Kim Williams - How ACO REACH Transforms Quality and Equity

In this episode we hear from Kim Williams, Senior Manager of Government Programs at CHESS Health Solutions about the value of ACO REACH. She shares her expertise on what it is, why it was created, and how it benefits the patient and provider by being a care collaboration model that improves quality while incentivizing health equity.

Kim Williams, welcome to the Move to Value podcast.

Kim Williams

Yeah. Thank you so much for having me.

It's really a pleasure to be here.

Thomas Royal

So Kim, today I want to explore some of your knowledge that you have and your expertise.

So let's talk about ACO reach first.

Can you explain what ACO reach stands for and how it differs from the other ACO models?

Kim Williams

Sure, I'm happy to.

ACO REACH stands for realizing equity access and community health.

And really, the differentiator of this model is in the name itself.

It's looking at HealthEquity and getting patients access to care in a timely fashion, but it's also looking at social needs and also working with community health providers to have a more coordinated approach in the patient's care journey. And so a lot of the programs requirements that we see

are centered around those core principles.

And this is a huge shift away from your traditional fee for service model, where everything is based on quantity of services to now looking at value.

Now we are looking at not just at the bigger picture. We're looking at the entire picture.

We're looking under the rugs and we're addressing root causes in this ACO reach model, also part of what makes this model unique is in the innovative payment structure and that is what I call a capitation-like model.

So this means that CMS will give us a prospective payment upfront and providers have the flexibility to structure that payment however they want to do that in a multitude of different ways.

So one option is that a provider can elect to do a fee-for-service pass through where you are paid 100% of what you Bill to Medicare. Or you can elect to get 90% of what Medicare pays you.

With an option to earn back bonus payments.

Or if you don't want any of those options, you can also say, hey, just pay me a per member per month payment upfront.

So that's called pmpm.

Pay me that amount monthly or however they want to structure that arrangement with the ACO.

So there's a multitude of different ways that you can go about this, and really the idea is that if the provider knows how much they're receiving up front to care for their beneficiaries, then they will be motivated to stay under that threshold and that benchmark.

And that's really where the shared savings comes in.

So I think the ability to select these payment options based on what you're comfortable with is not something you typically would see in other models outside of ACO reach.

Thomas Royal

Oh, that does sound pretty unique.

Kim Williams

Yeah.

Thomas Royal

So he touched on this a little bit, but I'd like to dig a little bit deeper and and if you could tell me what are the core goals of ACO reach and how does it align with the broader shift towards value based care and how does this model prioritize Health Equity and patient centered care in its design?

Kim Williams

Yeah. So, earlier you heard me mention that the goals of this model are centered around Health Equity access and community health.

And so I want to camp on certain components of those levers.

So I want to expand on why that matters and talk about the Health Equity for example. So as we're moving away from again the traditional fee for service and moving towards value based care, you see more and more payers prioritizing patient, HealthEquity and social determinants of...