ACO REACH For Providers
Do You Need JVS Health for Your Practice?
JVS Health is a healthcare organization formed in 2021 by seasoned value-based care leadership. It utilizes proprietary technology and establishes a network of leading providers with the mission of streamlining and modernizing healthcare. JVS Health now supports ACO REACH and is your partner in managing value-based quality standards and optimal clinical outcomes for your traditional CMS Fee For Service (“FFS”) beneficiaries.
FAQs
What is an ACO REACH?
The ACO REACH Model is a new program from the Center for Medicare and Medicaid Services (CMS) intended to move Medicare Fee-For-Service (FFS) patients into value-based arrangements. This program builds on lessons learned from the Accountable Care Organizations (ACOs) Model and Medicare Advantage Plans (MA). ACO REACH enter a value-based contract with CMS. Patients are automatically aligned to the ACO REACH based on Primary Care claims like the ACO model. However, ACO REACH is like Medicare Advantage in that it is a risk-bearing Model managing the care of a panel of patients.
Is your practice a good fit for the ACO REACH model?
While the ACO REACH model represents a significant opportunity, only some practices or organizations are necessarily a good fit for the model. Here are some factors to consider when deciding if the model is suitable for you:
Does Size Matter? The smaller the panel of Medicare FFS patients, the more likely a few catastrophic patients could negatively impact your performance. However, becoming part of ACO REACH insulates you from downside risk while you grow your panel. Understanding your current patient population and payer mix is essential in determining the level of risk-share ideal for your practice when partnering with JVS Health. Medicare FFS patients are allowed and encouraged to voluntarily align to your practice if they choose to continue their provider relationship with your practice. Doing so creates the opportunity and a higher level of patient engagement. JVS will assist you by helping you reach out to these patients and encouraging them to engage with your practice, creating patient loyalty, retention, and panel size growth. As your panel size grows, so does the overall patient panel managed by JVS Health, allowing JVS Health to invest in enhanced patient benefits not historically available to Medicare FFS patients.
Attribution: Do you practice episodic or reactive medicine only? Is it likely that you see patients that may not return? If so, then the ACO REACH model is not suitable for you. A significant pillar of the model is that you are responsible for the patients attributed to your panel. It is highly recommended that you see your Medicare FFS patients at least once quarterly. The model is designed so that if patients seek primary care services outside of your practice, it will result in a loss of attribution. If you cannot actively engage with your patients and manage your patients’ care, it is unlikely you will do well in this model. JVS’s outreach increases your ability to keep your patients engaged with your practice and eliminate “transactional medicine,” thus improving patient outcomes.
Patient Engagement: The physician-patient relationship is one of the most essential facets of the ACO REACH. Do your patients call you before going to the Emergency Room? Do they call you at home? Maintaining a good relationship with your patients ensures that the ball is not dropped during acute events or care transitions. It is crucial that you are the “Quarterback” of each of your patients’ care teams in creating your patient’s medical “home.” At its expense, JVS will conduct the necessary outreach to your patients to address their needs, support them, and keep them engaged with your office so you may provide them with continuous good care and eliminate “transactional medicine.” Having patients keep you “first” in their minds when they seek care helps lower costs over time and increases the opportunity to create gains from improved outcomes for your practice.
Why is the ACO REACH necessary?
With wide recognition of the unsustainability of US healthcare costs, the need to identify significant sources of savings has never been greater. It is no secret that the Medicare Fund (Part A) is already insolvent and is projected to have exhausted all reserves by 2026. With most ACOs unable to create significant savings, CMS has, through its Innovation Center, created new ways to move Medicare FFS patients into value-based models. As almost 2/3rds of all Medicare patients are not enrolled in an MA plan, this initiative represents a massive opportunity for entrepreneurial-minded physicians.
The primary goal of the ACO REACH is to create risk-sharing arrangements in the Medicare FFS landscape. The model is also intended to reduce the healthcare provider’s administrative burden while empowering patients by giving them provider choices. There are a few key components to being successful in this value-based model: improving the quality of outcomes through proactive care, keeping patients in their best health at home, and avoiding crisis care—in other words, the right care at the right time and place.
How is an ACO REACH beneficiary different from a Medicare Advantage Plan beneficiary?
Once a Medicare FFS beneficiary aligns to an ACO REACH PCP, the beneficiary becomes part of the ACO REACH program. The ACO REACH beneficiary’s Medicare benefits will remain the same; they can visit any doctor, hospital, or healthcare professional. Additional benefits to an ACO REACH beneficiary include access to the JVS Health beneficiary care management team, and an ACO REACH beneficiary advocate to assist with care management needs.
Where do I send my claim for ACO REACH beneficiaries?
You still file your claims (and encounters) as you normally file to CMS.
Who sends our office the E.O.B. (or remittance advice) for services provided to an ACO REACH Health beneficiary?
You will still receive an E.O.B. (or remittance advice) from CMS.
Who pays me for services provided to an ACO REACH beneficiary?
Continue to submit your Medicare Fee For Service claims per your existing process.
What if I want to recommend another provider for participation in the JVS Health network?
Please submit your provider nomination to seth@jvshealth.com or contact a JVS Health representative at 646.680.9046.
Why should you want to work with JVS Health?
If you are focused on improving quality and outcomes while reducing costs, growing your Medicare FFS market share, and earning shared surpluses created by improving patient outcomes, then you are already well-positioned for this new and unique opportunity created by Medicare in partnership with JVS Health.
You may have treated Medicare FFS patients under other value-based models, such as a traditional MSSP ACO, but may have faced attribution challenges or realized no shared savings. As an ACO REACH participant, the opportunity to realize Medicare savings is created by appropriately aligning patients via claims, voluntary alignment, and reducing utilization as a result of providing quality care focused on patient engagement and improved outcomes. Partnering with JVS Health may be a pivotal way to grow your Medicare FFS market share while participating in a proven risk-based contract model. JVS Health will work with you to engage and support those Medicare FFS patients who are aligned with you as their PCP. This eliminates patient attribution challenges encountered in ACOs, which often lead to the inability to achieve shared savings when patients are treated at out-of-network locations. With JVS Health as your partner, you can achieve gains from improved outcomes otherwise not seen in value-based payment models primarily driven via claims-based attribution.
JVS Health will also work with you to identify high-performing regional specialty providers and leverage the specialty network to deliver quality care to your Medicare FFS patients. We will work with your specialty providers to maintain engagement and help build relationships that meet the needs of the patient and the primary care providers.
Practices with a high level of Medicare FFS experience and a moderate to large Medicare FFS patient panel will find it beneficial to participate in JVS Health’s payment model which also includes the potential for a quality bonus and gains from cost-savings associated with improved outcomes. The c model provides consistent cash flow to the practice while supporting efforts to focus on patient engagement and personalized care in order to improve performance.
Do ACO REACH beneficiaries have an I.D. Card to identify them as an ACO REACH beneficiary?
No beneficiaries continue to use their Medicare benefit card.
Do I need to get referrals to see an ACO REACH beneficiary?
No referrals are required. ACO REACH beneficiaries are encouraged to follow their PCP’s guidance for care selection
Conclusion
If you identify with these patient care philosophies, are interested in learning more about JVS Health’s model, and would like to participate in this great new opportunity, JVS Health will gladly assist in reviewing the JVS Health partnership options in this value-based model. You can reach us by calling 646.680.9046 or emailing us at vanessa@jvshealth.com. We welcome all inquiries as we create a broad and diverse provider network.
