Why and how ACO REACH can transform primary care.

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.

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

Providers know all too well that the healthcare system in its current form is broken. Burnout and consolidations, along with an aging population with increasing needs, are driving a mass healthcare-worker exodus. And one study predicts that a whopping 75% of healthcare workers will leave the industry by 2025. It’s time to heal healthcare from the inside out. Let’s start by focusing on the people who keep the system running: primary care providers (PCPs).

In today’s healthcare system, PCPs are too often overworked, underpaid and underappreciated. Yet they remain the lynchpin to healing healthcare as the delivery vehicle for preventive, proactive care. The ACO REACH model sets PCPs up for success. Here’s how.

How ACO REACH delivers care that makes a difference

With the ACO REACH model, PCPs are enabled to deliver patient care the way they originally wanted. They have the time and support to help improve patient outcomes rather than simply react to their health conditions. With ilumed, our participating PCPs see their patients not just for their Annual Wellness Visit but are encouraged to have four or more visits a year (once per quarter), where they can check in more frequently and make treatment-plan adjustments as needed. This increased frequency of care is especially critical for chronic and complex conditions, which require more oversight. Also, our proprietary, cloud-based, BrainStream platform helps PCPs pinpoint at-risk patients and take a population-health approach to their patient panels. Further, our full-time patient advocates, ensure health equity remains top of mind for both ilumed and our practitioners.

How ACO REACH removes patient barriers to care

ACO REACH helps to remove social determinants of health (SDoH) barriers for patients aligned to the model. Where ACO REACH models have cost-share support arrangements in place, beneficiaries can visit their PCP regularly without the financial strain of meeting costs like copays for primary care visits. With access to concierge transportation services, patients might receive no-cost rides to healthcare provider appointments. In addition, where patients experience challenges in affording prescriptions, food or housing insecurity, ilumed’s licensed clinical social workers and nurse case managers help pinpoint and break down barriers.

Here’s an example of ilumed’s successful interventions. One of our social workers discovered that a patient was not taking her insulin because she couldn’t afford it. She connected the patient to a non-profit diabetes foundation and secured a 90-day supply of insulin. Her PCP had no idea she had a financial barrier. With ilumed’s support, PCPs across the nation optimize the delivery of care by filling in the blanks the traditional Medicare space leaves open.

Why giving PCPs predictable, sustainable income with ACO REACH changes primary care for the better

The traditional fee-for-service (FFS) model is reactive rather than proactive. Patients frequently wait until they get sick to see the doctor, and physicians react when patients come in to address their illnesses. It’s a sick-care system, not a healthcare system, that creates a hamster wheel for providers and patients alike, making it more costly and difficult to proactively treat disease. FFS also lends itself to unpredictable cash flow and the fragmentation of coordinated-care delivery to patients.

By shifting from sick care to healthcare and helping patients stay healthy in the first place, the ACO REACH model not only incentivizes PCPs to focus on quality over quantity but also helps them sustain their practices with a predictable monthly income stream. Improved cash flow can facilitate investment in enhanced technology, systems or additional staff. This is why we believe ACO REACH is the best alternative-payment model in Medicare.

How ilumed provides PCPs with boots-on-the-ground support

As healthcare providers continue to consolidate, supporting independent physicians is critical. We worked with a physician who began his own independent practice with 500 existing patients but learned that, because his practice was new, the Centers for Medicare & Medicaid Services was not able to align any patients to him using historical claims data. We engaged with his practice on-site and, within five days, helped him voluntarily align more than 300 patients. This successful effort helped generate a predictable revenue stream to support his practice’s growth.

What to know before joining the ACO REACH model

PCPs can only be aligned to one shared savings model with CMS. It’s very important to know which one you’re in before attempting to switch models. Decisions to join a shared savings model should not be taken lightly. Thought should be given to your financial, data reporting and clinical-support needs and what the ACO model offers. Do your due diligence, ask questions and be sure to find a partner that can help you grow and succeed with the business side of your practice and your patients’ healthcare journeys.

ACO REACH isn’t for every PCP, but for those practitioners who want to put health and care back into healthcare, leverage technology and engage in a team-based approach with their patients, the model is very attractive. Learn more about the ACO REACH model from our CEO, Debbie Finnel, here.

Why PCPs should choose ilumed as their ACO REACH partner.

At ilumed, the team has decades of combined experience managing the total global cost of care for Medicare beneficiaries. With our combined operational and clinical management experience, PCPs are empowered to be the best they can be. By partnering with ilumed, physicians can achieve what they went to school for: helping people improve their health.

When you work with ilumed, you’ll be joining our network of PCPs serving more than 55,000 beneficiaries and transforming healthcare for the better. You’ll be part of an organization dedicated to PCP and patient success with industry-leading clinical and operational experience. We know that when our providers are well cared for, their patients are too. Let’s heal healthcare—together. Connect with us.

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