Welcome to Nivano Physicians ACO REACH!

Nivano Physicians Inc. IPA ACO is an ACO REACH model that partners with Medicare Providers to provider whole-person care. The ACO REACH Model is a new healthcare delivery ACO model administered by CMS. Our Nivano ACO REACH Model is active in our contracting window and is recruiting Medicare Providers during the window of June 3, 2024, to August 1, 2024. We invite you and/or your provider organization to join our Model during this period. 

 

This model DOES NOT change how you see your patients, where they may be referred, nor does it change your billing process. By signing up with our Model, Medicare simply allows your straight (Original) Medicare FFS members to align through our ACO Model by converting the eligible Medicare beneficiaries who have history of being treated at your office/practice to receive additional exclusive benefits that the ACO REACH Model has to offer (with no additional costs to Member or Providers)! 


It DOES Improve the quality of care for people with Traditional Medicare, using novel tools and resources, that are otherwise, not available outside of this Model.

 

  1. Advances Health Equity: Innovative payment approach to better support care delivery and coordination for patients in underserved communities. Each ACO has a health equity plan that identifies specific communities and implements initiatives to reduce disparities.
  2. Promotes Provider Leadership and Governance: At least 75% control of the governing body is held by Participating Providers.
  3. Protects Beneficiaries: CMS vetting and monitoring of ACO’s for greater transparency and protection for members.
  4. Increases support to Providers: ACO’s had the responsibility to carry out initiatives for the providers and members and creates the foundation of providing whole-person care for Providers’ members.
  5. Improves Patient Experience and Reduce Medicare Spending through case management involvement and patient management.

 

We are inviting Individual Medicare Participating Providers, Organizational Group Practice Providers, and Preferred Providers to join our growing ACO Model through our quick and seamless sign-up process. 


MODEL KEY POINTS

  • The future of healthcare includes ACO models. CMS is headed toward Value Based Care. CMMI wants every Medicare beneficiary in an ACO plan by 2030. Managed care and Traditional Medicare may become obsolete and participating providers can get ahead of the curve in healthcare delivery. Providers can start receiving the incentives to join and the experience and not be blind-sided by the almost inevitable.
  • Whole person care model and health equity focus. The structure of the model allows for the beneficiary to be taken care of by the ACO for whole person care through coordination to social benefits and programs and through other medical services.
  • Waivers through Beneficiary Enhancements that waive Medicare payment rules, and other payment rule waivers to improve care coordination and service delivery.
  • Flexibility in Structure: Allows flexibility in administration and allows Medicare FFS members to still go to providers without prior authorization but allows the extra benefits a managed care model would have. No restriction on provider or member choice.
  • Provider leadership. Participating provider driven model with the voice and votes of providers at the forefront. 
  • Investment in underserved communities with a focus on complex chronic and seriously ill beneficiaries.
  • Medicare FFS has no beneficiary support for navigation through healthcare delivery but ACO REACH enables this benefit.
  • Flexibility in how the benchmark is utilized and how the care is distributed.
  • No Downside risk for participating provider, as providers are still paid through capitation and or APO services, and providers do not have to pay shared losses. However, providers do earn shared savings as an incentive. The providers have the benefit of getting paid for all aligned members, even if the member is not seen in the office or is only receiving care through the ACO and other specialties through capitation and alignment procedures.
  • Better outcomes for members and providers. Provider reputation and beneficiary health is improved.
  • Providers may still partner with managed care organizations with no loss of business and have opportunities to align more Medicare FFS members to the practice through Signed Voluntary Alignment (SVA) forms.
  • No Quality Reporting in ACO REACH as compared to managed care or MSSPs.
  • There is great potential for financial gain for all participating providers but no downside risk is assumed by participating providers.

 

Providers who wish to participate have the advantage of getting ahead of the CMS Medicare health care delivery trajectory by joining this accountable care model, have additional financial incentives that increases the revenue and profitability of the Provider or Group/Practice, increase Medicare beneficiary retention and alignment to Provider or Group/Practice, increase the quality of care for the Medicare beneficiaries, and Providers have no downside risk! 


The contracting process is easy and seamless:

  1. Provider or Provider Group express interest in joining the ACO REACH Model. 
  2. The Administrator and/or ACO REACH Team personnel will contact the Provider to discuss the compensation reimbursement and email the ACO REACH Presentation as a resource of how this Model works and the benefits overview. 
  3. Provider will receive the Participating Agreement contract via email or Docu-Sign. 
  4. Provider signs the Participating Agreement and emails back to the ACO REACH Model.
  5. The Administrator will add the Participating Provider or Preferred Provider to the PY2025 Provider List and notify CMS.
  6. The Contracting Process is complete, and the Provider and their Medicare beneficiaries may enjoy the benefits of joining our model for Participating Year 2025! 

For contracting information, questions, or how to sign-up, please contact our ACO Team:

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