The world of value-based care (VBC) is placing an increased focus on health equity goals.
Accountable care organizations (ACOs) need to focus on core strategies that are both aligned with these goals and applicable across various VBC models.
During a May Becker's Hospital Review webinar sponsored by Bamboo Health, Chris Skowronek, Vice President of Payer Strategy at Bamboo Health, shared insights about a new ACO model announced by the federal government with built-in mechanisms to facilitate health equity goals.
The three key takeaways were:
1. The ACO REACH model puts a strong focus on health equity. In response to growing calls to address health disparities, the Biden administration's focus on health equity, and feedback from the ACO and payer community, CMS and the Centers for Medicare and Medicaid Innovation (CMMI) recently announced the overhaul of the ACO Global Provider Direct Contracting model, revamping it into the ACO Realizing Equity, Access and Community Health (REACH) model.
Highlights of the ACO REACH model include modifying the equity benchmark by increasing payments for beneficiaries (patients) in the top decile while decreasing them for those in the bottom 50 percent, requiring ACOs to have a health equity plan and a data collection system that enables monitoring and incentivizes provider outreach to underserved communities. "To date, [ACO REACH] will be the first real push to incentivize value-based care entities to take those populations on," Skowronek said.
2. Top considerations are maximizing revenues and shared savings. As the ACO REACH model is expected to attract a high volume of applicants across the model’s standard, new-entrant, and high-needs population participant types, it is vital for organizations interested in participating to differentiate themselves. Two key levers organizations should focus on to differentiate themselves and ensure success across VBC models are maximizing revenue and maximizing shared savings, Skowronek said. Details include:
- Strategies for maximizing revenue include beneficiary engagement tactics that support retention and via care management processes that support maximizing quality scores
- Strategies for maximizing shared savings should incorporate care management processes that minimize avoidable utilization, and beneficiary engagement tactics that support proactive, preventive care.
3. Interoperability frameworks need a reality check. Healthcare has made great strides toward foundational interoperability in terms of defining data quality, data requirements, exchange protocols, and security and compliance standards— and their respective normalization and orchestration processes. But for all the advances made, interoperability remains a set of technical and operational constructs that have created little actionable value for end users. "The goal of interoperability is to improve care for the patient and make the life of a provider easier and more efficient," Skowronek said.
To convert foundational interoperability ("where users hear all the noise") into actionable interoperability ("where users realize all the value") with an eye toward health equity, organizations need to enrich their interoperability frameworks to facilitate the delivery of specific patient- and care-related data to the right clinician or care manager at the right time. Other necessary advancements include building in activity triggers that can initiate standards of care, and automation mechanisms wherever the mere process of data exchange can drive task completion without human intervention. Only when such improvements are made will interoperable data serve its ultimate purpose: to help patients, providers, and care managers easily navigate the complex care transition points that most impact healthcare outcomes.
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