The ACO Realizing Equity, Access, and Community Health (REACH) Model, introduced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center, represents a significant advancement in value-based healthcare. It is designed to improve quality of care and access for Medicare beneficiaries, particularly those with complex health needs. This model encourages collaboration among healthcare providers, including primary and specialty care doctors, hospitals, and community organizations, to enhance care coordination and patient outcomes.
A pivotal aspect of ACO REACH is Voluntary Alignment (VA), which empowers patients to actively participate in their healthcare management. VA offers numerous benefits for both providers and patients, leading to a more satisfying and effective healthcare experience for all.
Strategic Patient Alignment in Value-based Care
Understanding VA necessitates a grasp of its role within value-based care. Traditionally, patient alignment with healthcare providers in Accountable Care Organizations (ACOs) relied on claims-based methods, categorized into prospective and retrospective alignments. Prospective alignment involves assigning patients to care entities based on pre-year service records, while retrospective alignment depends on services rendered within the year. Despite its prevalence, claims-based alignment faces challenges, notably the narrow look-back period utilized for alignment and limited patient choice. Recognizing these weaknesses, the introduction of VA by CMS in 2017 marked a transformative shift, offering patients and providers a more dynamic and choice-driven approach.
What is Voluntary Alignment?
Voluntary Alignment (VA) is a process that allows Medicare beneficiaries to select a primary provider proactively. This can be achieved by ACO REACH beneficiaries through:
- Submitting a Signed Voluntary Alignment (SVA) Form to the ACO *
- Registering on Medicare.gov and logging in to attest to their primary practitioner (MVA)
Such empowerment leads to better control over healthcare decisions, timely access to enhanced benefits, and improved patient-provider relationships.
* Front desk staff can provide this attestation form to patients if they are on the ACO’s alignment list.
Benefits for Providers
For providers, when a beneficiary indicates a primary provider, it enables greater insight into the beneficiary’s condition through additional information providers receive through ACO participation. Patients can also receive coordination of care leading to promoting better health outcomes and more efficient care. This trust provides healthcare professionals more opportunities to change behavior and leads to a better patient and provider experience. Through VA, ACOs can also expand the number of beneficiaries assigned to them, which can help increase potential savings, improve quality of care, and enhance population health programs within the ACO.
Benefits for Patients
Voluntary Alignment has many advantages for patients. By choosing a primary clinician, or clinician a Medicare beneficiary believes is responsible for coordinating his or her overall care, individuals are encouraged to be more involved in their own healthcare. This increased engagement can foster stronger patient-doctor relationships, leading to better health outcomes and patient satisfaction. Declaring a primary clinician also allows patients access to various programs/tools that are only available to patients of doctors participating in an ACO and can assist in better coordination of care.
The ACO REACH model, with Voluntary Alignment as a benefit, stands as a beacon of innovation in value-based healthcare. Voluntary Alignment offers numerous advantages for doctors, patients, and ACOs alike. By promoting patient choice, voluntary alignment allows patients and providers to work together proactively on their health.
REFERENCES:
https://www.cms.gov/priorities/innovation/media/document/aco-reach-rfa
https://www.cms.gov/files/document/register-mymedicaregov-and-choose-your-primary-clinician.pdf