What Specialists, Clinics and In-patient Facilities Need to Know About ACO REACH

By: Bill Lane, EVP Network Development & Global Risk Contracting

The ACO REACH model helps primary care re-establish itself as the lifeblood of the healthcare system, but ACO REACH isn’t just for primary care providers (PCPs). I’ll explain why ilumed, as an ACO REACH organization, is the connective tissue between PCPs, specialists, clinics and in-patient facilities and why these other provider types should join the ACO REACH model.

How ACO REACH helps improve health outcomes and lower costs across the healthcare ecosystem

The ACO REACH models incentivize value over volume by connecting the dots between different provider types, with PCPs at the center. We ensure beneficiaries get the right level of care—rather than too much or too little—in the place that’s most conducive to the patient’s health outcomes at the right time. Here’s how that works in practice.

Ilumed removes barriers to care and increases patient support

Let’s say a cardiologist is seeing an ilumed beneficiary who hasn’t been taking their medications. Our licensed social workers can help pinpoint and resolve any health-equity issues, whether that’s transportation to and from the pharmacy or financial strain. Our case managers and clinical outreach team can help them adhere to their treatment plan with hands-on help and coaching, whether they need a better system for tracking their medication doses or simple ways to add more exercise into their daily life.

ACO REACH helps providers increase health equity by extending patient support and care. Instead of the patient having to shoulder burdens alone, they have the resources they need. In sum, ilumed manages unmanaged care in the system at large.

Ilumed reduces unnecessary costs and improves outcomes

Now, let’s say a patient gets a heart stent but experiences complications during the procedure that only requires an overnight stay. Typically, Medicare requires a three-day stay to authorize payment to an in-patient facility. This means that beneficiaries who only need one night in the hospital are staying longer than necessary, which taxes the system and costs more.

With ACO REACH, we can waive that three-day requirement to pay the hospital appropriately for the overnight stay and get the patient into the right care in the right place at the right time. Plus, we’ll engage their PCP within 72 hours to be sure they’re in the loop of what happened and the patient’s adjusted treatment plan.

When the patient is discharged with a laundry list of instructions and medications, ilumed’s clinical and case managers are ready to help alleviate confusion and overwhelm. We can even perform home visits should the need arise. Rather than pay providers for the volume of care they delivered, we pay them for the quality of care delivered—plus we pitch in to be sure that care is delivered at the highest level.

Ilumed provides healthcare-provider technology that works

We’ve entered a data-driven era, but data without the right context is just noise. Too many electronic-medical-records platforms leave too many blind spots. Ilumed’s technology is different—and it works.

Our proprietary BrainStream platform gives providers from PCPs to specialists, clinics to in-patient facilities the actionable insights they need on a patient no matter where that patient receives care in the United States. We’re able to aggregate claims data from the Centers for Medicare & Medicare Services along with admit discharge or transfer notifications from Bamboo Health as well as each state’s health information exchange to provide unprecedented 360-degree views into a patient’s claims activity without geographic bounds across the nation.

We’re able to close the gaps on care by notifying their PCP of any updates no matter where a patient receives care and bolster that care with our active clinical support, case management, transitional care management and patient outreach teams. It’s a very cohesive approach to healthcare delivery that also drives patient satisfaction.

Additional benefits of ACO REACH by provider type

Specialists

We’re highly selective when it comes to the providers we work with, and specialists are no exception. We look for those independent specialists who deliver high-quality, cost-effective care so we can help enhance their position. We do that through our network of PCPs that represent more than 55,000 beneficiaries nationwide. Word of mouth continues to drive consumer behavior with five times more sales than paid media. Rather than try to compete with huge conglomerates through expensive marketing campaigns, we use the power of word of mouth to help specialists grow their patient panels organically.

We’re also helping build more flexible models with specialty care to advance incentives that reduce costs while improving outcomes. For example, we’ve been looking at cancer care and exploring how to bundle costs or create a case rate that rewards these specialists for the exceptional work they do caring for complex cases.

Rural health clinics and federally qualified health centers (FQHCs)

Increasing healthcare access and quality of care are two main pillars of the ACO REACH model—and they are key to the success of rural health clinics and FQHCs. By partnering with an ACO REACH like ilumed, rural health clinics and FQHCs can do even more for their patients and their financial outlook. With ilumed, rural health clinics and FQHCs have transportation-support services, clinical and case management support as well as patient outreach. Plus, we’re able to pay a higher, more predictable rate than their all-inclusive rate.

Hospitals

Hospitals live and die financially by their average daily census. This creates a push/pull between filling beds and getting patients the right care. Because ACO REACH is so focused on preventive, primary care, many hospitals see ACO REACH as being anti-hospital admissions, but that couldn’t be further from the truth. ACO REACH is anti-unnecessary admissions and readmissions.

One-third of patients discharged from hospitals to skilled nursing facilities are readmitted to the hospital within 30 days. Emergency room visits for patients aged 65 years and older cost more than twice as much as those aged 17 years and younger. The constant recycling of patients through emergency rooms and hospitals coupled with the higher cost of care due to more complex conditions contributes to provider burnout and unnecessarily raises healthcare costs system wide. With ilumed, hospitals can help prevent unnecessary visits, admissions and readmissions, helping the hospital focus more on the patients that need to be there, alleviating the cost of care and reducing provider burnout. ACO REACH isn’t out to get hospitals; we’re out to help them increase efficiencies and provide the kind of care they dream of giving by optimizing care delivery.

It’s time to rethink how you deliver healthcare with ilumed

With more than 30 years of healthcare operations and management experience, I can say with confidence that ilumed is the best in the business. We know how to manage the cost of care globally with every provider type out there. We know how to improve patient outcomes, and we know how to create sustainable provider systems, facilities and practices. We know how to help providers get back to what they do best: helping people. Join us today.