WHAT IS A REACH ACO?
The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (the Innovation Center) has started the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model to encourage health care providers to share a common set of goals aimed at improving overall patient care, increasing collaboration across care teams, and helping patients access the care they need. This model brings together doctors, hospitals and other health care providers in an organization called a REACH ACO.
WHAT IS Senior Health Connect ACO 4?
Senior Health Connect ACO 4 is the name given to the REACH ACO through which Preferred Primary Care Physicians is participating in the ACO REACH Model.
DO I NEED TO DO ANYTHING?
No. Your provider’s participation in the REACH ACO does not impact your Medicare benefits. You are still free to see any provider you choose. If your Primary Care Physician is participating in the ACO REACH Model, then you may be automatically aligned to the ACO based on your previous Medicare claims billing. This just means your doctor is responsible for your overall cost and quality of care.
DOES THIS AFFECT MY INSURANCE?
No, your Medicare insurance does NOT change at all. This is NOT a Medicare Advantage Plan or HMO. PPCP providers will continue to bill Medicare for services provided. You will continue to keep your same benefits but may also have access to additional benefits such as the 3-Day SNF Waiver. Enhanced benefits will be reviewed annually.
CAN I KEEP MY SAME PROVIDER?
You still have the freedom to go to any doctor, hospital, or other healthcare provider of your choice that accepts Medicare.
WHO HAS ACCESS TO MY INFORMATION?
Providers who are active in your treatment have access to your medical information along with Medicare and the REACH ACO. Your medical information is always treated confidentially and is not shared with anyone who is not involved in your care. We continue to follow strict HIPAA regulations for privacy.
WHAT IS THE SKILLED NURSING FACILITY (SNF) 3-DAY WAIVER BENEFIT?
With the SNF 3-Day Waiver Benefit Enhancement, Medicare will waive the requirement for a 3-day inpatient hospital stay prior to a Skilled Nursing Facility (SNF) admission. This means that you may be able to go directly to a participating SNF from your physician’s office, home health, or the emergency room. If you are admitted to a hospital, you do not need to remain at the hospital for 3 days before moving to a SNF. This allows for greater access to the patient’s Medicare benefits and decreases unnecessary hospital stays. If you need to be admitted to a SNF, your PCP office or the hospital social worker will help determine whether this may apply to you and coordinate your transition to a participating facility.
HOW DOES THE 3-DAY SNF WAIVER BENEFIT ME?
In certain instances, it is medically appropriate to move directly to skilled nursing care and/or rehabilitation services at a Skilled Nursing Facility (SNF) without a prior hospitalization.
The 3-Day SNF Waiver allows patients to receive the right care at the right time in the right setting without requiring a hospital stay. Of course, if a hospital stay is necessary, this will not prevent you from receiving the care you need.
Our Preferred SNFs have agreed to work closely with the ACO to ensure communication between the SNF and your primary care physicians. This communication leads to increased care coordination among your entire health care team.
WHICH SNF’S ARE APPROVED TO USE THE WAIVER BENEFIT ENHANCEMENT?
Only CMS-approved Preferred SNFs can participate in the SNF 3-Day Waiver. These SNFs are required to maintain an overall rating of 3 STARS or higher under the CMS 5-Star
Quality Rating System. We have contracted with several Preferred SNFs who have agreed to work closely with Preferred Primary Care Physicians and the ACO to improve quality and care coordination. You are free to select any Medicare-Enrolled SNF and do not have to go to a Preferred SNF; however, this waiver is only available when one of the following SNFs is selected.
For more information on Senior Health Connect ACO 4 and the 3-Day SNF waiver, click here or call 1-866-407-1660 or talk with your physician during you next visit.