Accountable Care
High needs patients residing in nursing facilities challenge the healthcare system. More than ever, these patients and the facilities who care for them need comprehensive Provider care models that provide high touch 24/7 availability, and a focus on prospective clinical problem solving. Ultra Health Providers (UHP) deliver this model, and can offer our partner facilities participation in a uniquely structured, value-based care model called High Needs ACO REACH.
​
UHP is an active, pioneering participant in the 2024, 2025, and 2026 High Needs ACO REACH. This ACO is unlike others in that it focuses on the highest risk and generally highest acuity patients in our healthcare environment, including residents of nursing facilities.
​
UHP is in a unique position to extend participation in the High Needs ACO REACH to select nursing facility partners and physician partners in the form of a shared savings gainshare. UHP will share with the facility a percentage of the gainshare earned on patients who reside in your facility, at no risk or cost to the facility. This is possible because UHP has taken on financial risk itself as the Provider Group caring for these patients. The downside risk that UHP is exposed to is not extended to the facility or other Providers.
​
UHP proudly practices their model of care in hundreds of facilities across many states in the midwest, midsouth, and southeast.
ACO Frequently Asked Questions
FAQ
What is an ACO?
"ACO" stands for Accountable Care Organization. An ACO enters into a contractual relationship with CMS (specifically, MSSP or CMMI) to execute a value-based care model focused on traditional Medicare beneficiaries. An ACO is responsible for managing quality clinical care and, in so doing, for avoiding unnecessary spending, primarily through higher Practitioner attentiveness to patient medical needs. Providers, including nursing facilities, Medical Directors, and Attending Physicians/Nurse Practitioners continue to bill and receive traditional Medicare reimbursement as usual from CMS. The participating entity responsible for the care of the patients in this ACO, and ultimately responsible for overall healthcare costs on participating beneficiaries, is UHP.
What is a High Needs ACO REACH?
"REACH" stands for Realizing Equity, Access, and Community Health, and is a product of CMS' Centers for Medicare and Medicaid Innovation (CMMI) division. ACO REACH was created to foster equity for historically underserved and vulnerable populations. High Needs ACO REACH is a specific type of ACO REACH that focuses on high acuity/high risk ("high needs") patients - the most vulnerable and often most underserved in America. In this way, and in many others, a High Needs ACO REACH is unlike other ACOs.
How are Shared Savings ("Gainshares") determined and distributed in an ACO and what does that really mean?
Simply put, Gainshares (shared savings) or losses in an ACO are determined by calculating the comparison of Medicare, Parts A & B expenditures for the ACO-aligned patients against a (projected) "benchmark" cost structure set by CMS. Gainshares or losses in High Needs ACO REACH are determined by a complex mathematical calculation that compares a concurrent benchmark with the ACO's individual participating beneficiaries' aggregated risk scores, concurrent risk adjustments that may occur during the year, and quality outcomes. A gainshare or loss is determined by how the pool of participating beneficiaries' actual costs in the performance year compare with the benchmark for that same pool of beneficiaries in the performance year.
How do patients align to and participate in a High Needs ACO REACH?
Patients are either attributed to Practitioners who are registered participants of the High Needs ACO REACH via a plurality of medical claims on those individuals, or they voluntarily align to those Practitioners by completing a simple consent form during the performance year. Patients must also have significant, well-documented chronic and/or acute medical conditions (Risk Score) to qualify for this particular High Needs ACO REACH. There is nothing else required of patients, facilities, or Medical Directors and Attendings.