The Medicare Beneficiary Experience Represented

by Laurel J Pracht

 Laurel J Pracht, BFAC Member

                                                           Research Patient Advocate

In 2014 the Centers for Medicare and Medicaid Services (CMS) established a structure for the Quality Innovation Network (QIN) dedicated to continue the work of the Quality Improvement Organization (QIO) program dedicated to local quality improvement.  Within the QIN – QIO and National Coordinating Center (NCC) Beneficiary and Family Advisory Councils (BFACs) were established in response to the concerns of persons served by the Medicare program.  Members of the BFAC are not only beneficiaries and / or family members, but represent the lived experiences of CMS patients.  The beneficiary is at the center of our work to help increase awareness of the patient perspective / impact of CMS’ aim of Better Care, Healthier People and Smarter Spending. 

Members of the BFAC reside in many parts of the United States, from Kona, HI to Arlington VA, from small rural towns to cities joined together as beneficiary and family representatives.  Patient wisdom is a “must have” factor toward improving health care for beneficiaries.  Within this role, BFAC members work with the QIN NCC team to advise quality improvement professionals on best approaches to priority areas for improvement.  Advisors rise above disease-specific interest to address patient challenges, like the impact of insufficient communication with patients and their families or the influence of confusion about coverage / cost on patient decision-making.  Highlighting such areas of concern results in improved patient satisfaction and anticipated health outcomes. 

Engagement of all stakeholders from providers to healthcare facilities with the final component being the consumer or beneficiary, via the BFAC, is vital toward raising awareness of what is effective in best approaches towards improving care.  If people do not think an approach will be effective, the BFAC discusses and suggests alternatives with the anticipated result leading to healthier people in our communities while lowering costs to beneficiaries.

As a beneficiary / consumer and BFAC member, the Council’s input is a valued facet toward identifying best practices resulting in improved beneficiary experiences today and in the future.  As a member of this council, advisors consistently put the patient / beneficiary at the center of their work aimed at improving the customer’s experience and overall satisfaction.  Recently several member of this advisory council met in person to discuss approaches toward effectively representing beneficiaries as well as identifying what matters to patients!  Each member represents various disease types as beneficiaries and / or caregivers, however all are dedicated to improving the patient experience.

To learn more please visit the QIO Program website:

The Role of the Quality Innovation Network National Coordinating Center (QIN NCC):    

“The QIN NCC believes that the quality, safety and experience of healthcare in this country can be exceptional. Therefore, our collective action is to provide support to the QIO Program and specifically QIN-QIOs in their use of quality improvement methodologies, evidence-based best practices, and innovative approaches to maximize improvement efforts. We build capacity to improve healthcare and health in the U.S. by providing tools, templates, reports, analysis, technical assistance, coaching, training, information, promising practices, innovative approaches, opportunities for peer-to-peer connections, guidance, and virtual learning venues.

 The QIN NCC is committed to this work so that:

•We, as a nation, can achieve the goals of the Three-Part Aim: enhance patient experience, improve population health, and reduce costs

•All caregivers – professionals and non-professionals, clinicians and social service providers feel cared for themselves and can better meet the demands of caring for us when we are sick and as we age

•We can positively impact and inform health care policy

•Patients, families, and caregivers are active participants in improving healthcare, supported as partners in health, and receive the most effective, safe, timely, and seamless care that our system has the potential to provide

•We can collectively build a health system that supports a healthy population and enables us to age well in our own homes and communities

In Arizona, Laurel J Pracht was selected as a member of the Beneficiary and Family Advisory Council.  She is a research patient advocate on the national level and believes issues important to patients should be prioritized.  This advisory council is the only such council to bring the collective voice of the patient / beneficiary to the forefront.