Wy­den calls for changes in the push for ACOS

Modern Healthcare - - LATE NEWS -

Medi­care’s ac­count­able care push isn’t do­ing enough for the pa­tients who need them the most, said Sen. Ron Wy­den (DOre.). Wy­den, speak­ing last week at the National Ac­count­able Care Or­ga­ni­za­tion Sum­mit in Wash­ing­ton, said the at­tri­bu­tion rule un­der the Pa­tient Pro­tec­tion and Af­ford­able Care Act re­quires ACOs to “serve ev­ery­one com­ing through the door.” That’s in­tended to pre­vent them from avoid­ing ex­pen­sive pa­tients, but it has hin­dered ACOs from spe­cial­iz­ing in co­or­di­nat­ing care for chronic con­di­tions, he said. “Our ob­jec­tive should be to make the ad­verse se­lec­tion is­sue dis­ap­pear, by cre­at­ing spe­cific con­sumer pro­tec­tions for se­niors in plans that spe­cial­ize in se­nior chronic care, while fully re­tain­ing the cur­rent pro­tec­tions against dis­crim­i­na­tion for all other se­niors un­der the cur­rent law,” said Wy­den, a mem­ber of the Se­nate’s Spe­cial Com­mit­tee on Ag­ing. He also noted a gap in where providers are form­ing ACOs and where the high­est num­bers of the sick­est se­niors live. For in­stance, he said ACOs are not be­ing es­tab­lished in Alabama—home to many se­niors with poor health—but se­niors in Mas­sachusetts have ac­cess to six Medi­care ACOs. Medi­care re­im­burse­ment, he said, should be re­con­fig­ured to tar­get ar­eas with the high­est in­ci­dence of chronic ill­ness, and re­ward prac­ti­tion­ers in those ar­eas who im­prove care and keep costs down. Dr. Mark McClel­lan, di­rec­tor of the En­gel­berg Cen­ter for Health Care Re­form at the Brook­ings In­sti­tu­tion and for­mer CMS ad­min­is­tra­tor, said Wy­den’s pro­pos­als raised im­por­tant is­sues and that re­vi­sions to Medi­care’s ac­count­able care rules and terms are likely as of­fi­cials learn from early re­sults. “Peo­ple rec­og­nize that pa­tient en­gage­ment is absolutely cru­cial to a preven­tion-ori­ented, pa­tient-cen­tered health sys­tem,” McClel­lan said.

— Jessica Zig­mond and Me­lanie Evans

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