10 Reasons Why You Should Choose ilumed As Your Medicare ACO REACH Partner

By Melanie Miller, Senior Vice President, Operations

I worked for another healthcare provider as part of their executive team in 2022. That was when I got to know ilumed’s leaders, mission and approach to healthcare. In the boardroom that day, I heard heartfelt stories of patients and stories that showed how ilumed’s staff, from an entry-level person to the CEO, went above and beyond for patients and providers alike. I was so impressed,  I told a colleague, “One day, I’m going to work for ilumed.” And here I am.

It was the best decision I’ve ever made and why I’m so passionate about encouraging providers to partner with ilumed. Here are my 10 reasons why you should choose ilumed as your Medicare ACO REACH partner.

1. Our mission to heal healthcare

We know healthcare is complicated, but we also know that simple solutions are out there. It’s time to heal healthcare from the inside out and the outside in. ilumed's approach to the ACO REACH model does just that by helping providers care for their patients like they’ve always wanted. We set providers up with sustainable financial models that help them invest in their staff and infrastructure while earning incentives for exceptional care.

On the patient side, we know that navigating the healthcare system can be downright demoralizing. That’s why we wrap our arms around patients as much as we do around providers. We make it a priority to ensure that nobody falls through the cracks, especially those who are most at risk. We know reducing chronic illness and boosting population health won’t be fixed overnight. That’s why we show up every day for our patients and providers.

2. Dedication and determination

Our outreach starts the minute a patient is admitted to the hospital. An ilumed nurse calls to check on them once they’re admitted and within 24 hours of discharge, because we know those first few days back home are critical. We don’t just stop there. We continue our follow-ups through 30 days and beyond that if needed. From the second we’re notified about a hospitalization, we go to work, and we don’t stop until we've addressed the situation fully.

Health happens at home, the grocery store, in the community—not just the exam room. We know that when a natural disaster wipes out your entire house and neighborhood, it isn’t something you can just get over. You’ll need care packages and a team to help you get back on your feet for the long run. Our compassion for the providers and patients we serve runs deep.

3. Departmental expertise and seasoned leadership

At ilumed, our leaders have more than 300 years of combined experience delivering value-based care solutions. They practiced Medicare value-based care and removed barriers to social determinants of health before those terms existed. Our team is a well-run ship that functions across departments—operations, member outreach, census administration, case management, and social work—to achieve the higher goal of delivering quality care sustainably.

We’ve had providers call us “intrusive”, which is actually one of the best compliments we could get. We want our providers to do well. We want our patients to do well. We want our staff to do well. We go to great lengths to make it happen, whether that’s providing meals to patients through one of our partnerships or coaching providers to adjust their schedules to accommodate more last-minute appointments so patients don’t have to seek acute care elsewhere. All our value-based care solutions lead to care-delivery transformation, which ladders up to making patients healthier.

4. Financial stability for providers

In traditional fee-for-service Medicare, providers get paid per service. However, this can create bad incentives that lead to revolving-door care rather than addressing the root causes of patients’ diseases. Value-based care, on the other hand, rewards providers for the quality of care they provide and is based on patients’ health outcomes. Value-based care sounds great in theory, but it can be difficult in practice. That’s why ilumed's ACO REACH model offers providers three ways they can get paid:

1. Base payments that are typically higher than what they would receive in fee-for-service Medicare arrangements, which create a baseline financial security for providers and their practices.
2. Generous, quality incentive bonuses based on the quality of care provided to patients regardless of how much that care costs.
3. Shared surplus savings that let providers share in the savings they created through high-quality, affordable care.

ilumed helps you not only understand the strict guidelines around each payment but also helps to adjust your clinical and operational processes to achieve all three payments.

5. Excellent beneficiary enhancements that enhance quality of care and patient quality of life

At ilumed, we aim to not only remove barriers to care but also enhance the quality of care that patients receive. Ultimately, this increases the beneficiaries’ quality of life. Here’s how we make it happen.

Cost-sharing benefit enhancement

Typically, traditional Medicare beneficiaries are responsible for 20% of covered Medicare costs. While that percentage might seem reasonable, for many Medicare beneficiaries living on a fixed budget, that amount can mean the difference between seeing the doctor and buying groceries. Our beneficiaries do not have to worry about deductibles or coinsurance. It’s always $0 to see their primary care provider (PCP), which helps keep them tethered to their PCP and removes barriers to visiting their doctor.

Transportation

For many beneficiaries, getting to and from the doctor or the pharmacy proves to be too challenging because of the financial burden, not having reliable or affordable transportation or mobility issues. Our transportation services eliminate a potential hurdle for many with rides to and from the doctor or the pharmacy that we schedule for them, free of charge. In 2023 alone, we provided over 3,000 rides.

In-kind services like food delivery

As I mentioned before, too many Medicare beneficiaries need to make dangerous tradeoffs due to financial strain. Should I buy beef or my insulin this month? Should I pay for the electricity or this low-sodium meal package? We know that food is medicine, which is why we’ve partnered with Pearl Mae Foundation, Mom’s Meals and U.S. Hunger to get nutritious food in the hands of patients. Last year, we provided over 50,000 meals to beneficiaries.

Outreach, clinical and social support

Staying on track with treatment plans once patients leave the exam room can be overwhelming. That’s why our outreach, case and disease managers and social workers are so vital to your patients’ adherence. Our teams help patients schedule appointments, make lifestyle adjustments, develop new strategies for managing their treatments and symptoms and connect with community organizations as needed. It’s a great way to help empower patients to take charge of and invest in their health. We even offer gift cards patients for achieving goals determined by their case management enrollment.

6. Unparalleled provider support

From day one, we wrap our arms around the providers we work with to set them up for success. We carefully walk providers and key stakeholders through the details of contracting and our expectations for working with us. After that, we ensure their assigned ilumed provider representative is available from 7 am to 11 pm daily for any ad hoc needs. Because we sit in on Centers for Medicare & Medicaid Services (CMS) calls biweekly, we’re able to give providers real-time updates on changes and nuances to Medicare’s ACO REACH program. All in all, our provider support is second to none.

For providers who are already delivering value-based care to Medicare beneficiaries, working with ilumed takes your organization to the next level. With ilumed and the ACO REACH model behind you, you’ll have more financial and clinical resources available to your staff and your patients. We’re like a value-based-care tide that lifts all boats.

7. Commitment to ACO REACH health-equity plans

Healthcare shouldn’t be dictated by income, race, gender, sexuality, or geography. That’s why health equity remains a key priority for CMS and for ilumed. We aim to deploy our health-equity assessment to 100% of our beneficiaries because we know disparities and barriers might not be immediately apparent or something all patients feel comfortable talking with their doctor about. We help alleviate any taboos or embarrassment patients or providers might feel by doing the form completion and servicing ourselves. Our proprietary platform, BrainStream, then helps doctors pinpoint the most at-risk patients at scale. When you work with us, you have a partner who can help you create and execute your ACO REACH health-equity plan.

8. Low team-member churn

Our ilumed team is like a family. We have an engaged and passionate workforce who are excited to work with providers and patients. As Helene, a licensed master social worker at ilumed, says, “Working at ilumed gave me a chance to be part of the change I longed for.” As I mentioned before, the compassion and dedication of ilumed’s leadership is why I chose to work here myself. Seeing our leaders show up as servants for our providers and patients keeps me and our wider team motivated to do the same.

9. Consistent and healthy growth

As a startup, ilumed continues to grow at a sustained rate. In 2021, we earned $16.5 million in series A financing. Last year, we closed out the year with a record-breaking number of beneficiaries served. We aren’t growing too fast and getting out over our skis or growing too slow and resting on our laurels. Instead, we make smart investments and expansions that help us help more providers and patients in real, tangible ways.

10. Our drive to succeed

We embedded a growth mindset in our culture, which helps us succeed in both the short- and long-term. We know that the success of our providers and patients is our success. At the heart of this success is our CEO, Debbie Finnel, whom we all love. When floods and mudslides hit southern California in early 2024, she was the first one asking how we could support our affected patients and providers. She inspires us to serve first and lead second.

It’s time you had a partner you can count on. It’s time to connect with ilumed. While you’ve been caring for your staff and your patients, who cares for you? With ilumed by your side, you’ll have the additional financial, operational, clinical, and psychosocial resources you need to deliver exceptional care to every Medicare beneficiary. You’ll have a partner by your side who can help you heal healthcare. Get in touch.