It's never a bad time to explore joining an ACO or finding a better fit for your practice. Picking the wrong partner could limit your opportunity to succeed in value-based care with your traditional Medicare patients. Here's what to know as you weigh your decision.

The Medicare Shared Savings Program (MSSP) has evolved since its origin more than a decade ago, and it's an important steppingstone to true value-based care. MSSP limits the financial risk, but it also offers participants as little as 40% of the savings created by doing the hard work of controlling the cost of care. The government keeps the rest.

With ACO REACH, launched just this year, the upside stays with physicians and the ACO.

Below, read why full-risk REACH is worth your consideration. 

Partial Risk, Limited Reward

MSSP participants still need to join an Accountable Care Organization. And that ACO should assist each provider to improve the health of patients while reducing costs. But for practices taking no downside risk, the shared savings top out at 40%. No risk of losses, but only 40% of the upside. CMS keeps the rest of the savings even though you put in all the effort.

Providers willing to assume some of the downside can work their way up to 75% risk. But if you’re ready to unlock the potential of value-based care, consider going all in. 

The Shared-Savings Basics

Patients probably don’t realize they’re part of an ACO. And not all your Medicare patients will be aligned to your ACO. But those who are aligned will get a risk score based on their medical history documented in your EMR.

The higher the risk, the more Medicare is willing to pay.

The difference between what Medicare expected to spend on a patient’s care and what’s actually spent becomes your shared savings rate. If Medicare thinks it will cost $12,000 to care for Mrs. Jones and with better coordination it costs $9,000, full-risk providers and their ACO keep the difference — so long as they also hit quality metrics.    

But the ACO can also lose — and many do. If this fictional patient costs $20,000, the full-risk ACO funds the overage. That’s how Medicare and other payors benefit. 

There’s more to it, but you get the idea.

And with full-risk REACH, those savings stay with providers and ACOs.

The Full-Risk Opportunity

ACO REACH, successor to the Global and Professional Direct Contracting Model, creates new incentives for providers who operate in underserved areas — particularly in the more rural parts of the country. Equity and access are baked into the program (and the name).

But just as importantly, REACH ACOs can take full advantage of value-based care through a full-risk program. REACH ACOs retain 100% of what they collectively save and share with their provider partners. That means every avoided hospitalization goes directly to the shared savings rate and your bottom line.

All the while, patients thrive because physicians are incentivized to be laser focused on prevention and wellness, held accountable by a requirement to meet quality scores.

Excited yet?

Whether partial or full, the out-of-pocket risk falls on us.

Wellvana takes 100% of the upfront financial risk. You share the rewards.

Full risk keeps us focused on the top priority of holistic care that keeps patients as healthy as possible. To succeed, Wellvana provides complimentary services to your practice.

REACH is still new, but we don’t mind sharing our early numbers.

After bringing in nearly $50M in savings in 2022, we expect our doctors to nearly double that in 2023 while achieving one of the highest savings rates for REACH in the country.