April 25, 2022
Read Time: 6 minutes
“The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.”
You know your patients. You strive to give them the best care possible. However, the current fragmented nature of the healthcare system often works against you rather than for you. It needs innovation. Enter ilumed. We create simple solutions for a complex industry with the Accountable Care Organization Realizing Access, Equity and Community Health (ACO REACH) model.
Challenges faced by today’s healthcare providers
Healthcare is changing. Providers face several challenges in their day-to-day life. Mental health, labor shortages, decreased trust, and increased levels of chronic conditions all contribute to systemic problems.
Among providers, 75% report anxiety and 74% report depression. Labor shortages also have a significant impact on providers; 29 out of 50 states won’t be able to fill their demand for nurses by 2026 and 21% of family medicine, pediatric, OB/GYN and other primary care physicians are expected to retire by 2026. There are currently decreased levels of trust due to the pandemic and systemic inequities in healthcare as well as increased levels of chronic conditions. Of U.S. adults, 27.2% have multiple chronic conditions while 51.8% have one chronic condition.
The ACO REACH model offers support for providers so that you can do work that matters. It provides insights from data and value-based care experts as well as tools and resources to provide the right care to patients at the right time. This value-based care model offers more support for chronic conditions and social determinants of health and focuses on prevention and proactive care. With patient education and empowerment, built-in transportation services, and connections to community health and wellness resources, your patients can rest easy.
What is an ACO REACH model in healthcare?
ACO REACH is an alternative model designed to revolutionize the way medical practices provide care. It’s available nationwide and was designed by The Center for Medicare and Medicaid Innovation (CMS). The CMS Innovation Center aims to improve the healthcare system by achieving better care for patients and communities while also reducing costs for beneficiaries and helping providers and Medicare be more efficient and effective with their funds.
The CMS ACO REACH model can lower costs as well as improve outcomes for beneficiaries who have traditional Medicare. Traditional Medicare operates under the fee-for-service (FFS) model. In other words, providers are paid for each service they administer, like tests and treatments. Medicare beneficiaries under an FFS model must coordinate their own care by acting as the go-between for different providers such as their primary care provider (PCP) and specialists. Providers in one area might not be aware of what’s going on elsewhere. This can be complex and confusing, especially for high-needs patients and patients who are handicapped by socio-economic conditions.
ACO REACH combines elements from traditional Medicare, Medicare Advantage and Accountable Care Organizations (ACOs). Unlike some of these program models, ACO REACH beneficiaries retain absolute freedom of choice to select providers, additional services not included under the traditional Medicare program and high-quality, coordinated care. What’s not to love?
ACO REACH maintains the perks of Traditional Medicare
Traditional Medicare has a few perks: choice simplicity, provider freedom for beneficiaries and ease of use. Choice simplicity means beneficiaries don’t need to compare 39 different Medicare Advantage plans during the Medicare Advantage Annual Enrollment Period and then repeat the process each and every year. Beneficiaries can see any provider who accepts Medicare instead of dealing with restrictive networks. Finally, referrals from a PCP are not, under the ACO REACH model, necessary to see a specialist.
ACO REACH offers extra benefits similar to Medicare Advantage
ACO REACH offers Medicare Advantage-style assistance such as transportation for office and pharmacy visits, a $0 copay for routine visits with a PCP, home visits and more. These services give beneficiaries a way to get the most out of their care. People who don’t have a car or access to public transportation would be able to see a doctor of their choosing or go to the pharmacy. No-cost copays allow those on a fixed income to be able to receive care without breaking the bank. Finally, home visits are great for those who have trouble with mobility or are otherwise compromised as might be the case following an inpatient stay.
How ACO REACH delivers coordinated, high-quality care like ACOs
ACO REACH entities help healthcare professionals provide high-quality care. They use a value-based care model (VBC). In VBC models, providers are compensated based on the quality of care they provide. VBC aims to provide better healthcare for individuals and populations, all while reducing overall costs. Ilumed can identify at-risk patients through its BrainStream platform, helping providers address barriers to healthcare that individual patients face, whether it’s medication adherence, transportation to doctor’s appointments or chronic-condition management. We share this information with providers and assist providers with care options so that they, the providers can strategically care for their patients rather than waiting for a patient to present. Ilumed uses a team-based approach to offer proactive, preventative care. We work with your practice and you to help patients achieve the best possible outcomes.
How does the ACO REACH model work?
ACO REACH entities take on the financial risk for Medicare beneficiaries in terms of the quality and cost of care. They use a capitation rate, which is a set dollar amount per patient per unit of time paid to the provider before they deliver health services.
The benefits of ACO REACH
There are several benefits for both patients and providers. For patients, there’s integrated, value-based care as well as increased support for managing their care at the doctor’s office and at home. This includes scheduling assistance, medication adherence, and support with social determinants of health such as food insecurity, loneliness, or transportation issues.
For providers, there’s increased clinical and concierge support. This includes risk stratification, operations support, concierge services, advocacy, preventative health and wellness campaigns, and health and wellness community resource coordination. Providers can identify the most at risk patients and give them the support they need, implement a value-based care model that can allow them to transition away from a fee-for-service model, and help build relationships between patients and support services.
Is ACO REACH right for my practice?
Every practice has different needs. You might be interested in value-based care but are unsure of where to start. If your practice isn’t yet on the road to value-based care, the ACO REACH program might be right for you.
Is a large portion of your practice participate in Traditional Medicare?
If a substantial portion of your Medicare practice is on Traditional Medicare, ilumed provides plenty of clinical and outreach support and can help you achieve improved cashflow and, potentially, increased profits while improving patient care and happiness. In effect, ACO REACH contracting can take your practice to the next level at no additional cost to you and without your practice having to assume risk.
Are you struggling to care for high-needs populations?
ACO REACH entities can provide a high-needs population with specialized care for complex health issues. At no additional cost to your practice, you can offer more one-on-one support for patients with ilumed’s clinical and concierge services. Patients can benefit from specialized care.
As a real-world example, we discovered that one patient over-indexed on emergency-room visits. So, we helped her provider discover the catalyst for these visits. Then, we coached the patient to reach out to her PCP first before going to the ER. We got her the support she needed and empowered her, with 24-hour access to support, to take charge of her health. As a result, the patient’s health improved.
Are you struggling to create sustainable care and a profitable practice?
If you’re struggling to provide sustainable care, ilumed can help turn things around. We can get you started with a value-based care model. We give you the guidance and tools you need to get better outcomes while improving your cash flow and, potentially, increasing your bottom line. Ilumed puts patients and their well-being at the center of everything we do. We’re not expecting you to do busywork and data entry for us. You’ll notice the value of your work when you partner with ilumed.
Are you interested in healing healthcare?
You got into practicing medicine to solve your patients’ complex health problems. Ilumed can help you tackle even more complex problems in the healthcare industry. You’ll be championing a better future for providers and patients alike. Join ilumed as an innovator in the healthcare-delivery space.
A changing model means more equity
Ilumed has worked as an ACO REACH entity with CMS since the program was announced. As an ACO REACH organization, ilumed helps to promote health equity for historically underserved beneficiaries by expanding the number of providers these beneficiaries have access to. We can help more providers discover if ACO REACH is a good fit for them.
Embracing the model
Now you can get back to healing people. Ilumed can help you make a difference. We’ll have your back when you take on the challenges that face the highest-need patients with better, more sustainable care with corresponding financial improvement within your own practice. Now your practice—and your patients—can thrive.
Want to find out more? Check out our FAQs page.
Ready to take the next step? Contact us.