Upward Health announced today it secured a contract for the new Accountable Care Organization (ACO) model through The Center for Medicare and Medicaid Services (CMS). The model, titled ACO REACH (Realizing Equity, Access, and Community Health), is the most recent innovation announced by CMS. ACO REACH is focused on advancing health equity, promoting provider leadership, and improving Medicare beneficiary protections. Upward Health is one of just 22 accepted applicants in the country for a High Needs Population ACO, designed to serve Medicare beneficiaries with complex healthcare needs.

The ACO REACH model encourages healthcare providers to improve the coordination and quality of care offered to traditional Medicare beneficiaries. The High Needs focus is a natural fit for Upward Health, which has been serving high-risk patients for years – such as frail elders living in long-term care settings, individuals with serious mental illness, and individuals with intellectual and developmental disabilities. Upward Health previously served as a Preferred Provider in the CMS predecessor program to ACO REACH; it will be building on this experience to launch its own ACO in 2023.

ACO REACH offers several benefit enhancements, such as telehealth, care management home visits, post-discharge home visits, and cost-sharing waivers, all of which align well with Upward Health’s model of care. “We see this as a tremendous opportunity to offer home-based care to underserved patients,” said Glen Moller, CEO of Upward Health. “We applaud CMS for creating a model which enables several impactful services that have been shown to improve the health and satisfaction of patients, all while reducing medical expenses.”

Upward Health will initially participate in the ACO REACH model in several of its current states, including Massachusetts, New York, and Rhode Island. In Massachusetts, ACO REACH will expand a multi-year partnership between Upward Health and the Seven Hills Foundation, a comprehensive health and human services network, and a Preferred Provider in Upward Health’s ACO.

“Upward Health has provided excellent in-home medical care for our individuals with intellectual and developmental disabilities, preventing unnecessary trips to the hospital,” said Kathee Jordan, Executive Vice President & CEO of Seven Hills Foundation and a Board Member of Upward Health’s ACO REACH. “We look forward to delivering care to more individuals with complex needs and to improving the health of people who are often under-served by traditional medical systems.”

In addition to Seven Hills, CareLink and Spectrum Health Systems will serve as Preferred Providers in Upward Health’s ACO. MedElite will serve as a Participant Provider.

Please note: 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.

ABOUT UPWARD HEALTH

Upward Health is an in-home multidisciplinary provider that partners with health plans and other risk-bearing entities to address the unique needs of the most high-risk, high-need users of the health care system today. Using a unique, in-home community-based approach to meeting a patient’s needs, Upward Health facilitates and delivers care that improves outcomes and the quality of life for every patient it serves. Upward Health has a measured Net Promoter Score of 86, among the highest in the healthcare industry. To learn more, please visit www.upwardhealth.com.

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