The Equity in ACO REACH, Explained
The Equity in ACO REACH, Explained
Perhaps you’ve heard that the Centers for Medicare and Medicaid Innovation just slapped a new name on an old program in 2022 to come up with ACO REACH. But that's not accurate: there are some substantive differences worth understanding now that REACH is heading into year two.
The health equity opportunities are real and have already shown enough promise to lure a flood of participants who work in the most underserved parts of the country.
The value-based care model that REACH replaces, Global and Professional Direct Contracting, contained no explicit health equity considerations. Even the side-by-side comparison from CMMI reveals the equity omission.
Here’s what’s behind the “E” in REACH (Realizing Equity, Access, and Community Health).
Accountable Care Organizations were brought about by the Affordable Care Act more than a decade ago to help drive down costs and improve quality of care. They allow primary care providers to group together and take collective financial risk on their patients, a bit like an insurance company.
For Medicare programs, like REACH, the government uses health history to estimate how much a patient should cost in a given year. If the provider — participating in an ACO — can do it for less, they share in the savings. Usually this means prioritizing preventive measures and improving coordination with specialists, hospitals and post-acute providers like nursing homes. But if the ACO and provider don’t manage the patient well and the expenses spike, they could owe CMS — and many do.
Overserve the Underserved
Using a measure called the Area Deprivation Index, CMS designates underserved areas where providers now receive additional money to care for each patient. An estimated 4.2 million Medicare beneficiaries live in these counties including much of Mississippi, Arkansas and Alabama, along with large swaths of Texas and Kentucky. Previously, federally qualified health centers (FQHCs) and rural health clinics have been disadvantaged by ACO programs. The number of such clinics has already doubled with the introduction of REACH.
Demographic Data to Improve Quality Scores
CMS is looking for an efficient way to capture demographic data on every Medicare patient, including race, ethnicity, preferred language and gender identity. Providers with REACH ACOs are asked to retrieve the info from patients, though if patients would rather not share, the provider still gets credit. The demographic data helps CMS better understand the inequities in healthcare in order to track progress. Data collection is also time well spent for providers since ACOs get a bump in their quality score. Even the slightest score increase can result in a sizable payout difference .
Everyone Needs a Plan
All 132 ACOs in REACH (including 3 run by Wellvana) are required to submit a Health Equity Plan that identifies disparities in a designated service area and outlines targeted initiatives to improve health outcomes and reduce inequities. As of now, there are no penalties or rewards tied to carrying out the plan, but CMS will track progress each year.
For NPs and PAs
Since midlevel providers have been shown to expand access to care, REACH slightly widens their practice scope. Under the program, nurse practitioners and physician assistants have the authority to order hospice, diabetic shoes, cardiac rehabilitation, infusion therapy and medical nutrition therapy.
Wellvana’s Equity Commitment
No matter the requirements of an ACO program, Wellvana believes value-based care improves health equity because it rightfully incentivizes primary care to address social determinants of health and improve access to care.
Wellvana has invested accordingly by:
Incorporating government data streams that flag social determinants of health — When a doctor knows their patient doesn’t have a car registered with the state, it’s a pretty good sign transportation will be a challenge, which is the case for an estimated 3.6 million Americans.
Hiring social workers — Nurses helping to manage patients with multiple chronic conditions find themselves regularly playing the role of social worker — helping patients sign up for Meals on Wheels or arranging free or reduced cost transportation to an appointment. So Wellvana started hiring experts in social programs and behavioral health to better support the needs of patients beyond what’s been available in the fee-for-service healthcare system.
Doubling down on care management and care coordination — The days and weeks between appointments become the literal cracks in the health care system. Care management and coordination fill the gaps. Scheduling patients for follow-up visits and offering high-touch remote service to those who’ve just left the hospital or are dealing with multiple chronic conditions ensures patients have consistent access to healthcare services and improves outcomes.
Partnering with underserved community groups — With elevated rates of conditions like diabetes and hypertension among key minority communities, value-based care follows the data to help where help is most needed. Wellvana has begun hosting targeted events to increase access to screenings and health education.
Value-based care has not yet proven to be the great equalizer in healthcare. Early in the advent of ACOs, there was even some concern about exacerbating inequities. But the REACH program looks to ensure that the value movement doesn’t lose its focus on health equity and reaches patients who have been overlooked by the U.S. healthcare system.
It’s up to participating REACH ACOs to deliver on the revised mission. Wellvana will stay close to CMS to share data, offer constructive feedback to optimize their value-based care models and continue to educate policymakers on the impact of full-risk accountable care through the lens of our ACO participants.