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Complete Care Academy Collaborative

A major challenge facing small and mid-size housecall programs is financial sustainability. Despite vigorous objections from the American Academy of Home Care Medicine (AAHCM) and other stakeholders, the Medicare Physician Fee Schedule has reduced reimbursement for in-home clinical services by nearly 10 % over the past several years. While revenues are decreasing, rising inflation is increasing practice costs. Regulatory and documentation burdens are further increasing practice overhead. Narrowing margins threaten practice sustainability. When practices cannot thrive, patient access to care suffers.

A New Opportunity for Home Care Clinicians

While many home-based clinicians have been oriented towards traditional fee for service models, Medicare has been increasingly steering providers towards value-based models of care. Unless home care providers adapt to these models of care, there are few remaining pathways towards practice success.

A new pilot model from the Center for Medicare and Medicaid Innovations (CMMI) has emerged that offers increased performance-based practice revenues for
providers of home-based medical care. The program, known as the High Needs (HN)
ACO REACH, focuses on improving care and access for medically complex and high-cost patients. In a typical home care program, 50% or more of the patients in the practice may qualify for enrollment. To ensure favorable access to this care model for our members, AAHCM has entered into a collaboration with a cutting-edge healthcare organization to offer access to an Academy supported HN ACO REACH program.

The Academy program offers practices of all sizes a pathway into a value-based payment arrangement. Our ACO enables home care providers to share in the benefit
created by reducing medical costs and increasing clinical quality. These are
the savings that we create every day. These are savings that, up until now, have not
been available to those who contribute most to those savings - home care clinicians.

This care model can potentially increase revenues on enrolled Medicare patients by
more than 50%. 

Program Features and Benefits

The program is designed to fit multiple types of housecall practices. The financial arrangement carries minimal downside risk and substantial upside potential. Participants in this model will be able to access the following features and benefits: Monthly case rate payments that cover fee for service visit revenue plus
an advance on shared savings to improve cash flow.

  • Shared, performance-based savings that are better than those available to home care clinicians in most current ACO models.

  • Access to learning tools, practice support and analytics that assist practices in improving performance. 

  • Limited downstream risk compared to other HN ACO REACH models. In the academy model, participating practices are limited to 2.5% downside risk with full upside shared savings.

  • Strong governance that includes providers and AAHCM members, to ensure that practices receive the necessary tools and resources for improving care and outcomes. 

A Time-sensitive Opportunity

There is an enrollment deadline for the 2024 calendar-year. Practice information
must be submitted by early August in order to have the option to participate.

 

Next Steps

If you are interested in exploring this opportunity further, please click here to provide your contact information. When we receive your information,  we will contact you to arrange a meeting to further discuss the program. As an additional benefit to exploring this opportunity, you will receive a complimentary membership in AAHCM for 2023.

 

The statements contained in this document are solely those of the authors and do not
necessarily reflect the views or policies of CMS. The authors assume responsibility
for the accuracy and completeness of the information contained in this document.

 

HN ACO REACH Webinar

June 8, 2023