Medicare’s new payment model, ACO-REACH has the potential to positively impact healthcare for medicare beneficiaries across the United States. Leading physician practices are taking advantage of the opportunities afforded by this new reimbursement approach by partnering with the 132 organizations approved by CMS for the ACO Reach program. .
What are ACO’s?
Accountable Care Organizations are networked organizations, consisting of doctors, hospitals, other health care providers, that voluntarily provide high-quality care to their beneficiaries. Several iterations of ACO’s have come forward since the Affordable Care Act in 2010 including the GPDC (Global and Professional Direct Contracting Model). This led to a greater number of care providers forming ACO’s and reaping benefits from accumulated cost savings.
The latest innovative value-based care payment model introduced by the Biden Administration is the ACO-REACH model (Accountable Care Organization Realizing Equity, Access and Community Health).
This model seeks to build on the desire of Centers for Medicaid and Medicare services of finding new and better ways of improving quality and lowering the cost of care.
Key Features of the ACO-REACH Model
Prioritizing Health Equity, especially in underserved communities. As part of this, CMS is actively directing its efforts towards better addressing health disparities. ACO Reach providers are required to implement solutions to address existing health disparities.
Changing the medium for providing primary care. The shortage in primary care physicians remains a key barrier to health access in underserved communities. Professor Clayton Christensen in his book, The Innovator’s Prescription spoke of how advancements in medical technology will enable nurse practitioners to share in much of the workload of primary care physicians. The ACO-REACH model seeks to enlarge the scope for nurse practitioners practicing within accountable care organizations. The expansion of these APP (Advanced Practice Providers) can help in addressing caregiver shortages in underserved areas.
A bigger role for Providers in ACO governance. Providers only constituted 25% of an ACO’s governing board under the GPDC model. With regard to important ACO decisions, this included very little input from those who were treating the patients. The ACO-REACH model has raised that percentage to 75% now, which gives providers a greater role in ACO governance. Now, those in charge of governing decisions will be those who are most familiar with what their patients need.
Successful outcomes in this regard will show everyone that tackling healthcare disparities will not only benefit patients but will bring financial sustainability for providers as well.
ACO-REACH Model: Benefits for New-Age Providers
Being a value-based program, ACO-REACH reimburses providers on the basis of patient health outcomes and quality of care given, and not only the number of services provided. This payment structure acts as an incentive for providers to keep their patients happy, healthy and not charge them for every service they offer.
ACO REACH requires participating organizations to tackle health access among communities that have had very poor access to quality primary care over the years. In addition to this, the model pays an extra $30 per month to providers taking care for the most vulnerable Medicare populations. Thus, the ACO Reach program seeks to provide quality care to underserved Americans that the health system has ignored for far too long.
ACO Reach is transforming healthcare as it helps people make a smooth transition towards value-based care.
Hucu.ai is part of the value-based revolution. In order to deliver on the promise of higher quality, lower cost care, value-based care providers must have collaboration and communication across the care continuum. Quality can be improved with greater visibility by assuring that health conditions are identified and addressed before they become more serious.
Hucu.ai is providing revolutionary patient-centered messaging that improves efficiency and reduces burnout. With staffing shortages plaguing healthcare, particularly in primary care, the only way physician groups can grow is by retaining staff and lowering burnout. Hucu.ai brings the entire organization to one place organized by patient, subject or department, that increases teamwork by balancing synchronous and asynchronous communication.
In Hucu.ai, you can notify specific people with configurable notifications, that enables culture development with recognition and appreciation which happens naturally when teams are communicating well with each other.
Leading providers need simpler solutions to coordinate better care. Hucu.ai is replacing this SMS texting, because it is just easy to use while being more secure, better organized and more manageable.
The ACO-REACH model brings a wide range of benefits to new-age providers. First of all, it makes the management of financial incentives and the generation of predictable revenue streams a whole lot easier. This creates space for providers to have greater focus on the overall health of the communities they serve. This model appeals to innovative physician groups and healthcare organizations. It offers them the opportunity of alleviating the existing burden on primary-care physicians, providing quality care to at-risk populations and encouraging organizations, not part of Medicare FFS, to invest in value-based care.
ACO Reach seeks to benefit both new-age providers and patient populations alike. Now, there are a greater number of revenue opportunities for primary care physicians, such as stable monthly payments and shared savings. On the other hand, there is a lowered out-of-pocket expense for patient populations. There is an ease in accessing post-acute providers such as skilled nursing and home health providers.
That is often where the value is lost due to lack of visibility as patients transition from the hospital to skilled nursing facilities or home health care and home. Since patients do not receive the right oversight and follow up without appropriate communication, quality can be improved with the greater visibility that Hucu.ai provides.
Healthcare today is fraught with challenges in the way people are trying to communicate with many manual one to one methods. Hucu.ai reduces dependency on manual answering service processes and enables care organizations to communicate better and coordinate timely care to patients.
How Hucu.ai can help with ACO Reach
What we at Hucu.ai can do is help these providers manage their ACO reach populations by identifying and focusing on patients that are at high risk.
Hucu.ai offers tools to manage patient populations for better process consistency which delivers better results. For example, physicians can manage patients in specific programs, with each program containing stages of care. Patient status is easier to manage across the program queues, with the entire team having visibility. Thus, outliers can be addressed and patients get the care they need faster. Physician group teams have visibility into population needs and outcomes.
In Hucu.ai, you can develop programs to proactively care for your at-risk populations. As ACO Reach beneficiaries are cared for, we can track and review each patient’s journey.
Sources
ACO Reach: Can a new model make health disparities a priority?
Everything You Need to Know about ACO REACH
Medicare Advantage and ACO REACH Driving the New Era of Healthcare Providers.
How is the ACO REACH Model different from other Value-Based Care (VBC) programs?
