As the healthcare landscape continues to evolve, the transition to value-based care models present opportunities and challenges. ACO REACH (Accountable Care Organization Realizing Equity, Access, and Community Health) is a transformational program from the Centers for Medicare & Medicaid Services Innovation Center designed to promote high-quality, equitable, and cost-efficient care.
What is ACO REACH?
Accountable Care Organization Realizing Equity, Access, and Community Health is a CMS model aimed at improving care delivery while addressing health disparities for traditional Medicare beneficiaries aligned with the model. It replaced the Global and Professional Direct Contracting Model, offering a more patient-centered approach with a key focus on:
- Health Equity: Reduce disparities in care by expanding access to care and addressing social determinants of health.
- Patient-Centered Care: Provide high-quality, person-centered care across a continuum of services.
- Accountability: Increasing provider performance by linking financial rewards to improved outcomes and cost reductions.
In this model, participating organizations share financial risk and reward with the CMS to ensure effective, patient-centered care.
Benefits of ACO REACH for Medicare Beneficiaries
Coordinated, Comprehensive Care: Traditional Medicare Beneficiaries experience an integrated approach to are, reducing fragmentation and improving outcomes. Care teams work cohesively to address medical, behavioral, and social needs, ensuring a seamless patient experience.
Improved Access to Care: By focusing on underserved populations, ACO REACH helps patients overcome barriers such as lack of transportation, limited health literacy, and financial constraints.
Focus on Preventive Health: By encouraging proactive steps in patient care, including routine screenings and management of chronic diseases, ACO REACH helps keep patients healthy and out of the hospital, thus reducing the need for costly emergency interventions.
Enhanced Patient Engagement: With tailored care plans and education programs, patients are more engaged in their own health, ensuring better treatment adherence and long-term results. REACH also offers several benefit enhancements. This includes waiving the three-day inpatient stay requirement before being transferred to a skilled nursing facility, waiving copays for certain services, and other benefits. These vary from ACO to ACO.
Benefits of ACO REACH for Clinics and Health Care Providers
Incentives for Value-based Care: REACH aligns incentives with improved outcomes and cost efficiency. Providers can gain a share of the savings they earn through value care delivery. ACO REACH also operates a quasi-capitation model, allowing for upfront funds flow rather than waiting a full 9 months after the performance year to see any savings from the model.
Advanced Data Analytics: Participants are provided with increased data compared to other total cost of care models, like the Medicare Shared Savings Program. These advanced reports are aimed to help providers identify care gaps, monitor performance, and target high-risk populations for intervention.
Health Equity Initiatives: ACO REACH heavily emphasizes health equity, requiring providers to create a health equity plan to address their patient population and reporting on social determinants of health annually. Clinics can use this process requirement of the model to address disparities in care delivery, positioning themselves as leaders in improving health outcomes for vulnerable communities.
Reduced Risk, Greater Flexibility: Allows for two arrangements of risk sharing, 50% or 100%, so that can organization can determine and select its level of readiness and capacity.
Reputation and Competitive Advantage: Participation in this model demonstrates a commitment to the cutting edge of innovation and quality coming from CMS, enhancing an organization’s reputation and appealing to patients, and payers.
Waiver Benefits: Offers flexibility through waivers designed to reduce traditional Medicare restrictions, allowing providers to innovate and deliver care more effectively.
Role of Finance Teams in ACO REACH
Healthcare finance teams are instrumental in helping lead the transition to REACH. Key responsibilities include:
- Financial Modeling: Analyzing all possible savings and risks to understand the best participation options.
- Performance Tracking: Tracking benchmark trending to ensure alignment with program goals.
- Resource Allocation: Investment in various tools and training to optimize care delivery and efficiency.
- Capitation Reimbursement: Finance and revenue cycle teams work together to utilize the upfront payments from CMS to reimburse providers in innovative ways, which can include over 100% of Medicare.
In close collaboration with clinical teams, finance teams drive success in this value-based care model.
Why Participate in ACO REACH?
This model offers a path to delivering better care at lower costs while addressing inequities in health care delivery. For providers and clinics, the benefits include:
- Improved care coordination through multidisciplinary teams, allowing providers to earlier identify and address patient needs.
- Predictable revenue through its capitated payment structure. With monthly population-based payments, providers can invest in innovative approaches that drive better patient outcomes.
- Innovative pathway and long-term sustainability in the market.
ACO REACH ensures patients receive increased access to care, improved outcomes, and meaningful care tailored to each patient’s needs.
Getting Started with ACO REACH
Since the Innovation Center has closed any new applications to the model, providers looking to participate will have to join an ACO that already has an Realizing Equity, Access, and Community Health (REACH) contract. Consider your organizational readiness for value-based care by:
- Reviewing current models of care delivery and financial models.
- Understand program requirements through discussions with CMS or experienced ACO administrators, such as CHESS Genesis.
- Partnering with a company, like CHESS, to build the infrastructure necessary to support care coordination and data-driven decision-making.
CHESS Genesis represents an opportunity to lead the charge in value-based care. For providers and clinics, participation improves patient outcomes, helps attain financial stability, and puts them at the forefront of discussions around health equity. ACO is more than a care delivery model; it is a path to improvement in healthcare.
Are you ready to transform your practice and elevate patient care?
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