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Massachusetts health care — wonky, with a healthy dose of reality

ACOs are an "opportunity to accelerate progress toward genuine patient-centered care delivery"

ACOs are an "opportunity to accelerate progress toward genuine patient-centered care delivery"

January 22, 2016

Earlier this month, Health Care for All actively contributed to the Health Policy Commission’s public hearing concerning their ACO (Accountable Care Organization) certification standards. ACOs provide coordinated care through their doctors, hospitals and other clinical and non-clinical staff, working together to improve the quality and affordability of care. HCFA representatives Steve Slaten, Valerie Spain, Brian Rosman, Alyssa Vangeli, and Helen Hendrickson testified at the hearing, offering consumer viewpoints on how to strengthen the proposed standards.

HCFA Leadership Council members Steve Slaten and Valerie Spain testify on ACO standards

HCFA’s Leadership Team representatives Dr. Stephen Slaten and Valerie Spain (pictured above) spoke as consumer representatives at the hearing. Slaten, a psychologist, advocated for the meaningful inclusion of consumers in the governance of ACOs. The inclusion of independent consumers on ACO boards—at least two, he argues—would improve accountability. He spoke from personal experience with doctors who did not keep the patient's best interest in mind. To really shift care to be patient centered, it requires the message from the top be, “no, we really mean it this time.”

Spain, too, spoke for consumer engagement and transparency. She called for meaningful consumer engagement through consumer advisory councils to ACOs, with a built-in feedback loop, public annual reports, and professional support. She urged the Commission to "...be bold. We are at a juncture of great opportunity. Boldness will bring a groundswell of support from disability groups, non-profits, and consumer organizations. Go as far as you can, you’ll have room to step back if needed. Don’t go halfway–if you go halfway everything will coalesce around halfway measures."

HCFA's Brian Rosman and Alyssa Vangeli spoke about the need for ACOs to play a role in population health. "Perhaps the 'C' in ACO should also stand for 'Community'," Rosman said. Because ACOs are responsible for keeping their patients healthy, they should identify the particular needs of its patient population based on criteria that includes social determinants of health, which could include factors such as homelessness or unstable housing, age, primary language, race and ethnicity, geography, gender identity and sexual orientation. ACOs should engage Community Health Workers, who can bridge the needs of patients outside clinical care. Vangeli emphasized that holding ACOs accountable for improved health and experience of care will require quality measures that are focused on outcomes and patient-reported data. She asked that the HPC work with ACOs and payers to monitor and track under-service and underutilization. ACOs should educate their enrollees on what an ACO is, the benefits of care under the ACO, and the responsibilities and rights that accompany receiving care from an ACO.

Helen Hendrickson spoke on behalf of HCFA's Oral Health Integration Project, and advocated for the inclusion of dental care and oral health in the ACO design. The need for improved access to dental care is an imperative, Hendrickson emphasized. “Dental decay is the most prevalent chronic disease among children,” she said attested. Poor oral health has also been linked to chronic conditions, including heart disease, diabetes, and stroke. And there are significant costs to the overall healthcare system. In Massachusetts, MassHealth paid $11.6 million from 2008 to 2011 for emergency room dental care for adults. She suggested PCPs offer oral exams and referrals to dentists when needed. The proposal does not explicitly include oral health providers and Hendrickson urged the Commission to revise several standards.

Written public responses to the ACO plan can be sent to the Health Policy Commission at HPC-Certification@state.ma.us. Comments must be received by 5:00 pm, January 29th.

            -- Jessica Imbro