CVS, inVio creating South Carolina ACO through REACH
The organizations said the collaboration will strengthen care coordination for patients.
Photo: Mario Tama/Getty Images
CVS Accountable Care Organization, a division of CVS Health, and inVio Health Network, a collection of more than 5,600 South Carolina providers, are collaborating to create a new accountable care organization through the ACO REACH program.
ACO REACH focuses on reducing barriers to care by providing coordinated, patient-centered care to improve the overall health, clinical outcomes and satisfaction of patients with traditional Medicare.
The organizations said the collaboration will strengthen care coordination for patients, using advanced analytics, as well as value-based care and population health-management services and programs.
WHAT'S THE IMPACT?
inVio Health Network was formed when Prisma Health Upstate and Prisma Health Midlands Networks, which operated as two separate but aligned organizations, came together in 2021.
The agreement with CVS builds on their successes in the Medicare Shared Savings Program (MSSP). Since 2015, they successfully managed Medicare patients through MSSP, reducing costs by over $81 million, while earning top-decile quality for more than 60,000 Medicare patients.
Dr. Bill Gerard, CEO of inVio Health Network, said the new model allows for enhanced resources and clinical services across the network, where inVio will collaborate with CVS' Minute Clinic locations across South Carolina.
"We are on a collaborative value-based journey with our physicians and healthcare clinicians to improve the quality and health across South Carolina, regionally, and nationally," said Gerard.
THE LARGER TREND
ACO REACH replaced the Global and Professional Direct Contracting Model.
The Global and Professional Direct Contracting Model was controversial because opponents, including progressive Democrats, believed it would lead to the privatization of Medicare.
Physicians for a National Health Program, an organization of 25,000 doctors who supported Medicare for All and opposed Medicare privatization, rejected the ACO REACH model as well.
In August 223, CMS announced changes to ACO REACH for 2024 that it said were a response to stakeholder feedback. The changes were designed to increase predictability for model participants, protect against inappropriate risk score growth, maintain consistency across CMS programs and CMMI models, and further advance health equity, CMS said.
ACO Reach came under scrutiny in 2022, when an estimated 20 lawmakers reached out to CMS over alleged fraud. Lawmakers expressed concern that at least 10 participants in the earlier model had records of healthcare fraud.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
