Renee Kinder

We all know it to be true. Common sense, really. When we as therapists coordinate our care more efficiently across teams and settings our patients excel. 

They feel supported. And in many cases, they are allowed the opportunity for more successful and safe transitions into lesser restrictive environments.

We also know that our skilled care, its impacts and the patients’ ability to maintain functional abilities extends well beyond the time during which direct care provision is provided.

The rehab is never just about therapy alone.

With patient care and rehab, like raising children, it takes a village.

Parents who support each other for school pick-ups and drop-offs; teachers who provide additional support, snacks, or even Valentine’s cards because Mom is traveling (Thanks!); and neighbors who come together for meals or shared play dates. 

None of us could do this alone and, honestly, who would want to!

This theme is noted throughout the Feb. 24, 2022, announcement from the Center for Medicare and Medicaid Innovation (Innovation Center) regarding a release for a Request for Applications (RFA) to solicit a cohort of participants for the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model.

If understanding ACOs is a new conversation for your therapy team, here are some basic facts:

  • Remember that the Affordable Care Act (ACA) created the Medicare Shared Savings Program, CMS’ largest ACO initiative, to provide beneficiaries in Traditional Medicare the opportunity to receive care that meets the full range of their needs.
  • ACOs work to improve chronic disease management, ensure smoother transitions from hospitals to homes, and promote preventive care that keeps patients healthy.

Now on to what is new on the ACO front.

First, some history and background because progress is moving quickly. 

In October 2021, CMS outlined a renewed vision and strategy for how the Innovation Center will drive health system transformation to achieve equitable outcomes through high-quality, affordable, person-centered care for all beneficiaries 

CMS’ ACO models and programs are an important component of achieving this vision.

Second, what is the purpose of REACH?

One, to encourage healthcare providers to coordinate care to improve the care offered to people with Medicare – especially those from underserved communities, a priority of the Biden-Harris Administration.

Two, CMS is also committing to greater transparency by releasing more information on current GPDC model participants and strengthening monitoring to ensure beneficiaries whose providers participate in GPDC and ACO REACH receive high-quality, patient-centered care during 2022 and beyond.

Third, who is responsible for care?

In ACOs, physicians and other healthcare providers join together to take responsibility for the quality of care their patients receive and the total costs of that care. 

These responsibilities encourage providers to coordinate the services across clinicians and care settings. 

Consider this point as an immediate initiative if you need to improve physician and community engagement. 

How is your therapy team engaging with physicians? What quality metrics are you assessing collectively? 

Finally, how does REACH promote its initiatives in THREE KEY areas: 

  1. Advancing Health Equity to Bring the Benefits of Accountable Care to Underserved Communities
  2. Promoting Provider Leadership and Governance
  3. Protecting Beneficiaries and the Model with More Participant Vetting, Monitoring, and Transparency

Advance Health Equity to Bring the Benefits of Accountable Care to Underserved Communities

The ACO REACH Model promotes health equity and focuses on bringing the benefits of accountable care to Medicare beneficiaries in underserved communities.

CMS will use an innovative payment approach to better support care delivery and coordination for patients in underserved communities and will require that all model participants develop and implement a robust health equity plan to identify underserved communities and implement initiatives to measurably reduce health disparities within their beneficiary populations. 

Promote Provider Leadership and Governance

The ACO REACH Model includes policies to ensure doctors and other healthcare providers continue to play a primary role in accountable care. 

At least 75% control of each ACO’s governing body must be held by participating providers or their designated representatives, compared to 25% in the GPDC Model. In addition, the ACO REACH Model goes beyond prior ACO initiatives by requiring at least two beneficiary advocates on the governing board (at least one Medicare beneficiary and at least one consumer advocate), both of whom must hold voting rights.

Protect Beneficiaries and the Model with More Participant Vetting, Monitoring, and Transparency  

CMS will require additional information on applicants’ ownership, leadership and governing board to gain better visibility into experience in healthcare delivery, ownership and financial interests, and affiliations to ensure participants’ interests align with CMS’ vision. 

CMS will employ increased up-front screening of applicants, robust monitoring of participants, and greater transparency into the model’s progress during implementation, even before final evaluation results, and will share more information on the participants and their work to improve care. Last, the ACO REACH Model will include stronger protections against inappropriate coding and risk score growth.

In closing, we know caring for patients takes a village, it takes coordination, engagement and accountability on all parts in addition to appreciating what makes those we serve unique in their care needs.

Therapy teams and providers must appreciate this dynamic for success in the ever-growing ACO environment. 

Want to learn more about REACH and the RFA process? Information and resources can be found here- Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model | CMS

Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty and is an advisor to the American Medical Association’s Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected]

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.