THE CLIENT
Multiple healthcare provider organizations.
BACKGROUND
In early 2022 HMA and Wakely Consulting Group, an HMA Company, assisted multiple clients with their applications to participate in the new Centers for Medicare and Medicaid Services (CMS) Medicare Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model program. The purpose of this model is to improve quality of care for Medicare beneficiaries through better care coordination and increased engagement between providers and patients including those who are underserved. ACOs and participating providers are held responsible for patients’ total cost of care and must meet certain quality metrics. In return, they have more flexible payment arrangements, can achieve shared savings, and can provide additional services such as telehealth, home-based care, and more options for post-acute care.
APPROACH
The HMA and Wakely team tailored their approach based on each client’s needs. Support included helping clients determine whether to apply; the most appropriate levels of risk and capitation to take on; clinical design, governance structure, and provider recruitment; and how to approach the model’s health equity requirements. The team also provided estimates of the total number of aligned beneficiaries based on client participant provider lists along with financial projections of performance in the program. Finally, the team drafted responses to application questions and provided some clients with a mock score to help them understand strengths and weaknesses of their application.
RESULTS
The application selection process was highly competitive. Of the 271 applications received, CMS accepted just under 50 percent. Notably, nine out of the 10 organizations HMA and Wakely supported were accepted into the model. Since their acceptances, the team has helped many of those clients prepare for implementation on January 1, 2023.