Timothy Peck, MD

Late last month CMS announced the establishment of the next generation of the Direct Contracting Entity program, known as ACO REACH (Realizing Equity, Access, and Community Health). This is among the most important developments in nursing home patient care in recent history. 


ACO REACH is the rare type of program that both sides of the aisle have been able to get behind; it combines the embrace of innovation and technology solutions (i.e. telemedicine, remote patient monitoring, etc.) that Medicare Advantage plans have been able to incorporate, with the expansion of access to those who otherwise would not have it.  

The structure of this program can be transformative for skilled nursing facilities that embrace this opportunity, for the ACO REACH provider groups they partner with, and for the patients they care for. 

I’ve worked as a provider in both hospitals and SNFs. I’m a serial healthtech entrepreneur, and designer of healthtech products and services. I have felt both the restrictions that fee-for-service (i.e. episodic care and delivering volume of services over quality) puts on providers, and I’ve felt the empowerment of value-based care (i.e. prioritizing the right thing to do for the patient, rather than just doing services for services’ sake). ACO REACH encourages and incentivizes team-based care between facilities and providers, and this is a very good thing for all capable and caring actors in the healthcare ecosystem, and most importantly the patients they care for. 

The patient and provider experience is vastly improved when providers and healthcare facilities take financial risk for the quality of the healthcare they deliver. This is particularly true for nursing home patients. Taking risk removes the incentives that lead to episodic care, and our most vulnerable patients are those most in need of longitudinal care (i.e. considering the whole of the patient experience) not simply individual patient encounters. 

ACO REACH aligns the incentives of 1. Medicare, 2. physician provider groups and 3. institutions (e.g. Skilled Nursing Facilities, healthcare systems, etc.) to work toward bringing the most value to the individual patient, patient populations and the healthcare system as a whole.

Further, ACO REACH creates an incentive system where both SNFs and providers can benefit by delivering value-based care for the entirety of the resident population in SNFs, whereas traditional MA plans only oversee a fraction of SNF census, and often under incentivize SNFs to focus on value-based care.

Many traditional models of value-based care (Medicare Advantage included) incentivize multiple parties to do right by the patient, but also incentivize those organizations to take risk on “the right patients.” The healthier and wealthier the patient, the less risky, the less costly. These patients tend to be easier to reach with technology, easier to communicate with in English, they have higher health literacy rates, and/or have less negative social determinants of health restricting their access to care. 

This incentivizes risk-bearing entities to get the “right patients” in their program, and limits access to underserved patients. It also means that nursing home patients, and the SNFs that care for them, are often cut out of the opportunity for value-based care because they aren’t the “right” beneficiaries.

Indeed there’s a school of thought that Medicare Advantage has better outcomes than original Medicare because those enrolled are on average wealthier/more literate/more reachable. There is certainly some truth to that, but Medicare Advantage programs also are empowered to – and have the ability to – adopt new technologies and consider patients holistically, which certainly also contributes to improved outcomes and decreased costs. And the most innovative MA programs show time and again – regardless of their patient population – that applying new technologies to patient care reduces cost and improves outcomes.

SNFs and provider groups that figure out how to leverage technologies and novel programs to reach and treat high-risk patients will separate themselves from the rest of the industry in the years to come. Those entities will attract the interest of the machines that fuel innovation – namely venture capital investment and healthcare system investment, as well as the decisions of where entrepreneurs, builders and designers spend their problem-solving time. 

ACO REACH enables those resources to be purpose-built to serve the most vulnerable among us. And to benefit the SNFs and providers that care for them.

The introduction of ACO REACH is a massive step forward for SNFs and providers, and those that are committed to value and innovation are going to make a tremendous impact for nursing home patients. 

Tim Peck, MD, is a serial entrepreneur and the Executive Board Chair of Curve Health, a technology company that enables SNFs to provide remote physician access to their residents. Peck also serves as the Executive Portfolio Director of Health at IDEO – a global design and innovation company – where he devotes his time to improving patient and provider experiences through human-centered design.

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.