Struggling to Provide Value-based Care? Its Time to Switch to ACO REACH.

Today’s healthcare providers are asked to do more with less. Do more prevention, provide a more compassionate bedside manner, use more technology and data, serve more people with more complex needs and spend more time with them. The demands feel endless, yet your personal and professional bandwidth remains limited. There are only so many financial resources, so many staff members, so much time. To top it all off, trust in doctors has seen a precipitous 9-point decline from 2019 to 2023, according to Gallup. When you feel like you’re working so hard and getting nowhere and don’t feel respected, you feel bitter, resentful, burnt out. All this contributes to why 40% of doctors are moderately interested in exiting their current organizations.

Meanwhile, the Centers for Medicare & Medicaid Services (CMS) continue to push for more accountable care for Medicare beneficiaries in the form of value-based care. What is value-based care? It’s care that rewards quality of care over quantity of care. In fact, by 2030, CMS wants all Medicare Part A and B beneficiaries to transition away from fee-for-service care into value-based care. The tension between the harsh realities of healthcare delivery and CMS goals may feel like being caught in a never-ending game of tug-of-war.

Why providing value-based care can be a challenge

Shifting from fee-for-service care to a value-based care model means transforming everything about the way you practice medicine. It’s not just a change in care delivery but also a metamorphosis of your finances and operations as well. For providers who are used to getting paid per service, switching to getting paid on patients’ outcomes can be a shock. In the short term, fee-for-service seems like a smarter strategy, but what ends up happening in the long run is that costs can skyrocket, and waste can proliferate—this is essentially where we are now with America boasting $4,000 more per person spent on healthcare than other high-income countries for worse health outcomes. While shifting to a value-based care financial model can work in the long-term to reduce costs and improve outcomes, providers can have a rude awakening in the short-term. It can feel like working harder for less revenue.

From an operational perspective, value-based care requires more coordination and communication among staff and between other providers, whether they are specialists, hospitalists or acute-care providers. To do this effectively, you need more interoperable, real-time data and more sophisticated technology infrastructure. You also need to train your staff to think and act differently in this new value-based-care model.

Delivering value-based care puts an emphasis on prevention and addressing root causes. Prevention means getting much more involved with seeing patients regularly instead of once a year. It also means having the right screening and data tools in place to pinpoint the highest risk patients. It also means expanding the scope of healthcare beyond the exam room to the home and wider community.

Many providers haven’t been trained in asking about or resolving social determinants of health like food insecurity, transportation hurdles, financial strain, loneliness/social isolation and housing insecurity. It can feel invasive or taboo for you and/or your patients. But the reality is that these social determinants of health weigh more heavily on health outcomes than either genetic factors or access to healthcare. Shifting your entire mindset around what healthcare means can be difficult and even feel just plain wrong or demoralizing.

ilumed's ACO REACH approach tees up providers and patients for success in value-based care

At ilumed, we have centuries of combined experience in delivering value-based care. We provided value-based care before there was a name for it. We know how to meet you where you are on your value-based-care journey, whether you are still practicing fee-for-service care or you’re in an accountable-care arrangement already. We know how to leverage value-based care in multiple delivery channels, whether that’s primary care, specialist care, hospitals or clinics.

Financial sustainability and opportunity

We also know that getting the finances right remains essential to delivering high-quality care. Providers should have predictable, sustainable revenue streams so they can focus on doing their best work for and alongside their patients. At ilumed, we pay providers in three ways:

1. We give a base payment that’s typically higher than what you would earn in Medicare’s fee-for-service model.

2. We also provide you with a quality bonus payment for exceptional care, regardless of the cost of that care, because we recognize how challenging it is to move the needle with a single patient, let alone your entire panel. That hard work deserves reward.

3. When you’ve been a steward of high-quality, low-cost care, you share in the surplus savings with us.

Operational transformation

ilumed helps you rethink how your organization operates. That could be a small, but meaningful, change, like leaving space open in your schedule for last-minute and urgent needs so that you aren’t pushing patients to unnecessarily seek acute care in urgent care centers, emergency rooms and/or hospitals. It could be a bigger change like adopting a new technology, such as our proprietary BrainStream platform, that gives you 360-degree views into your patients’ Medicare claims data and provides patient risk-scoring so you can preemptively target the patients with the highest health needs before an acute situation arises.

We also act as an extension of your staff. Our outreach team provides concierge services to patients, booking transportation services for them to and from your facility so they don’t risk missing appointments and scheduling appointments on patients’ behalf.

Radically improving care delivery

At ilumed, we pride ourselves on caring for providers and patients with equal amounts of compassion. We truly wrap our arms around to ensure both have what they need when they need it.

Our case and disease managers help patients stay on track with their treatment plans between visits, whether that’s taking medications as prescribed or making lifestyle adjustments. That alleviates the burden on your staff from having to do so much follow-up and helps them focus their time and attention. Our social workers help patients connect to mental health and community resources, whether that’s finding food banks or senior centers. That gives you and your staff the peace of mind that your patients’ bodies, minds and spirits are being cared for in equal measure.

Our partnerships with organizations like the Pearl Mae Foundation, Mom’s Meals and U.S. Hunger ensure that your patients have reliable access to nutritious food week after week, because food is medicine. This helps your patients feel their best and improves their health—and it helps you by removing a root cause at the heart of too many chronic conditions.

When it comes to value-based care, you don’t have to go it alone or try to reinvent the wheel. When you work with ilumed, we’ve got you and your patients in our arms, and we hold you both tight. It’s time to make the change. At ilumed, we help you do more and be more by giving you more. We have a proven track record of value-based care solutions. Let’s heal healthcare—together. Get in touch.