REACH vs MSSP: What to Know Before the ACO Deadline on August 1
REACH vs MSSP: What to Know Before the ACO Deadline on August 1
If you're planning to treat Medicare patients in the future, now is the time to ramp up your knowledge of value-based care.
Currently, 2030 is the Centers for Medicare and Medicaid Services’ goal to reach universal accountability. Five years may seem far out, but every day you wait is a day you fall behind.
Not all accountable, value-based care is created equal. In fact, a majority of Accountable Care Organizations don’t participate in the programs that offer providers the greatest opportunity to share in the savings they create.
Too many providers are stuck in partial-risk programs that were always intended to be a waypoint en route to full-risk.
Even if you’re new to risk, it’s important to understand how improved clinical outcomes can drive expanded financial opportunity. But going all-in requires an experienced partner.
It helps to see value-based care as a path from fee-for-service to full-risk.
Everything Beyond Fee-For-Service
Whether through an Accountable Care Organization or a Medicare Advantage contract, patients in full-risk arrangements receive a benchmark based on their medical history.
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 ACO participants keep the difference — so long as they also hit quality metrics.
ACO participants can also lose — and some do. If this fictional patient costs $20,000, they're on the hook for the overage.
It's easy to see why providers fear full-risk. But what if you had a partner who would shoulder the upfront risk to open the door for your practice?
See how your practice could perform as a part of Wellvana's ACO.
See how your practice could perform as a part of Wellvana's ACO.
MSSP: A Steppingstone along the Full-Risk Path
The Medicare Shared Savings Program (MSSP) is the largest accountable care program in the country and offers partial risk programs. Participants can start with no risk and 40% of the upside created by controlling the cost of care.
This can be a great place to start. Just as many top MLB draft picks spend a season or two in the minor leagues, value-based care also has a farm system to prepare you for full-risk.
No matter where you start, we believe every provider can reach their potential to succeed in
full-risk programs, like ACO REACH and some Medicare Advantage contracts. That way 100% of the upside stays with the people who did the work and can invest it in improving patient care.
The Full-Risk Opportunity of ACO REACH
ACO REACH is the successor to the Global and Professional Direct Contracting Model and helps 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 “Realizing Equity and Community Health” or REACH).
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 save and share those savings with their provider partners. That means every unnecessary hospitalization that’s avoided contributes to shared savings.
All the while, patients thrive because physicians are incentivized to focus like never before on prevention and wellness, held accountable by a requirement to meet certain quality scores.
Full-risk is a lot to bear. You can’t do it alone.
Wellvana takes the lead on risk and investing in your practice. You share the rewards.
Participation in ACO REACH requires posting a financial guarantee with the Centers for Medicare & Medicaid Services. We handle that. But that’s only the start of supporting your success in value-based care.
Your practice will need more support, and so will your patients. But they’ll never see out-of-pocket costs for our programs.
"It's easy to see how patients get lost in the system. For those of us who know the ropes, it just takes a little problem solving to keep them from falling through the cracks.” - Kristina Miller, RN
The right partner with the right programs.
We know that patients we engage with our care management services, known as Foundational Care, see a 22% drop in hospitalizations and 16% lower medical spend. Practices that use Clarity, our population health tool, for a majority of their patients, see savings rates 2.7x higher than those who don’t.
Putting your patients first, we put you on a path to succeed in value-based care.
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