As a relative ACO newcomer, the ACO REACH (Realizing, Equity, Access, and Community Health) Program is proving itself worthy through year-over-year growing numbers of participants. The Program currently has 184 participants and 47 preferred providers. Among the program’s satisfied members is the Southfield, Mich.-based Renovis Health, which was co-founded by current CEO, Reginald Euburuche, M.D., who looks to continue serving the healthcare needs of elderly and home-bound Medicare communities in the Detroit area by way of the benefits that the ACO REACH Program offers. To further enhance the ACO REACH program benefits for patients, Dr. Euburuche and his colleagues recently reached out to the professionals at Innovaccer as their choice for a solutions partner that could help them manage their analytics and improve their analytics capability.
Following in the previous footsteps of the GPDC (Global and Professional Direct Contracting) model, the ACO REACH Program differs from its predecessor with “increased provider governance, a stronger focus on health equity, and improvements to risk adjustment,” according to program descriptions. Euburuche recently spoke with Healthcare Innovation, and shared his experience with the REACH Program, and why Renovis Health opted to join. Below are excerpts from that interview.
Why did Renovis Health choose to participate in the ACO REACH Program?
The ACO REACH’s programmatic vision and goals of improved quality of care, one that embraces Health Equity for all populations, is closely aligned with Renovis’ vision to empower all persons with health and the freedom to stay healthy and age in place. Renovis’ care model places great emphasis on enabling quality driven medicine to underserved and disenfranchised communities and elderly populations. This population has always been dear to me and is the reason I dedicated my practice, and now Renovis, to caring for older adults, helping them navigate the currently uncoordinated and corporate-driven system of medical care.
To that end, our strategy keeps physicians at the helm of patient care, as physicians know best the needs of those they serve. At Renovis, we are physician-led, and continue to cultivate a provider network that is physician-driven, and that is inspired and committed to serving the same communities identified through the health equity goals of the ACO REACH Program. We represent and live the ACO REACH governing body standard; having individuals from our provider network—including a beneficiary representative and a consumer advocate—actively represent our patient population and the geographies we serve.
What are the goals of the ACO REACH Program?
The ACO REACH Program was redesigned to advance care quality and health equity. Renovis’ goals are aligned with these goals. We are committed to working with our provider network in underserved areas, enabling proactive, coordinated, and accessible quality care that can positively impact the quality of life for our aligned population and patients. Our tailored care management, home- or nursing-friendly care settings, and population health analytics also support the ACO REACH Program by reducing cost waste, and allowing for customized care interventions that mitigate or prevent the onset or worsening of medical conditions before they can escalate into further complications.
How hard do you think it will be to achieve these goals?
We believe our experienced management team and the implementation of our robust care management program, along with our investment in population health analytics and reporting technology support programmatic goals. Additionally, our physician-led approach and persistent engagement with our provider network, along with the guidance lent by our engaged governing body, allows us to be nimble and responsive to patient needs and the goals of the ACO REACH Program.
What might be some reasons that organizations/hospitals/physician groups choose the REACH Program over the Medicare Shared Savings Program (MSSP)?
Renovis believes that ACO REACH organizations and providers choose ACO REACH participation for various reasons, some unknown to us. Some of the reasons made known to us include selection of an ACO REACH Program due to its flexible reimbursement structure, one that expands the shared savings opportunity (as compared to legacy programs) in direct relation to an entity meeting established performance standards. Another popular aspect of the program is the streamlined quality measures, i.e., the smaller number of targeted health measures; this supports focus on measures that have greater impact and health improvements.
We chose ACO REACH for several reasons: First, the program is committed to health equity – Most of Renovis’ geography and experience includes serving persons identified by the area deprivation indices. Second, the ACO REACH Program supported our current physician-led vision and structure. With the creation of the ACO REACH Program, entities were required to have at least 75 percent of the organization’s governing body be composed of providers. Renovis’ structure is physician-led from the onset; ACO REACH’s goals are nicely aligned with our current structure and no further action was necessary on our part to align.
Another program aspect that was important to us is the availability of ACO REACH waivers and patient support services aimed at increasing timely engagements with our beneficiaries, including, the direct dialogue and collaboration with CMMI (Center for Medicare and Medicaid Innovation) leadership on process efficiency gains or future administrative changes that can improve the ACO REACH Program.
Additionally, ACO REACH participation qualifies as an Advanced Alternative Payment Model (AAPM). This facilitates provider qualification under MACRA (Medicare Access and Chip Reauthorization Act of 2015), allowing for a 3.5 percent lift in provider compensation (relative to FFS [Fee-for-Service]). Participation in an AAPM eliminates the burden of individual or group practice level MIPS (Merit-based Incentive Payment System) reporting requirements as the same is accomplished by the ACO REACH entity. And it mitigates provider exposure to the 9 percent MIPS performance penalty for lack of reporting. This is a great boon for smaller practices that may not have the volume needed to take advantage of the interoperability of larger groups.
Last, leveraging the use of G-Codes that are specific to the ACO REACH is another reason. G-Codes enable post-discharge, face-to-face visits and Case Management interventions that are much more robust than standard Transitional Care Management services and codes.
Was Renovis Health participating in any other programs prior to joining the REACH Program, and if so, what were they?
Yes, Renovis participated in the Global and Professional Direct Contracting (GPDC) Model, which was the grandfather of the ACO REACH Program.
Looking to the future, where do you see the ACO REACH Program in five years, and where do you see Renovis in five years? What do you believe Renovis’ role will be at that time?
The CMS Innovation Center has been experimenting with various demonstrations and innovation programs over the last 10 years in order to curtail unnecessary spending, improve the patient experience, and improve the quality care/health outcomes of the Medicare beneficiary population. These are long-term and necessary goals that are here to stay and that will likely see improvements resulting from lessons learned and successful innovations applied to current programs. What we foresee is the expanded use by CMS for pre-payment or capitation tools that serve as an alternative way of paying healthcare providers in a manner that holds them accountable for outcomes and costs.
By the end of the initial ACO REACH Program's five-year term, the program will reach full capitation. This underscores CMS’ commitment to programs, such as the ACO REACH Program, that provide stable, upfront payments to healthcare providers that allow them to focus on their patients’ care needs, and holds them accountable for the value of the care rendered and resulting outcomes. Renovis is fully prepared for this transition and welcomes full capitation with risk and shared savings.
In five years, Renovis expects the organization’s success in ACO REACH will position us as a leader in the healthcare landscape. We expect to still be involved with CMS, the Medicare FFS population and the ACO REACH Program (or any predecessor program), but our organization will look different in that our reach will be broader. As our organization matures, and as we fine-tune our approach/offerings, we expect not only our current provider network to grow, but also expect that the markets and patients we serve will expand. Our five-year plan provides an expansion that includes: additional markets, larger provider-led network, Renovis Cares (a practice management arm) Renovis Choice (a care management firm), and a Clinically Integrated Network. All the related entities will support each other and serve as a common thread of collaboration, care model, and vision.
The industry is hungry for a solution to the current confusing, disparate, and costly system of care that is currently part of the aging experience. However, our first years in this program have demonstrated, beyond a doubt, that we can make a difference, and that we are prepared to care for this population. It can only get better from here as we continue to evolve, continue to learn from our providers, patients, and CMS, and continue the path and commitment that we have carved out for ourselves and the Medicare population.