Kim Williams – The Broader Impact of ACO REACH

Today we continue our ACO REACH conversation with Kim Williams, who discusses how this model facilitates enhanced care for the patient. She also shares insights on measuring success, engaging providers, and the broader impact of ACO REACH on healthcare equity and value-based care

Thomas Royal

Kim Williams, welcome back. Thanks for sticking around so we could continue our conversation here today.

Kim Williams

Thank you, Thomas.

I’m happy to be back and ready to continue our conversation.

Thomas Royal

So last time you know, we discussed a lot of the nuts and bolts of ACO reach.

You know what it is, how it helps us, the various entities that are involved.

One of the things that I want to talk about a little bit is the is the patient.

So we, you know, previously you mentioned a HealthEquity plans sdoh screenings.

What beyond that and including that specific advantages, does ACO reach offer to the patient compared to traditional fee for service models?

Kim Williams

Yes. So, in ACO reach the advantages for patients are actually quite substantial.

Especially in care delivery through waivers or what they call benefit enhancements and incentives. So, for example, with the public health emergency coming to an end, a lot of the telehealth flexibilities that existed during the pandemic are no longer an option after March of this year. So if you were if you are an ACO reach, this is still an option through the telehealth waiver, which removes geographic restrictions and allow patients to get care from their provider regardless of where they are. So you know they can be in their living room doing a check in visit. It is so beneficial for rural communities and patients with mobility issues. I’ve had site visits with providers that really stress the importance of telehealth because they are in a more rural setting where it’s not, you know, good for the patient with mobility issues to go back and forth to the offices. So I think that’s definitely a huge plus for those types of population. There is also a financial benefit play that patients can take advantage of, and that’s through the cost sharing for Part B services. Now this one allows reach ACOs to reduce or eliminate cost sharing for Part B services and remove financial barriers for things like a primary care visit or your chronic care management, even preventative services. So for instance, CHESS has it set up right now to where we can waive chronic care management co-pays. And so the hope is that. If we’re able to waive those co-pays, patients will be more willing to seek intervention. And really participate in chronic care management programs when you know they’re not too worried about those co-pays. Chronic care management is just super important in this model, alongside of transition of care management because it focus on preventions. And so I think again this is a win win situation for both providers and patients and also ACOs alike.

Thomas Royal

Well, that’s fascinating.

I so I I know that when we talk about there’s options of care and financial efficiency for the patient, how does the program ensure patient receives more coordinated and personalized care?

Kim Williams

Yes, so care coordination plays a huge role in ACO reach. And you heard me mention earlier that implementing the HealthEquity plan requires coordination from everyone. But I want to specifically highlight the great work that care coordination teams put into personalizing the care for our traditional Medicare patients in this population, right? So first the the outreach to the patients are beyond the normal amounts and I’m I’m using our HealthEquity plan as an example here because our care management teams spend more time on the phone with patients, really to better understand why. Why are they not getting their cancer screenings, for example? And often we get clues to help us solve the next piece of the puzzle.

So for example, through these phone screens, we learned that one of our patient refused to get a cancer screening because they were scared and it might sound simple, but we didn’t know that because typically you will look in the chart and you see that the patient declined but you don’t know why. And they weren’t sure. In this instance, the patient was not sure that the cancer screening, what that entails, they wanted to connect with their providers more. So, they made, you know, the care management teams really made sure that that patient got that proper visit to where their providers can set aside time to explain to them the importance of this cancer screening and how that impacts the patient’s care. And and another, you know, another patient that we found just really wanted someone to go with her to get her mammography screening. So, and that’s just from a moral support standpoint.

So, you know we reach out to family members, we reach out to some church members and sometimes even utilize our community health workers to just be there for moral support. And that’s I think how you move the needle in care from this perspective. And that’s just a couple examples from that one initiative. There are much more great work care managers do for patients on a daily basis when it comes to transition of care. And I think particularly under REACH, again, transition of care is just key to preventing readmissions and unplanned admissions in the quality measure domain, but you have to remain proactive with these patients. You have to offer social support and going back to the goals. In our REACH acronym because access and equity is part of this model. There are personalized efforts that we have to do for these patients in order for them to receive the right care at the right time and at the right place and I think REACH really shines a light on how we personalize some of those care for our patient populations

Thomas Royal

That’s great. That’s a lot of good investigation, discovery and support that’s happening for the patient.

Kim Williams

Yeah, for sure.

Thomas Royal

I think that that’s awesome.

Kim Williams

It was a lot of leg work in the beginning, but definitely worth it.

Thomas Royal

Yeah, it’s great. It’s great to hear those patient stories that really that really makes it real. A lot of times we get we get caught in some of the conversations about how things work and financial benefits and hearing, hearing the impact on the patient.

Kim Williams

Mm hmm.

Thomas Royal

I mean, that’s why we do this.

Kim Williams

That’s right.

Thomas Royal

And so does the provider. So, let’s move on to what the key steps are for a provider or a health system interested in joining an ACO REACH program. How would they join and and what advice would you give to providers or systems considering participation in ACO reach?

Kim Williams

Yes. So, for providers who are interested in joining, let me just walk you through both the practical steps and the financial considerations. So for ACO REACH, there are no more application periods. If you want to be in this model, you would have to join an existing REACH entity like CHESS Genesis. I think this is also beneficial to know that you have to understand what appetite you have for taking on risk. So you want to assess your practice or network situation. Are you more advanced in risk taking?

Do you know how to take care of traditional Medicare patients and do it well? Next, you would want to weigh your options. So there are two risk tracks in ACO REACH. The first option is the professional track, which takes on 50% upside and 50% downside. And then there is the global option that is full risk and that is 100% upside downside. And so for CHESS, we offer the professional track. So, if you’re newer or not yet comfortable with being in a risk aggressive model and and ready to take on 100% of the risk. Then the professional track is a great option for you and that’s something that we offer.

But beyond the dollars, my advice is really to look at your patient population, your quality metrics, and your care coordination processes. Do you have success stories?

Do you have those transition of care programs that you’re comfortable with? Do you know what gaps you have in your network that you may want to use those upfront payments to achieve, and I really encourage you to reach out to us for more information, any of our CHESS subject matter experts can supply you with more information and run through different payment scenarios with you. Once you feel like you’re ready, we have an awesome team of dedicated staff and compliance experts that can get you signed up into the model and work with you to implement it from from start to finish.

Thomas Royal

That’s great. So. I’m a provider, right? I’m not. But let’s let’s just metaphorically say that I am for the sake of this argument, ’cause I can have I can assure you that a lot of people will confirm that I am not. So I’m a provider and I’m willing to take on risk and invest in new achievement and transformation. What resources or tools are available to me to ensure successful implementation and and how does, you know,

specifically, CHESS support my practice or the health system that I work for in navigating ACO REACH.

Kim Williams

Well, one thing that’s really impressed me about REACH is the support system. In contrary to other traditional Medicare models, we get a lot of reports for ACO REACH participants and we’re able to do some really cool things with those reports over time. So here at CHESS, we’ve built an ACO REACH quality dashboards that looks at provider level performance month over month trends and it even has patient level information that we send out to our what we call our value partners on a regular cadence. We have predictive analytics tools that also identifies those rising risk patients and patients within various risk categories, whether it’s high, medium or low. And we have that specifically for care coordination efforts, right. We can supply those to your care coordination team, or if you want us to hub your services, then we can definitely help prioritize which types of populations to target for gap outreach and just where to prioritize your work. We also do financial modeling. So again, if you’re interested in joining ACO REACH, we model those financial scenarios for you.

We will look at your historical performance and tell you how you could perform in the model and I think another important thing to call out is the claims reimbursement support because of the innovative payment structure that you heard me mention earlier. That requires some setting up to do, and so we have subject matter experts that can work with you to get these advance payments to your ACH account. We help you build out the workflows to ingest the files and be able to have this ongoing support from a revenue cycle perspective. And so I think we’re also open to innovative payment structures at the NPI level. So if you think that you want something more innovative and want to incentivize certain NPIs, we can definitely work with you to build that out from a revenue cycle perspective as well.

Thomas Royal

That’s great. Well, OK. So now I’m I’m in and I’m doing the right things. I’m I’m I have an open mind for new workflows et cetera. All of the things that that I’m I’m doing to transform my practice. So now how do I measure the success? What milestones should I look for, should I aim to achieve for this?

Kim Williams

So I think achieving shared savings is part of the equation, but because the model is so comprehensive, you heard me talking about SDOH. You heard me talking about HealthEquity planned. I see success in ACO reach really beyond hitting the financial targets. We look at the quality measures, were we able to avoid utilization?

Did we perform in line with our peers when it comes to preventing readmissions and unplanned admissions? If yes then check I define that as quite successful, the HealthEquity plan, Needless to say, if you are moving the needle on your targets, even if it’s just 1% or 2%, I think that is successful because that is a start. We are going somewhere and our patients in these vulnerable geographic locations are getting the care that they need. So that’s a win in my book. For CHESS, we’re celebrating the fact that we hit our goals this year in the HealthEquity plan and increasing our breast cancer and colorectal cancer screening rates by 3%, so I think it just it depends on you know what is it that’s important for you, your patients and your community and that’s how you measure success in, in, in this program.

But there’s several levers that you can pull to define success and you can start with some of these.

Thomas Royal

Yeah. I think to me that sounds like true success because that that’s when everyone wins, especially the patient, and I think that’s awesome.

Kim Williams

Yeah. And I also, Thomas, you know, I also think about provider engagement.

I think about our wonderful provider champions and how they were with us every step of the way in implementing this type of program. You know, they had invested interest in HealthEquity from the beginning. A few even volunteer to go through the leads list and call every patients on the list so we can achieve our goals. We had providers that encouraged us to look at a different perspective when it comes to timely follow up visits because they knew that their offices are booked and so access was going to be a challenge. Well, if access is a challenge, how can you get patients that are timely follow up right? And so they push us to think about telehealth options and these are the things that makes me love what I do. And I love that the ACO REACH program really sparks conversations around things that matters to the patient. So I think any of those things can be defined as success and wins.

Thomas Royal

Agreed. That’s that’s very collaborative model. I really like this.

OK. So let’s pivot a little bit here if I may. I want to. I want to know more about what you think, so I’m going to use the old crystal ball metaphor, if you don’t mind. If you had one. If you had a crystal ball, Kim, what do you see in the future for ACO reach and if it does go away, what lessons did we learn from it that can be applied to other value-based care models?

Kim Williams

Yes. So, with ACO reach, it does run until 2026, but I see the principles of ACO REACH becoming more ingrained in how we deliver healthcare regardless of what they decide to call the model in the future, right. The lessons we’re learning about addressing HealthEquity coordinating care beyond the clinical settings and also focusing on those preventative measures are all fundamental shifts and those things are here to stay. So even if the model evolves these core principles, in my mind, you know the equity, the access, the Community health, I think we will continue to see components of this in future iterations. I also think that under the new administration we will see CMMI try and add additional values and additional levers, maybe giving us more waivers to create a more Medicare Advantage competitor in the traditional fee for service market. So I could see some of these models, maybe not an ACO REACH, but others becoming mandatory, assuming that the new administration wants to get every beneficiary or patients in a value based care model by 2030 and that’s, you know, that’s been the goal that the CMMI and CMS has had for a very long time is to get these patients into a value based care model by 2030.

Thomas Royal

Fascinating. Well, we’ll see. I’m very confident in your accuracy because of your expertise. So what’s one thing you wish more people understood about the potential of ACO REACH Kim?

Kim Williams

Well, I think we touched on this, but with the right collaboration, it has the potential to really disrupt the fee for service game and it has to be felt from top to bottom, right. Everyone would have to understand how this is driving change to the national culture of reimbursement model that’s been in place for decades, and I’m talking about that fee for service. So, ACO REACH is, you know, it’s just that pathway to practicing medicine the right way. And how we’ve always wanted our health systems to do this, and now we have the flexibility to address the root cause and do something about it, but we need to do it together and in much more collaboratively.

Thomas Royal

Agreed. Well, well, Kim, I always like to end with asking what’s something that I haven’t asked? What questions am I missing in in terms of the nuts and bolts of ACO REACH, the impact on the provider, the system, the patient, the payer, what’s one thing that you want everyone to know or to touch on before we wrap up today?

Kim Williams

I think we’ve highlighted all of the operational levers and the financial impact of this model, but I also, you know, encourage everybody to think about this from the patient perspective, especially if you are, you know providers within a system.

Think about where Healthcare is going, right? There’s been a lot of different models over the years. Now we’re looking at a new administration, so we’re expecting for things to change, but you don’t want your patients to kind of fall behind.

And so as you are thinking about participating in ACO REACH, just know that there are so many substantial benefits that patients can receive from this type of model.

And you definitely have support teams at CHESS that can help walk you through what that could look like for you.

Thomas Royal

Outstanding Kim, this has been great. I appreciate your time today. Kim Williams, thank you for joining us today on the move to Value podcast.

Kim Williams

Thank you, Thomas. It was a pleasure to be here. Thanks for having me.