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How rural providers can act big and stay small with accountable care

Rural health organizations face challenges including staffing shortages, rising costs, and a growing Medicare population. A recent report highlighted 136 rural hospital closures from 2010 to 2021 that has exacerbated the problem. Rural residents are also less likely to utilize preventative health services, which adds to the concerns of an already compromised and often isolated patient demographic.

The plight of rural Americans and underserved communities and the providers who serve them has not gone unnoticed. Recently, the Centers for Medicare and Medicaid Services (CMS) has placed a greater emphasis on health equity and improving outcomes for underserved communities. In late 2022, CMS introduced changes to the Physician Fee Schedule that could help rural providers successfully participate in value-based care. Most notably, CMS announced the Advance Investment Payments (AIP) program, which will provide upfront funding that rural-based providers and FQHCs can use to implement the infrastructure, technology, and resources required for success in the Medicare Shared Savings Program.

The AIP is modeled after the ACO Investment Model (AIM). Caravan Health, now part of Signify Health, sponsored more than half of all ACOs that participated in AIM. In total, the rural providers who participated in the program generated $382 million in savings throughout the three-year agreement period. Based on AIM’s previous successes, it stands to reason that with the right partner, rural providers can achieve success in value-based care.

For some rural providers and health systems, ACO participation has been perceived as too risky. Indeed, the transition to value-based care has specific requirements and benchmarks that must be met in order to earn shared savings. However, these transitions and benchmarks are not intended to preclude providers but rather support them in making greater impacts with their patients. By implementing and optimizing population health methodologies, rural providers learn how to use team-based approaches to annual wellness visits and chronic care management that can bring in new and sustainable revenue streams while improving quality of care.

For rural providers and smaller health systems, ACO participation offers opportunities to simultaneously benefit from the advantages of being smaller, community-based physicians while utilizing the resources, technology, and methodologies of much larger institutions. Through ACO participation, rural providers can improve their virtual size and resources while maintaining that small-town sense of community.

Signify Health works closely with rural providers and ACO participants to ensure they have resources to be successful. All too often, the annual wellness visit (AWV) is an underutilized tool that can help improve patient outcomes by identifying gaps in care, uncovering previously unknown concerns, and identifying new diagnoses or red flags such as medication compliance. In the example below, Hunt Regional Medical Centers (HRMC) improved their rates of AWVs by 13 percent along with their patient outcomes.

Located in Greenville, Texas, HRMC serves its community with a wide range of inpatient and outpatient services including surgery, cancer care, cardiac rehabilitation, imaging, radiology, and more. When HRMC staff noted that fewer than 40 percent of their patients were scheduled for or had received an AWV, they decided to increase their emphasis on this foundational preventative care step.

In Q2 of 2021, ACO data demonstrated that 37.3 percent of eligible patients had completed an AWV. The population health nurse spearheaded the initiative by creating a master list of all Medicare patients in HRMC’s seven clinics who qualified for an AWV. Staff and providers adopted the stance that they  couldn’t perform an AWV if it isn’t scheduled. Patient lists were provided to every location, and front desk staff were tasked with contacting every patient to schedule an AWV.

The initiative included following up with every canceled appointment or no show to reschedule. By Q4 of 2021, the percentage of HRMC patients who had received an AWV had increased to 50.5 percent, an impressive increase especially during pandemic conditions. These efforts supported improved patient outcomes and were so successful that today prevention screenings and AWVs are included in every patient’s standing orders.

CMS is encouraging all providers who care for Medicare beneficiaries to participate in an accountable care model by 2030. To be successful and sustainable in today’s healthcare environment, rural providers will need to make the necessary investments in value-based care. ACO participation can offer rural providers the ability to take advantage of the size, scale, and resources of much larger organizations while maintaining their autonomy – all to benefit their patients and improve outcomes.

NRHA adapted the above piece from Signify Healtha trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.

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