Equality Health will use ACO REACH model to further its mission of addressing the social determinants

Equality Health recently announced their participation in the federal Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) value-based payment model. The program aims to promote health equity and address the social determinants of health for Medicare populations in underserved communities, said Beth Patak, Executive Director of the ACO at Equality Health.

 

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The new program will replace the Global and Professional Direct Contracting (GPDC) value-based payment model on Jan. 1, 2023, which Equality Health has been part of since Jan. 1, 2022. The programs are administered by CMS and its Center for Medicare & Medicaid Innovation (CMMI), 

ACO REACH is an evolution of the GPDC program that places a greater focus on the social determinants of health, Patak said. According to CMS, ACO REACH will “… test 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.”

Patak said the ACO REACH model’s focus on the social determinants of health fits right into Equality Health’s mission to drive down costs while keeping the quality of care high.

“CMS realized very quickly that taking care of the underserved and looking at those social determinants that truly are impacting the overall quality of care needs to be at the forefront … I truly believe that we’re going to be able to serve more Arizona patients because we’ll be able to collaborate with more primary care doctors and additional team members in the clinical realm,” she said.

Patak said this alternative payment approach will use capitation, where providers have access to a consistent revenue as opposed to being paid each time they see a patient. In this model, CMS pays Equality Health the capitation, and the organization pays the providers on a monthly basis. 

She emphasized how this financial model will incentivize providers to engage in preventative care with their patients. 

“[The provider] doesn’t have to wait for the patient to show up for their annual wellness visit or a sick visit three months from now, [the provider] can manage their [patient panel] now because the revenue remains consistent … They can coordinate with other specialists, with our care coordinators, and keep checking on that patient and prevent an unnecessary admission,” she said.

Anabell Castro Thompson, Senior Vice President of Health Equity, says participating in the ACO REACH model is part of a larger effort to create a more culturally competent and accountable health care delivery system centered around whole-person care. She said an approach that focuses on the social determinants of health will in turn allow patients to better manage their complex, chronic conditions.

“[We understand] that 80% of the health equation is the social determinants of health, and 20% of the equation is really excellent medical care … In the absence of being able to meet basic needs, medical care becomes a luxury. We have a lot of very complex medical patients here at Equality Health … If you don’t have refrigeration and you’re a diabetic, you’re not going to be able to refrigerate your insulin. [If you don’t] have stable housing, then you don’t have access to a refrigerator, and you’re not going to be able to manage your diabetes.”

Patak said a value-based payment model like ACO REACH will not only allow providers to assess the social needs of their patients, but make efforts to address them as well.

“If a patient can’t get transportation to the doctor’s office, or if they have to decide if they’re going to buy their next meal versus medication … When they’ve got all these challenges, they’re not going to be taking care of themselves. It’s not just asking the patient what’s going on in their life, it’s actually connecting them to resources,” she said.

Thompson will be speaking on the “Moving from awareness to action on health equity” panel at our 2022 Arizona State of Reform Health Policy Conference on May 26th. Register for the conference here