CVS Accountable Care Organization, a division of CVS Health, is partnering with health systems and primary care physicians, among other providers, for participation in Medicare's ACO Realizing Equity, Access, and Community Health initiative.
Chicago-based Rush University System for Health and Long Island, N.Y.-based Catholic Health are two health systems that recently partnered with CVS ACO, which is connecting with providers across the country to partner in the ACO Reach program to address health disparity, improve outcomes and reduce waste in the healthcare system.
Mohamed Diab, MD, CEO, of CVS ACO, spoke to Becker's about his ACO Reach goals, the benefits CVS offers providers it partners with and the financial incentives required to accelerate the shift to value-based care.
Note: Responses were lightly edited for length and clarity.
Question: What does CVS Health aim to achieve through CMS' ACO Reach program in the coming years?
Dr. Mohamed Diab: Value-based care works for both the physician and the patient. We really see this as the future of healthcare. CMS wants 100 percent of Medicare beneficiaries to be enrolled in value-based care by 2030; that's why we are reaching out to all types of providers across the country to join CVS Health to support providers in this journey. The focus is to address health disparity, improve outcomes and reduce waste in the healthcare system.
Q: What other markets or regions are you looking to expand into?
MD: We are in discussions with various providers across the country, including health systems and primary care providers. We are also reaching out to primary care physicians and providers in rural and underserved areas because we believe these physicians can benefit greatly from the support we provide and help them transition from fee for service to value-based care. CMS' deadline is Aug. 1, so this is our busy season talking to providers and explaining our model.
Q: What are the biggest opportunities for providers partnering with CVS ACO?
MD: The shift from fee for service to value-based care is not easy. It requires significant investment in technology, analytics, care management and population health programs. We bring CVS Health's assets to providers to facilitate that transition. This is tied to CVS' value-oriented enterprise strategy, which is centered on improving convenience of and access to care and supporting providers — especially those in primary care.
We use our community-based facilities in the retail centers we operate to augment what primary care providers offer so they become part of the clinically integrated network of our provider partners. They become an extension for after hours and weekend care, perform annual wellness visits when the physician doesn't have enough space on their schedule or take on patient visits post-discharge from the hospital when there is no availability in the primary care provider's practice. In addition, this modality can help close some of the clinical gaps in care through patient engagement at the MinuteClinic and the retail pharmacy.
We bring significant value-based care analytics to our provider partners as well as actionable opportunities to improve care and reduce unnecessary costs in the EHR. With Epic, we have the ability to communicate with our providers that use Epic or any other interoperable EHR. We make it easy to provide actionable insights to the provider at the point of care, allowing them to focus on patients who are high risk or have multiple chronic conditions. We also surround them with multidisciplinary care teams — including social workers, pharmacists and community health workers — so the primary care physician can practice at the top of their license and we can manage the patients upstream so they don't end up in the ER unnecessarily.
Q: How exactly does the financial incentive work for physicians?
MD: We connect payments to specific clinical transformation activities, such as annual wellness visits or follow up on post-discharge visits. The whole point of value-based care is that you are working on behavioral economics. But there has to be a financial incentive to reward the physician who is moving away from the transactional fee-for-service system into value-based care. In addition to addressing health disparities and improving access to care, providers are incentivized to keep their patients healthy, rather than just being paid when the patient is sick.
Q: How do you aim to improve care coordination through the Rush and Catholic Health partnerships, particularly around social determinants of health?
MD: It starts with collecting the data from these beneficiaries around social determinants of health. Once we collect the data, we use analytics to identify opportunities and work with our provider partners on specific interventions. We are working with Catholic Health on a number of initiatives, including transportation and food security. We use our data to connect with providers as well as community programs that provide support around specific social determinants of health. We see ACO Reach as a great opportunity to show our commitment to addressing health disparities and improving access to the population at large.
Q: What are the biggest challenges you face there?
MD: Practice transformation is not easy. Physicians are used to practicing in a fee-for-service environment, so this is not like flipping a switch. We work very closely with the 4,000 providers we have. We meet with physicians and our provider partners like Rush and Catholic Health to try and make this easy and digestible for them. We outline the top priorities and opportunities we want them to focus on. You have to make it very actionable but also very easy for the physician. We try to communicate with them about the opportunity in a very user-friendly format and do it in the EHR. We provide our population health services on Epic, which allows us bidirectional communication with the physician at the point of care so they don't have to log into a different system. They see it in front of them if they are using Epic or any other EHR. We give them the analytics and have our in-person and virtual multidisciplinary care teams support their patient populations.
Q: CVS Health recently acquired Signify Health, adding more than 10,000 clinicians to its network. How critical will Signify be to success in the ACO arena, particularly when it comes to home-based care?
MD: Signify Health will be extremely valuable, especially in the senior population, many of whom do not have a caregiver at home. Signify has more than 10,000 clinicians across the country and very robust analytics. You can help support these patient populations significantly if you are in the patient's home. The acquisition of Signify and its home care capabilities will be very helpful in this population.