With the push towards health equity and away from a fee-for-service model of healthcare, risk-bearing organizations have an opportunity to join the ACO REACH (Realizing Equity, Access, and Community Health) program. In the program, Centers for Medicare & Medicaid Services (CMS) encourages ACO REACH participants to work with underserved communities. Further, the program guidelines mandate the identification and mitigation of health equity barriers as well as corresponding reporting on the actions taken to address them.
Making progress effectively towards improved patient health outcomes matters as penalties will ensue in 2024 for ACO REACH participants whose efforts only look good on paper and do not deliver in practice.
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In 2022, the ACO REACH program saw a decline in participation, with 99 groups taking part compared to the previous year’s 132. Despite the program having a New Entrant participation option, specifically designed for organizations participating for the first time, some risk-bearing organizations initially did not succeed in the program in terms of ROI.
Challenges facing risk-bearing organizations
The ACO REACH program presents significant hurdles. For one, groups new to the program may struggle with managing unfamiliar patient populations and providers, often with limited prior knowledge. In practice, they must rapidly and accurately assess the risk of their patients for known and suspected medical conditions, all while adhering to the CMS guidelines.
Given the difficulties of doing so, not all participating organizations see improved ROI. In 2022, 76% of groups realized savings, while 24% incurred losses.
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Further, the Dunning-Kruger Effect may negatively impact groups’ successes as new entrants to ACO REACH. In particular, risk-bearing organizations that have previous substantial experience in the healthcare sector may have an overconfidence that they can also succeed in the ACO REACH program.
Focus on health equity
Those participants who perform better in the ACO REACH program have something in common: a focus on health equity. Some groups may treat health equity as a bureaucratic checkbox initiative, yet those who invest in this area can see it pay out in ROI.
To succeed, groups need to accurately identify the social determinants of health (SDoH) barriers affecting their patient population and determine which of these barriers could be addressed effectively. In practice, this might look like getting medically-tailored meals to patients living in food swamps – areas with limited access to nutritious food yet a plethora of fast food options. Prioritizing medically-tailored meals for these vulnerable patient populations can help people stay healthier, potentially reducing emergency room visits and reliance on other costly and inefficient healthcare services. Such endeavors to identify and address SDoH can lead to improved health outcomes and savings for the risk-bearing organization, too.
Technology to flag SDoH
Given the potential financial benefits and improved patient health outcomes, risk-bearing organizations are motivated to flag and address the SDoH barriers for each patient. However, with already overburdened physicians and unprecedented burnout rates – not to mention the administrative burden of doing the health risk assessment – having the time and resources to identify SDoH risk factors for each patient cannot fall on providers alone. Here’s where effective technology can help.
In particular, some technology can accurately note specific SDoH risk factors facing a given patient and offer targeted intervention recommendations based on that patient’s unique SDoH risk factors. However, for such tools to work, they need to leverage up-to-date data and hone in on risk factors for a given patient. To function in practice, providers should source technology that can zoom within a zip code, more specific than a neighborhood, so the recommended interventions apply to a particular person, rather than a one-size-fits-none model. The providers can measure the efficacy of the tool by the numbers they see in improved patient health outcomes as well as improved ROI for their organization.
Succeeding in ACO REACH
Given the complex patient populations risk-bearing organizations serve, ACO REACH participants – especially new entrants – can benefit from leveraging supportive tools to help address SDoH risk factors for their patients. Doing so well can improve both patient health outcomes as well as ROI: both key mile markers on the road to health equity.
Ultimately, the ACO REACH program represents a remarkable opportunity for healthcare organizations to begin to advance health equity and enhance patient outcomes, provided they navigate its challenges with a keen focus on SDoH risk factors and leverage the potential of technology to drive positive change for themselves and the patients they serve.
Photo: mikkelwilliam, Getty Images
With over 10 years of healthcare technology experience, and having led sales strategies for top-tiered companies including Athenahealth, DataRobot, and ClosedLoop.ai to name a few, Mike Ward's long history of driving successful healthcare tech has made significant strides in bringing innovative healthcare solutions to market. Ward’s experience in the healthcare industry including hospitals, payers, independent medical providers, and biotechnology, paired with his knowledge of sales, Software as a Service (SaaS), Data Analytics, Customer Experience, and Business Development, make him a key player for the Spatially Health team. Ward holds a Master of Science - MS in Healthcare Management from The Johns Hopkins University - Carey Business School.
