With Equality Health Direct, you’ll get all the benefits of the REACH model, plus the value-based care tools, technology and people support from Equality Health.
Equality Health Direct™ is an Accountable Care Organization (ACO) with physician-governed leadership and a collaboration of like-minded professionals supporting improved care for Medicare beneficiaries through an innovative CMS program.
An innovative CMS initiative, the Realizing Equity, Access, and Community Health (ACO REACH) model aims to support the shift from fee-for-service to value-based care, and to engage with Medicare beneficiaries in coordinating care while reducing the provider burden to meet healthcare needs effectively.
Equality Health Direct is uniquely positioned to support healthcare professionals to achieve the goals of the model. Through Equality Health’s Clinical Care Model, providers are supported in improving patient outcomes and lowering costs through population health interventions built around the most common opportunities for improvement.
This support includes in-office practice performance support:
Check out some of these most common questions from providers. If you’d like to learn more, contact us.
Healthcare organizations that applied with the CMS Innovation Center and were accepted are participating in the model are eligible. Primary care providers can participate by choosing to contract with Equality Health Direct. Primary care professionals are important participants in the model because they coordinate ongoing care and preventative services for Medicare beneficiaries.
Specialists and ancillary services may also participate in the model by contracting with Equality Health Direct. Medicare beneficiaries under the care of primary care providers who are contracted with Equality Health Direct are aligned to the ACO. Medicare beneficiaries have their same coverage, benefits, and choices plus they will benefit from their provider’s collaboration with other providers in the model.
Primary Care Providers have a unique opportunity to increase total Medicare compensation through:
Specialists and ancillary services have an opportunity to have deeper collaboration with high-quality primary care providers and improve care for Medicare beneficiaries.
Additional benefits for healthcare professionals include:
The opportunity to leverage Equality Health’s proven value-based care capabilities to drive shared success including:
CMS attributes Medicare beneficiaries based on historical claims. Not all established Medicare beneficiaries in your practice may be in the program because CMS uses historical claims. For example, newly aged in beneficiaries may not be included in the program until future years.
Beneficiaries may also align to their provider through a voluntary alignment process that would also include them in this program. Voluntary alignment is a process designed by CMS to support patients in communicating their desire to be aligned with a primary care provider for their care. Medicare beneficiaries are aligned in two ways:
A Medicare beneficiary actively selects a “Primary Clinician” on MyMedicare.gov or completes a paper form developed by CMS (the “Confirmation of Main Doctor Form”). This form is available online at Medicare.gov.
A Medicare beneficiary will be attributed to the ACO through claims-based alignment. Beneficiaries are aligned based on where the beneficiary has historically received their primary care services, based on billing activities.
Unlike patients who enroll in a Medicare Advantage plan, Medicare beneficiaries aligned in the payment model options under the ACO REACH model remain in traditional Medicare (fee-for-service (FFS)). Their healthcare coverage will not change, and they retain the freedom to seek care from their Medicare FFS provider or supplier of choice whereas MA plans often require patients to use a specific network of providers.
However, ACOs like Equality Health Direct are similar to MA plans in that they are risk-bearing entities coordinating the care of a specific panel of patients. It is important to note that Equality Health Direct does not pass the risk from this model on to participating providers.
For More Information
If you are a primary care provider, specialist or ancillary services provider who wishes to learn more about joining Equality Health Direct, please email us at equalityaco@equalityhealth.com or call 1-888-696-1122.
If you wish to know more about CMS’ ACO REACH model, go to https://innovation.cms.gov/innovation-models/aco-reach.