At this year’s Fall NAACOs Conference, plenty of attention was on the upcoming launch of the new ACO REACH model. The Centers for Medicare and Medicaid Services (CMS) selected 47% of applicants (110 organizations) to participate in the model. Another 99 groups currently participating in the Global and Professional Direct Contracting model (GPDC) will also automatically move over to ACO REACH.
As these 209 prospective REACH ACOs prepare for the first performance year, one thing is clear: success in the new model will require a lot of preparation and planning. Organizations embarking on the journey still have a lot of questions about how to approach innovative payment models, health equity benchmarks, and reporting.
Cedar Gate’s Chief Commercial Officer David Morris sat down with three industry experts preparing for ACO REACH to answer pressing questions during a breakfast panel session. All three panelists have extensive experience starting and running successful ACOs, and their attention is now shifting to how to translate those past successes into the new model.
Panelists included:
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Megan Mulligan, AVP of Government Programs at NeueHealth, the provider enablement arm of Bright Health Group. Megan has successfully run and managed two entities transitioning from direct contracting entities (DCEs) to ACO REACH. NeueHealth is adding a third entity that will expand its current geographic reach in six U.S. states. | |
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Khue Nguyen, SVP at CVS Health, which is running a DCE in several U.S. states and will transition to ACO REACH in seven of those states. CVS Health has always had a focus on population health, and the ACO REACH model is a new opportunity to partner with providers to continue with that mission and achieve their strategic goals. | |
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Andrea Osborne, SVP at VillageMD, which operates six DCEs that will all roll into ACO REACH with total care capitation payment models. They provide care to about 1.6 million patients through their extensive provider network. In addition to ACO REACH, they also have full value-based contracts for Medicare Advantage and commercial plans. | |
During the breakfast event, panelists discussed wide-ranging topics, including their reasons for entering into DCE models in the first place, and what they were looking forward to in the new ACO REACH model. They also dug into some of the inherent challenges for providers and healthcare facilities interested in moving from a fee-for-service world to a value-based model with so much focus on capitation (including partial capitation and total care capitation pathways). The conversation focused on four key areas:
To succeed, organizations need to plan ahead and anticipate some of the ways capitation will change cash flow and payment timing. They also need a dedicated team to review the weekly claims data that comes from CMS and meet the requirements for enhanced data collection, analysis, and reporting in this new model. Organizations must also have the necessary software tools and skills to translate data into actionable and proactive plans to meet cost and quality goals.
See the entire discussion on the NAACOs website (access to this video requires a NAACOs member or conference attendee login). If you didn’t attend NAACOs or can’t access the recording, check out our video series on the Cedar Gate ACO REACH Composable Tech Stack. We offer comprehensive software solutions that were purpose-built to help organizations like yours achieve ACO REACH goals.
