Prisma Health Boosts Accountable Care in Partnership with CVS Health Division

The South Carolina-based health system's ACO is working in collaboration with CVS Accountable Care.

Prisma Health has established a collaboration between its accountable care organization, InVio Health Network, and CVS Accountable Care to participate in the ACO REACH model.

ACO Realizing Equity, Access, and Community Health (REACH) is an accountable care model developed by the Centers for Medicare & Medicaid Services that features upside and downside risk for healthcare providers serving traditional Medicare beneficiaries. Clinicians participating in ACO REACH include primary care physicians and specialists. ACO REACH participants must have a plan to meet the needs of people in underserved communities and to address health disparities.

The ACO REACH collaboration between InVio Health Network and CVS Accountable Care will have both organizations capitalizing on their strengths, says Drew Albano, DO, MBA, chief medical officer of population health management at Prisma Health.

"They can look at ways to provide additional clinical programs or expand on existing programs," he says. "They can also work together to harness data—there are increasing volumes of data in the healthcare space, and these partners will be able to manage data and use it in a meaningful way. This collaboration also will supplement InVio Health Network's population health programs."

InVio Health Network's strengths include robust connections locally with Prisma Health's employed physician practices and the health system's medical group, Albano says, adding InVio Health Network has strong relationships with independent physician practices in Prisma Health's geographic footprint in South Carolina. That local presence will be complemented by CVS Accountable Care's national presence and CVS Health's MinuteClinics in South Carolina, he says.

InVio Health Network also has staff tackling population health and value-based care initiatives from different angles, Albano says.

"Some of those angles include addressing care gaps such as cancer screening, scheduling of wellness visits, and getting patients in for chronic disease management for conditions such as diabetes and hypertension," he says.

CVS Accountable Care also has extensive experience with longitudinal care and care coordination, Albano says. "This will help us do well in managing populations of patients as they transition from acute care such as hospitalizations back into their communities."

Navigating upside and downside risk

Prisma Health has been serving Medicare beneficiaries since 2015, including downside risk arrangements such as Medicare Advantage health plans. Prisma Health is confident that InVio Health Network can achieve shared savings in the ACO REACH model, Albano says.

"We feel it is important to equip our clinicians with resources that are going to help them better address the holistic aspects of a patient's care," he says. "We think about not only medical management but also helping the patient to align with their optimal health trajectory and care pathways. So, we think about how we get patients in for preventative visits, chronic care management, and medication adherence."

Providing access

To be successful in ACO REACH, InVio Health Network is thinking beyond traditional methods of providing access such as getting patients into ambulatory settings for evaluation, Albano says.

"What we have seen since the coronavirus pandemic is that there are novel models for access that we can start to leverage," he says. "Virtual visits are certainly an opportunity, particularly in behavioral health. CVS Accountable Care has sought to provide access through their MinuteClinics. We are thinking about chronic disease management using remote patient monitoring for conditions such as hypertension and heart failure."

InVio Health Network and CVS Accountable Care want to provide access through the traditional model of providing in-person office visits for patients, but they also want to decentralize that model by taking care of patients in their homes, Albano says.

"So, there are many avenues to provide access," he says. "Partnerships such as this one help us to showcase which avenue is best to pursue with each patient. We know that the one-size-fits-all model is not going to work. We must take a tailored approach knowing that we are going to meet the patient where they are at and address the needs that they have using the right access pathway."

Promoting health equity

InVio Health Network's plan to boost health equity in ACO REACH includes addressing social determinants of health, Albano says.

"We have implemented a process to screen patients for social determinants risk factors," he says. "We have a tool that not only helps identify social determinants of health but also connects patients to community resources. We close the loop—it is not just providing an available resource for an identified social determinant but also making sure the patient is able to have their social determinant addressed."

CVS Accountable Care has a robust care management capability, which will also promote health equity, Albano says.

"We are going to be able to scale up what we have done historically from a care management standpoint," he says. "For example, we are looking at how the CVS Accountable Care transitional care management team can do more acute-care transitions such as patients who have a hospitalization for surgery then are transitioned back into the community."