Consumer Engagement in Medicaid Accountable Care Organizations: A Review of Practice in Six States 

Wiitala K, Metzger M, Hwang A
Publication Year: 2016
Patient Need Addressed: Patient satisfaction/engagement
Population Focus: Medicaid beneficiaries
Intervention Type: Best practices
Type of Literature: Grey


Insights Results

Overview of article

  • This publication assesses the role of the consumer and their engagement in 6 state Medicaid Accountable Care Organization (ACO) programs: 1) Colorado; 2) Maine; 3) Minnesota; 4) New Jersey; 5) Oregon; and 6) Vermont

Methods of article

  • The research team reviewed relevant documents like federal waiver applications, requests for proposals, model contracts, and statutory language related to the design and implementation of the state’s ACO program to identify structures and requirements for consumer engagement. They also reviewed state websites for consumer engagement requirements and opportunities. Finally, the research team conducted semi-structured in-depth interviews with consumer advocates in each state to understand the consumer engagement experience from their perspective


  • According to consumer advocates, the following elements supported consumer engagement: 1) Requiring that multiple consumers and consumer advocates serve on ACO boards and consumer input on each ACO’s financial incentive models; 2) Helping the ACO initiative achieve bipartisan political support by promoting the potential advantages of the program from multiple perspectives; and 3) Encouraging ACOs to cultivate consumer advisory council members as potential board members
  • Interviews illuminated that program requirements alone are not sufficient. Thus, the publication outlines 8 factors that can impact consumer engagement: 1) Funding and resource gaps – fiscal support to help consumers meaningfully contribute to Medicaid ACO design, implementation and oversight (concern includes limited funding for competing healthcare issues); 2) Representative recruitment – recruitment of consumers that best represent the population (e.g., consumers and consumer advocates); 3) Bandwidth – concerns with consumer bandwidth to meaningfully play a role; 4) Technical nature of topics – technical theme’s potential impact on consumer interest and engagement; 5) Influence – lack of perceived impact or influence by consumers; 6) Scheduling (especially for consumers with young children); 7) Transportation; and 8) Training (of consumers)
  • This evaluation identified a need for tools to better monitor consumer engagement, need to assess whether consumer engagement structures yield meaningful consumer engagement
  • All 6 states studied engaged consumers to some degree at both the state and ACO levels, but the format and level of engagement varied greatly by state in the design, implementation and oversight of the ACOs
  • At the state level, forms of consumer engagement include: 1) Design- public input periods; 2) Implementation -public forums, regular stakeholder meetings and organized workgroups that included consumer representatives; and 3) Oversight – advisory committees that included consumer representatives and public meetings
  • At the ACO level, forms of consumer engagement include involvement of consumer advisory councils, consumer representation on ACO governance structures, and unique state requirements (e.g., mandated oversight by consumer advisory councils)
  • Key successes thus far in consumer engagement for Medicaid ACO programs include requirement of consumer input/role of consumer advocates on ACO boards during ACO design, inclusion of multiple perspectives for bipartisan support, and encouragement of ACOs to cultivate consumer advocates as potential board members

Key takeaways/implications

  • While all of the models reviewed include some structure for consumer engagement, the format and effectiveness of these structures vary widely. Moreover, beyond requiring consumer engagement, there are numerous steps that state policymakers and healthcare organization leaders can take to foster meaningful consumer engagement in the design, implementation and oversight of ACOs, including ensuring appropriate financial support. The recommendations to ensure meaningful consumer engagement in ACOs are applicable to other forms of healthcare delivery system reform efforts, as well
  • 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 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. 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