Access before appointment: How response time affects patient engagement and practice outcomes

Patient perception of access has quietly become one of the most important signals in healthcare delivery. Long before patients walk into the clinic or engage in a clinical assessment, they form impressions based on ease of access, responsiveness, and clarity around next steps. For busy practices striving to balance patient flow, care quality, and operational efficiency, the first response moment has become a benchmark of organizational reliability.

When Communication Becomes Care Access

Despite the rise of online portals and digital forms, phone communication remains a dominant channel for scheduling appointments and initiating care in outpatient settings. Across medical offices, research consistently shows that most new and acute visits begin with a phone call.

When calls go unanswered, patients do not always retry the same office. Many simply seek the next provider who responds faster, delaying or abandoning care.

The Operational Toll of Missed Access

Missed appointments cost the U.S. healthcare system more than $150 billion annually in lost revenue and inefficiency, with individual providers reporting an average of around $200 in lost revenue per unused appointment slot. Missed calls are frequently the first failure point that leads to unused appointments, idle capacity, and last-minute scheduling pressure.

Wait Times and Patient Perceptions

Longer hold times and slower responses correlate with poorer patient perceptions of access and lower satisfaction. Patients who encounter repeated communication barriers during scheduling or early outreach are significantly more likely to disengage and seek care elsewhere.

Efficiency vs Perfection: Rebalancing Early Responses

Applying clinical standards of completeness to the first response moment often creates unintended delays. Early acknowledgment does not require full resolution. It signals attention, reduces uncertainty, and preserves the therapeutic relationship.

Scheduling Friction and Practice Stability

When patients cannot schedule appointments that fit their routines, they delay care or request last-minute accommodations, increasing lateness and no-shows. Practices that support routine-aligned scheduling see better adherence and smoother workflows.

A Quiet Standard Shift

The practices that thrive are not perfect in every response. They are consistently responsive. Fast and friendly is not a shortcut. In medical practice, it is now the baseline expectation for access.

References

National Institutes of Health. Missed appointments and healthcare system cost impact. PubMed Central.

Agency for Healthcare Research and Quality. Patient experience and access to care.

Griffith KN, et al. Call center performance and patient perceptions of access. The American Journal of Managed Care.

Guy R, et al. Effectiveness of short message service reminders in increasing clinic attendance. PLOS One.

Parikh A, et al. Reducing no-shows through targeted communication strategies. Journal of Medical Systems.


Heather Revens is Founder and Chief AI Officer at Aligned Practice Studio. Contact:
heather@alignedpracticestudio.ai | alignedpracticestudio.ai

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How to counter medical misinformation and support engaged patients

In 2021, the American Health Information Management Association Foundation surveyed 1,059 U.S. residents age 18 or older in a nationally representative sample. The survey found that Americans typically seek out health information by contacting their doctor and the internet equally. Of those who secure health information from the internet, 86 percent are confident the information is credible.

This can sometimes be a challenge for healthcare practitioners, because health misinformation—information that is false, inaccurate, or misleading according to the best available evidence at the time—is abundant on the internet. Health misinformation is a significant obstacle in healthcare, as it can lead to misunderstandings, poor health decisions, and adverse outcomes for patients. In a recent survey of physicians by The Doctors Company, 64 percent of physicians named misinformation on social media one of the most challenging aspects of practicing medicine.

Calling Dr. Google

Patients’ engagement in their personal health can be an advantage, with the proper guidance and support from practitioners. However, when patients consult “Dr. Google,” some websites may provide inaccurate or misleading content.

This issue of accurate versus inaccurate online medical information was highlighted during the COVID-19 pandemic. In 2021, the U.S. Surgeon General’s advisory Confronting Health Misinformation focused on this serious threat to public health and called on all of us to limit the spread.

Challenges for Practitioners

Correcting misinformation requires time and effort: Practitioners are encountering longer visit times when there is a need to discuss internet-collected health information with patients. Patients can sometimes have a strong belief in and be adamant about the assembled misinformation, which can result in increased patient anxiety.

Practitioners who dismiss or criticize the online search efforts of patients may negatively impact practitioner-patient trust. It can also be a challenge to change patient perspectives when misinformation is deeply believed, even when the practitioner is providing information from a trusted source.

Addressing health misinformation with patients

Former American Medical Association (AMA) president Gerald E. Harmon, MD, noted in a 2022 press release regarding a new AMA policy addressing public health disinformation that “physicians have an ethical and professional responsibility to share truthful information, correct misleading and inaccurate information, and direct people to reliable sources of health information.”

It’s often said that trust is the medical currency of healthcare, and in partnering with patients to help them understand medicine, practitioners are making deposits. Ruth Carrico, PhD, DNP, APRN, explained to the American Association of Nurse Practitioners (AANP) her view that overcoming medical misinformation is a journey on which to partner with the patient, first understanding why patients turn to the sources they do for medical guidance.The AANP offers an infographic tool, A Clinician’s Guide to Medical Misinformation: Communication Is Key, to support clinicians in combating medical misinformation.

Patient Safety Strategies

Engaging with patients who are relying on health misinformation requires a thoughtful approach to ensure patient safety, retain trust, and promote health literacy. Here are some strategies practitioners can use:

• Listen to patients' concerns and beliefs without judgment. This fosters open communication and shows that you respect their perspective. By actively listening to concerns and providing clear, evidence-based information, practitioners can build trust and encourage patients to participate in their healthcare journey.
• Show empathy and understanding toward patients' fears and misconceptions. Acknowledge their feelings and provide reassurance.
• Use plain language to explain complex medical terms in simpler language. Avoid medical jargon and ensure that patients fully understand the information being provided. To support this, apply universal health literacy precautions—an approach that assumes all patients may have difficulty understanding health information and therefore emphasizes clear, accessible communication for everyone. Clear communication helps prevent misunderstandings and misinformation.
• Share reliable, evidence-based sources of information. Use reputable websites, peer-reviewed articles, and official health guidelines. (See the resources listed below.)
• Using the Teach-Back Method, ask patients to repeat the information in their own words to ensure they have understood correctly. This helps identify any misunderstandings.
• Use visual aids such as diagrams, charts, and videos to explain complex medical concepts. Visuals can make information more accessible and easier to understand.
• Gently correct misinformation by providing accurate information and explaining why the misinformation is incorrect. Use facts and evidence to support your explanations.
• Help patients develop critical thinking skills by teaching them how to evaluate the credibility of sources and recognize biased information. Critical thinking skills are essential in identifying and rejecting misinformation.
• Maintain a trustworthy and transparent relationship with patients. Be honest about what is known and what is still uncertain in the medical field. When patients are well-informed, they can actively participate in discussions about their care, leading to decisions that are aligned with their values and preferences.
• Schedule follow-up appointments to address any ongoing concerns and reinforce accurate information. Continuous follow-up and support maintain positive patient engagement.

Through these strategies, practitioners can effectively combat health misinformation and empower patients to make informed health decisions.

Reputable resources

These are reputable websites, known for their accuracy, credibility, and comprehensive coverage of health topics, where patients can find reliable health information:

• American Cancer Society (ACS): The ACS offers detailed information on cancer prevention, treatment, and research at https://www.cancer.org.
• American Heart Association (AHA): The AHA provides information on heart health, including prevention, treatment, and research on cardiovascular diseases at https://www.heart.org.
• Mayo Clinic: The Mayo Clinic offers expert advice on a wide range of health topics, including symptoms, treatments, and preventive care at https://www.mayoclinic.org.
• MedlinePlus: MedlinePlus, a service of the National Library of Medicine, offers reliable health information, including articles, videos, and links to other trusted sources at https://medlineplus.gov.
• National Institutes of Health (NIH): The NIH provides detailed information on medical research, clinical trials, and health conditions at https://www.nih.gov.
• WebMD: WebMD provides comprehensive health information, including symptom checkers, drug information, and articles on various health conditions at https://www.webmd.com.
• World Health Organization (WHO): The WHO offers global health information, including disease outbreaks, health statistics, and international health guidelines at https://www.who.int.

For guidance and assistance in addressing any patient safety or risk management concerns, contact Patient Safety and Risk Management at (800) 421-2368 or by email.


The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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3 strategies to strengthen patient engagement and reduce risk

Research indicates that engaged patients are more likely to follow their treatment plans, have the confidence and ability to achieve their health goals, and experience better health outcomes. Conversely, a lack of patient engagement can lead to poor outcomes, which may in turn contribute to dissatisfaction that could result in litigation.

A more recent analysis of medical professional liability claims where patient engagement was a contributing factor found 34% of events and 65% of indemnity paid were the result of high-severity injuries or death. The data further revealed that physician practices are particularly susceptible to such claims. Office/clinic locations accounted for 39% of the events and 46% of the indemnity paid—the highest among all the clinical settings reviewed. It is worth noting that patient-provider communication was often noted to be a root cause of these malpractice claims.

Perhaps these statistics should not be surprising because health care is truly a team sport. Successful outcomes require engagement and collaboration between providers and patients, with the patient as an essential team member.

Data suggests that robust provider communication promotes deeper patient engagement and trust. Furthermore, in our experience, patients are less inclined to file lawsuits against providers they like and trust. So, the good news is that every physician practice can take steps to strengthen communication, thereby engaging patients more meaningfully, improving the odds of better outcomes, and lessening the risk of malpractice claims.

Strengthen patient communication

Health care is inherently complex and challenging for patients to navigate. Consequently, practices are more likely to engage their patients when they are aware of the complexities and purposefully design their communications and systems to break down the barriers.

Here are three actionable patient communication strategies that can increase patient engagement and enhance the patient-provider relationship:

1. Cultivate a patient-centered practice atmosphere. First impressions are crucial, so practices need to engage patients quickly. Start by communicating with patients before their scheduled appointments, so they know how to prepare and what to bring with them. Also, set clear expectations about their rights and responsibilities as patients in your practice.

Ensure excellent customer service at every patient touchpoint. That includes showing compassion and a professional demeanor, as well as promoting good communication (including phone etiquette) and timely responses to patients’ inquiries.

2. Actively foster a two-way dialogue during patient visits. As providers, it can be easy to forget that the day-to-day language used in the office setting often sounds foreign to patients. Medical terms and jargon can be intimidating. Worse, “medical-ese” may prevent people from fully understanding their health status, risk factors, and treatment plans. Therefore, it is important to present health information in clear, plain language so that patients are empowered to engage, ask questions, and confidently manage their health.

When discussing health conditions and treatment plans, use words that most patients commonly use or understand. Use familiar objects or analogies to explain complicated ideas. In addition, remember that patients can often see your electronic health record (EHR) notes, so be sure to use plain and positive language in your documentation. Other strategies for improving dialogue with patients are to:

• Use “teach-back” techniques. These involve using open-ended questions and asking patients to use their own words to recap what you’ve talked about and their understanding of their treatment plans. If necessary, you should rephrase the conversation until the patient demonstrates they understand by accurately recapping the information.
• Manage patients’ expectations. Be empathetic but direct in your patient conversations and documentation so patients understand the full range of potential outcomes. Unrealistic expectations can lead to litigation.
• Be an active listener. This involves encouraging conversation by asking patients about their health goals and concerns, listening carefully, then educating and supporting patients accordingly. Active listening includes identifying potential barriers to care and being prepared to suggest practice or community resources to help overcome those barriers.

3. Respond promptly to adverse events and complaints. If patients experience an unexpected or adverse event, engaging in open and timely conversations with them may make a difference in the subsequent actions they choose to take. Be sure to confer with your risk consultant following adverse events and patient complaints. Proactively communicate with the patient to express empathy and concern. Patients may begin to distrust providers who appear indifferent (or even defensive) about their stated concerns. Conversely, a genuine expression of compassion from their provider can help make patients feel cared for.

Better communication, safer practice

Poet and author Maya Angelou said,“I've learned that people will forget what you said. People will forget what you did. But people will never forget how you made them feel.” Ensuring that patients feel heard and cared for is not only good medicine but also a core risk reduction strategy. Stronger patient-provider communication that enhances patient engagement can lead to better patient outcomes and may proactively mitigate the risk of malpractice claims.

To strengthen communication, encourage all practice staff to communicate respectfully and professionally. Be sure patients have time during visits to ask questions and clarify anything they’re unsure about in their treatment plans. Finally, if questions or complaints arise after the visit, listen actively and empathetically, and offer guidance or explore potential resolutions.

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Comparing primary care communication interventions to improve patient engagement

A cluster randomized trial evaluating interventions to improve patient-clinician communication found no evidence that the considered interventions had varying effects on patient engagement, despite strong implementation efforts. The study, published in the Journal of the American Medical Association (JAMA) Health Forum examined three intervention arms—a high-touch, high-tech and shared decision-making approach—across 21 primary care clinics in three U.S. health systems. Some secondary outcomes suggested a positive effect of in-person coaching, but ultimately the study’s findings indicate the need for implementation fidelity and alternative outcome measures for patient engagement.

“Our multiple study found no evidence of intervention effects on the primary outcome,” the authors of the study wrote. “Implementing successful pilot interventions into diverse clinical practices is challenging, particularly when minimizing disruptions to workflows…To better align outcome measures with interventions, alternative patient engagement metrics should be considered.”

According to the study, clinicians are often unfamiliar with patients’ reason for visits prior to meeting face to face. It’s also said that patients can struggle to recall the details of decisions made during their visits. The study is intended to enhance patient-clinician communication by building on a prior pilot study with the same goal. The pilot study created two interventions aimed at enhancing patient-clinician communication that was highly accessible to users.

“We chose the primary care setting for three reasons: it is essential for health care, most shared decision-making research is in specialty care and the pilot study in primary care showed potential utility,” the authors explained. “This study aimed to replicate and expand those findings in diverse settings.”

The intervention arms assessed in the study are multilevel, targeting patients, care teams and health systems:

• AskShareKnow (ASK): Posters placed in examination rooms encouraging shared decision-making.
• High-tech: Mobile application-based coaching promoting shared decision-making.
• High-touch: In-person coaching of clinicians with standardized training to promote shared decision-making.

The primary outcome was patient engagement as measured by CollaboRATE, a validated survey assessing shared decision-making. CollaboRATE asks patients to rate, on a scale of zero to nine, how much of an effort was made to:

• Help you understand your health issues.
• Listen to the things that matter most to you about your health issues.
• Include what matters most to you in choosing what to do next.

Secondary outcomes included the Net Promoter Score (NPS), which gauges likelihood of recommending the clinician, and patient confidence in managing their health. Statistical adjustments were made for demographic and contextual factors, including clinician characteristics, type of visit (telehealth or in-person) and health system variability.

The current trial was conducted in three health systems, UC San Diego Health, Reliant Medical Group and Sutter Health. Researchers conducted the randomized controlled trial with 4,852 patients (median age of 54 years) and 114 primary care clinicians. Clinic visits occurred between August 2019 and December 2021. Prior to intervention implementation, baseline surveys collected patient-reported experiences from January to July 2019. Patients were randomly assigned to one of the three arms—ASK, high-touch or high-tech—and were surveyed post-visit and again three months later.

Survey results

Among the 4,852 enrolled patients, participation rates were modest, with just 7% agreeing to take part in the study. Survey completion rates were stronger, with 73% of participants returning surveys within seven days post-visit. The study’s intervention arms had similar demographic characteristics across patients and clinicians.

Regarding CollaboRATE, the study’s primary outcome, there were no statistically significant differences between the intervention arms. At baseline, 63.9% of patients in the ASK group, 70.2% in high-tech and 67.9% in high-touch reported top CollaboRATE scores for shared decision-making. Postintervention, these rates remained consistent across the groups, with ASK achieving 68.2%, high-tech 67.4% and high-touch 67.0%. Adjusted analyses identified several significant covariates: older patients, those with higher confidence in managing their own health and those attending in-person visits were more likely to give top scores, while telehealth visits and certain system-level factors were associated with lower scores.

NPS results demonstrated higher proportions of “promoters” in the high-touch (86.8%) and ASK (87.0%) arms compared to high-tech (83.0%), although the differences were not statistically robust. Patients’ confidence in managing their health declined slightly across all groups three months post-intervention, with no meaningful differences between the arms.

Despite the absence of measurable effects in the primary outcome, the study highlights lessons that are critical for the implementation of communication interventions in real-world clinical settings. Researchers noted that the transition from a physical booklet to an electronic format may have diluted cognitive engagement with the intervention.

Secondary findings suggest that the more intensive high-touch intervention might offer advantages for the enhancement of NPS and patient confidence, although these findings lacked statistical significance. Researchers also emphasized the importance of adjusting for confounding variables, including patient demographics, the type of visit and differences in local health systems. Telehealth visits, for example, consistently returned lower engagement scores, suggesting challenges unique to virtual care environments.

Although the interventions failed to demonstrate significant effects on shared decision-making, the process of prompting patients to articulate their priorities remains valuable and continues to be used at one of the health systems studied. Researchers recommend integrating these interventions as quality improvement initiatives rather than research trials, waiving informed consent to boost participation and employing metrics like NPS to monitor impact. By refining engagement metrics and targeting implementation efforts, health systems may achieve better outcomes in the future.

 

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Back to basics: Putting patients first

There is nothing in my practice of medicine that equals the joy of focusing on patients and making every effort to ensure that each encounter fosters a positive doctor-patient experience.

Well, maybe one thing that exceeds that satisfaction is positive outcomes.

In my experience, the patients with whom I've developed close and trusting relationships seem to be better at following treatment plans, which helps improve positive outcomes.

For decades, research has found strong indicators that the quality of the doctor-patient relationship impacts health outcomes. One significant finding is that the physician's knowledge of the patient's disorders and emotional state is associated positively with whether the medical problem is resolved. Evidence shows that patients who feel they are not heard or respected by their doctors experience poorer outcomes.

A study from Massachusetts General Hospital finds that improving the doctor-patient relationship can produce health outcomes as beneficial as some common treatment protocols. It concluded that strategies such as making consistent eye contact, being attentive to patients' emotions, and helping them set goals can improve patient satisfaction.

Enhancing the doctor-patient relationship grows your medical practice

Start by recognizing that every patient is a walking advertisement for your practice. Suppose you have a satisfied patient, like any satisfied customer. In that case, they will tell 9-15 others about their positive experience. In contrast, 13% of patients (customers) with a negative experience will tell more than 20 people.

Access to your practice impacts the patient relationship

An important metric for patients is their ability to access the practice. It should be a goal to accommodate new patients within three to five days of their first telephone contact with the office. Ideally, established patients should be seen within two weeks of their request for an appointment. Of course, urgencies and emergencies should be seen the same day they contact the office.

Telehealth nurtures patient engagement

During the pandemic crisis that impacted doctors and patients, telemedicine improved the efficiency of the practice and made access to it much easier. Patients who can arrange a virtual visit the same day they call for an appointment are highly satisfied.

Delegating enhances efficiencies

One of the main complaints that today's patients have with their providers is that the doctor spends too much time looking at a computer screen and not at the patient. This situation can easily be resolved using a scribe or one of the new voice-to-text software programs to perform data entry. This process change enhances the doctor-patient relationship as it improves practice efficiency, allows doctors to see more patients each day, and has fewer records to review at the end of the day. This translates to less" pajama time" or time in the evening when doctors struggle to complete their medical records. This situation also leads to increased physician burnout.

If you can't employ a scribe, be attuned to engaging with the patient as you take notes. Explain what you are doing and the need to immediately update medical records in this manner. You can take a small break from typing to talk directly to the patient. Make eye contact. (Just think how you would like to be treated as a patient.)

Everyone appreciates timely follow-up

All phone calls, emails, and text messages should be addressed within 24 hours. Your patients will have a favorable impression of the practice if the lab and imaging studies results are reported to them within a day of a procedure or test.

Make use of online tools

The patient portal is an opportunity to increase your patient engagement. Patients can ask insurance questions, request refills, and ask follow-up questions of the provider, all at the patient's convenience. In fact, patients today expect an online experience with their doctors just like they receive from banks, hotels, and airlines.

Bottom line: A patients-first philosophy is an attitude and a strategy for a successful practice. Putting patients first means making every effort to ensure that each patient has a positive experience with your practice. Remember, it's never crowded on the extra mile!

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Matching the right patient engagement strategy to your specialty

As healthcare technology continues to evolve, patient expectations are shifting, with patients increasingly placing value on engagement. Now more than ever, patients want to be fully involved in their care process, with physicians who are just as fully engaged and committed to their care. In fact, 67% of respondents to a survey by ModMed found it important that their doctors are personable and engaged.

To meet these evolving demands, more private practices have developed new strategies to enhance patient engagement, from providing self-scheduling options to convenient payment options. However, patient engagement should go beyond just administrative work and scheduling appointments. Given the direct impact these strategies have on clinical health outcomes, it’s important to understand there is no one-size fits all approach. To enhance patient satisfaction and improve overall outcomes, private practices have to leverage the right forms of patient engagement based on the unique needs and nuances of their specific specialty.

Enhancing patient education in surgical specialties

For surgical specialties, placing an emphasis on effective patient education is key to achieving optimal health outcomes. In ophthalmology for example, preoperative anxiety can often lead to post-surgery dissatisfaction, making it even more critical to foster a strong relationship where patients feel like they are part of their own care process right from the beginning.

Before surgery, physicians should lay the proper groundwork and ensure their patients fully understand the nuances of the procedure, their treatment plans, and expected outcomes. One key way physicians can facilitate this full process is by providing patients with the right educational tools to fully understand the stages of their care journey.

Polling suggests that while around 94 percent of patients crave educational material, about a third don’t have access to the resources they are looking for. Providing patients with physical handouts and online digital resources that detail information on their different options for surgeries, what the type of surgery entails, and what they can expect during the post-op period is a simple, yet effective, way to ensure they feel confident about their procedure. While all of this information is critical to communicate during actual appointments, asynchronous materials also enable patients to seamlessly share information and educate the caretakers and family members who will be involved in their recovery process.

As patient expectations evolve, we’re also seeing more desire for educational materials to be visual and interactive. Leveraging the right software platform that allows patients to visualize surgical treatments and results can also go a long way in elevating patient trust. Research suggests that the use of digital aids in consultants before cataract surgery, for example, can help enhance patient knowledge, reduce anxiety and improve the overall decision-making process.

These asynchronous tools are valuable for ongoing patient reassurance, but of course, the art of direct communication cannot be overlooked — especially during the recovery process. Actively engaging with patients via telehealth appointments or direct secure messaging during the post-op period helps ensure patients are not experiencing any complications, allows them to ask any questions, and further builds provider-patient trust.

Empowering patients through automation

For specialties where long-term patient adherence is a major factor in driving positive health outcomes, it’s imperative patients not only have access to the right resources to fully understand their care, but also avenues that streamline the communication process and empower them to make more informed decisions. Patients are the most critical member of their own healthcare team, and the data shows when patients are involved in their care decisions, they experience a higher level of satisfaction.

This is where the significance of utilizing the right technology for your practice comes into the picture. Patients want direct two-way communication with their care providers, and lest they start sharing their personal phone numbers with patients, patient engagement platforms can fill that void. In specialties like allergy and immunology, for example, where patients regularly take medication and follow treatment plans to manage their ongoing conditions, the right practice management software with built-in digital engagement tools is key in navigating patients through their care journey.

Online 24/7 patient portals, for example, ensure patients have access to the right resources at all times, including handouts and materials related to their medications, allergy testing and other information pertaining to their in-person visits. These portals also provide patients with the opportunity to actively ask pertinent questions or raise any concerns, enabling them to become a consistent participant in their own care.

These solutions also pose significant benefits on the provider side. Leveraging a software solution with built-in, automated e-prescribing tools that can remember provider preferences and generate new prescriptions not only promotes medication adherence, but also allows providers to actively monitor patient conditions efficiently. Through the power of automation, providers can save several hours per week that would otherwise be spent on manually formulating allergy prescriptions, allowing them more time to spend on necessary face-to-face patient communication.

Emerging advanced technologies such as artificial intelligence (AI) also have the potential to enhance and streamline patient engagement even further — for patients, providers, and even front-office staff. While we’re already seeing the implementation of AI throughout the healthcare space to improve operational efficiency and reduce administrative burden, conversational AI tools such as ChatGPT may be able to streamline patient education even further by helping to field patient questions.

Personalizing your practice approach

It’s easy for practice owners to get wrapped up in the idea that just implementing the latest cutting-edge technology is the most straightforward solution to enhancing patient satisfaction. But effective patient engagement begins with the understanding that using one approach won’t move the needle for either the patient or the provider. Leveraging the right technology that streamlines patient communication and education, while also enabling providers to tailor approaches to meet every patient’s unique needs, is the first step in crafting a truly effective patient engagement strategy.

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Accountable care organizations need better engagement with patients

Accountable care organizations (ACOs) need better communication to explain how they are helping Medicare patients achieve better health at a better overall cost.

The National Association of Accountable Care Organizations (NAACOS) and the Health Care Transformation Task Force published “Reimagining Beneficiary Engagement in Accountable Care Models.” The white paper outlines how ACOs, the longest-standing alternative payment model (APM) in U.S. health care, can educate patients and correct misconceptions about “accountable care” and “value-based care.”

“ACOs also offer an important opportunity to address current health care delivery inequities, having demonstrated reducing racial and ethnic disparities in care and better serving rural and underserved communities,” the white paper said. “Yet, patients in ACOs or other APMs often are unaware of their inclusion in models and the benefits they provide. Additionally, the success of ACOs and APMs has overly focused on cost savings and not on improved beneficiary outcomes.”

The organizations offered recommendations that the U.S. Centers for Medicare & Medicaid Services should implement:

• Beneficiary communications should be tailored to different patient populations.
• Enhanced beneficiary engagement tools would enhance ACOs and other APMs.
• Accountable care models need meaningful input from patients, family caregivers and communities if they are to succeed.

“Effective patient engagement is paramount to the success of ACOs,” Jeff Micklos, HCTTF executive director said in a statement. “These recommendations strengthen Medicare policies to ensure that beneficiaries are fully aware of and can benefit from these innovative care models.”
Spreading the word

The Medicare Shared Savings Program (MSSP) is the largest ACO in the nation, existing for more than a decade. CMS previously required ACOs to submit any marketing materials and activities for approval before using those communications with patients. In 2023, CMS ended that requirement, but “the regulatory definition of ‘marketing materials and activities’ has not changed and many ACOs are cautious about developing content” that meets the CMS criteria.

CMS template language about accountable care is not provided in multiple languages and is not available publicly, which adds administrative burden, beneficiary confusion and operational complexity, according to NAACOS and HCTTF.

Primary care

Meanwhile, “the process of establishing a primary care relationship is an important step in a patient’s care journey.” But not all beneficiaries are aware of that. CMS also aligns beneficiaries with a practice location, not a specific clinician, which can lead to misattribution of beneficiaries and ACOs.

Patients may have limited internet access to select primary care clinicians. Annual wellness visits are limited to once every 365 days, which hurts ACOs’ ability to schedule the appointments in advance of cold and flu season, or to catch health problems early on.

ACO governance

MSSP ACOs must include a Medicare beneficiary on their governing boards. But many beneficiaries lack the expertise, background, time and resources needed to participate fully in ACO oversight, the white paper said.

CMS should allow caregivers to serve as beneficiary representatives, with more guidance on how ACOs can engage patients and caregivers in decision-making. Patient and family advisory councils or committees, and community advisory councils also could add diverse voices and expertise to ACO regulation.

In recent years, public evaluation of APMs has focused on cost savings, according to NAACOS and HCTTF. Instead, CMS must make patients the center of all aspects of any alternative payment model, they said.

“By adopting these recommendations, CMS can remove barriers that hinder more effective patient communication and engagement,” Aisha Pittman, NAACOS senior vice president of government affairs, said in a statement. “This will pave the way for a better patient experience and improved outcomes, which are goals of value-based care.”

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