Temple Health is participating in an innovative, equity-focused Medicare program by the Centers for Medicare & Medicaid Services (CMS) called ACO REACH (Accountable Care Organization Realizing Equity, Access, and Community Health). This pay-for-performance risk-sharing program is designed to encourage coordination among providers across the spectrum of care for Medicare fee-for-service beneficiaries, especially those from underserved communities. Temple Health has launched this program as Temple Care, Inc.
“What makes this model truly innovative is its requirement that we, as a participating provider organization, develop a Health Equity Plan—a first of its kind for Medicare—that benchmarks health disparities in our community and identifies the specific actions we will take to reduce them,” said Steven R. Carson, MHA, BSN, RN, Senior Vice President of Population Health, Temple Center for Population Health, LLC and President and CEO, Temple Care, Inc. “We collect patients’ demographic and social needs data, so that we can implement the most effective care strategies to achieve the best health outcomes for beneficiaries of this program,” he added.
In traditional managed care and accountable care payment models, providers of care to the sickest and most disadvantaged patient populations bear the greatest financial risk. The health equity benchmarked payment adjustment of Temple Care CMS ACO REACH program, however, makes financial spending targets higher and easier to hit because the providers serve the most socially and economically at-risk patients.
“Temple Health’s patient population experiences significant health disparities due to social and economic inequalities. The Temple Care CMS ACO REACH program increases the range of social and clinical support services we can offer and gives us substantial flexibility in the way we provide care to beneficiaries,” said Nina R. O’Connor, MD, FAAHPM, Chief Medical Officer of the Temple Center for Population Health. “Services include community health and social workers, nurse navigators, telehealth, post-discharge home visits to prevent unnecessary hospital admissions, and, of course, full traditional Medicare benefits with the ability to see any Medicare physician,” she added.
Temple Care’s participating primary care and specialty physicians, nurse navigators, community health and social workers, and post-acute care providers all share quality and outcome information, as well as CMS payment incentives, to achieve targeted quality health outcomes.
“This is a true population health approach to healthcare. Our physicians guide the medical care, which is supplemented by diverse teams of professionals who provide care management, home visits, and other preventive health services to remove barriers to access, address patients’ health needs, and sustain their well-being with community-based support resources,” noted Carson. “Our global monthly reimbursement is directly tied to our ability to meet and exceed evidence-based core quality measures, so this program effectively aligns incentives to provide value-based care,” he added.
“Our participation in ACO REACH advances Temple Health’s value-based care strategy to supplement world-class academic medicine with wide-ranging and innovative services that addresses social determinants of health,” said Michael A. Young, MHA, FACHE, President & CEO of Temple University Health System. “It advances our strategic goal to be positioned as a high value academic medical center among the general public, our community, providers, patients, vendors, investors, and governmental agencies,” he added.
The four-year program started in January 2023 and runs through December 2026. Enrollment in the program is optional and Temple has enrolled 6,500 beneficiaries.
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.