dr. J. Michael McWilliams, an associate professor of health policy at Harvard University, an expert in managed and accountable care.
Others think that the offer may confuse seniors, who could mistake it for a Medicare Advantage plan, necessitating significant staff resources to provide education.