For Healthcare Professionals

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
  • Equality Health’s CareEmpower® technology platform
  • Community-based care coordination resources
  • Quality incentives not  contingent on total performance

Frequently Asked Questions

Who is eligible to participate in the ACO REACH model?

Healthcare organizations that applied with the CMS Innovation Center and were accepted are participating in the model. Equality Health Direct is proud to be among the few entities throughout the United States that were chosen to participate in this innovative model.

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.

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.

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.

What are the benefits to primary care providers who are participating in Equality Health Direct?

There are many benefits to the provider:

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Primary Care Providers have a unique opportunity to increase total Medicare compensation through:

  • A unique payment model that converts Medicare payments from fee- for-service to capitation.
  • Sharing in the proceeds from efforts to improve care and reduce costs.
  • Quality incentives not contingent on total ACO performance.
  • Participation in a model that qualifies as an Advanced APM and may relieve providers of MIPS reporting.
  • Prospective attribution to know assigned Medicare beneficiaries at the beginning of each performance year.
  • Prospective benchmarking for awareness of cost target goal in advance.

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Specialists and ancillary services have an opportunity to have deeper collaboration with high-quality primary care providers and improve care for Medicare beneficiaries.
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Additional benefits for healthcare professionals include:

  • Equality Health Direct has physician-governed leadership, a proven model for success.
  • Collaborating with Equality Health Direct prepares practices for participation in value-based and risk-based contracts.
  • Participating in Equality Health Direct provides a predictable cash flow opportunity compared to fee-for-service.
  • The opportunity to leverage Equality Health’s proven value-based care capabilities to drive shared success including:
    • CareEmpower® technology platform
    • In-office practice performance support
    • Community-based care coordination resources

How are my patients attributed in Equality Health Direct?

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:

  1. 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.
  2. 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.

How does ACO REACH differ from Medicare Advantage (MA)?

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 (aka 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.