Aneesh Chopra: Greater ACO enrollment will bolster preventive care

Aneesh Chopra: Greater ACO enrollment will bolster preventive care

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In October, the Biden administration set a goal of ensuring all Medicare beneficiaries are enrolled in alternative payment models by 2030. Aneesh Chopra, who became the federal government’s first chief technology officer in 2009 and served under the Obama administration, thinks this push for alternative payment models will not only lead to a reduction in unnecessary expenditures, but also improve patient outcomes through higher preventive service utilization and primary care visits.

Chopra, who now serves as CEO of health analytics firm CareJourney, has the data to back this claim up. His company licenses CMS’ entire dataset for Medicare Advantage and Medicaid claims data, accounting for 145 million Americans, he said in an interview with MedCity News conducted in March. A recent CareJourney analysis showed that Medicare patients enrolled in value-based care arrangements were nearly two times more likely to get mammograms.

This analysis reflects a theme that is consistently present in CareJourney’s trove of claims data: accountable care organizations (ACOs) do a better job of reducing avoidable expenses than providers who aren’t enrolled in an ACO that has embraced an alternative payment model. The metrics used to measure this — preventable hospitalizations, avoidable emergency department visits, post-acute care utilization and so on — all show ACOs outperforming their counterparts, Chopra said in a recent interview. 

He also pointed out that CMS requires ACOs to report clinical data as well. HHS’ Office of Inspector General recently found that ACOs outperformed fee-for-service providers on 81 percent of quality measures, including blood pressure control and depression screening.

Unlike ACOs’ value-based care model, the fee-for-service model optimizes for providers’ schedules being open so more patients can come in for appointments. In this model, providers react to patient demand rather than keeping close tabs on patients that have not sought out care.

ACOs can assign patients a care manager to increase engagement in their care plan. These care managers help providers stay accountable for their patient base, often issuing reminders for wellness visits and screenings or scheduling follow-ups after an emergency room visit.

“That infrastructure is not funded in the fee-for-service model, but is rewarded in a value based care program, which is why CMS Innovation Center has said it wants every beneficiary in an accountable relationship because they would have a trusted advisor — or for lack of a better term, a quarterback — guiding their care.”

Having a trusted healthcare advisor increases a patient’s likelihood of seeking preventative care, including cancer screenings. President Biden’s February relaunch of the Cancer Moonshot program shined a light on the reduction of cancer screenings during the pandemic, so CareJourney dug into its data to see if this was an across-the-board problem.

Chopra and his team found that providers who were enrolled in an ACO were more likely to conduct cancer screenings, in part because they were graded on it. Their analysis showed that Medicare patients enrolled in value-based care arrangements were 1.8 times more likely to receive mammograms during the pandemic than patients not enrolled in such arrangements. These results are consistent with pre-pandemic periods, where patients in value-based care arrangements also experienced higher rates of screening. 

Screening patients sooner not only means they have a better chance at beating a potential cancer diagnosis, it also will lead to a significant reduction for CMS’ cancer care expenditures. To achieve these outcomes, Chopra said shifting more beneficiaries to value-based care models will require a larger campaign to recruit providers and beneficiaries in the ACO models, as well as a public conversation about the role of beneficiary choice.

“The results are better quality and lower cost, so why are we not actively encouraging this? The answer is we’re doing it by trying to convince doctors to sign up for the program,” he said. “And I argue we should do more to encourage beneficiaries to see the benefits of being a participant, maybe even encourage them to ask their doctor to sign up for the program.”

Photo: Feodora Chiosea, Getty Images

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