Move to Value Podcast

In this episode we revisit our conversation with Josh Vire, Vice President of Value-based Operations at CHESS Health Solutions, where he talks about North Carolina’s move to managed Medicaid and the work CHESS put into building a complete all-patient solution. Josh explains what managed Medicaid is, how AMH tiers operate, and the real-world hurdles practices face when entering this space. He also outlines the three core services CHESS offers, the population health tools behind them, and the engagement options available for groups seeking support. Josh closes with practical advice for practices preparing for managed Medicaid or value-based care in general. A clear, useful conversation for anyone navigating Medicaid transformation or working to improve care delivery in North Carolina.

In this episode of Move to Value, Emily Volk, Director of Quality, Risk, and Compliance at Northern Regional Hospital, returns to share how her team is navigating the operational realities of Medicaid managed care. From the early challenges of inconsistent documentation and payer confusion to building smarter EMR templates and leveraging care coordination through CHESS, Emily offers a grounded look at how one small hospital is tackling big problems. She discusses the importance of automation, proactive outreach, and the power of partnerships to streamline workflows, reduce hospitalizations, and improve continuity of care especially in a rural setting.

In this episode, we hear from Emily Volk, Director of Quality, Risk, and Compliance at Northern Regional, headquartered in Mount Airy, North Carolina. With nearly a decade of experience driving high performance in value-based care, Emily shares how her team is now navigating the shift into Medicaid managed care. Learn how a small rural hospital is leveraging strategic partnerships, expanding care coordination, and breaking down access barriers, all while staying focused on what matters most: better outcomes for patients.

Discover how clinically integrated networks (CINs) empower physicians, specialists, and pharmacy partners to deliver coordinated, patient-centered care. In this episode, Debi Hueter of WakeMed Key Community Care joins Rebecca Grandy from CHESS Health Solutions to discuss collaboration, trust, and innovation in value-based care. Learn how team-based care models reduce administrative burden, improve outcomes, and support providers at the top of their license.

Today, we're hear a conversation between Rebecca Grandy, Director of Pharmacy at CHESS and Debi Hueter, Executive Director of WakeMed Key Community Care, a clinically integrated network focused solely on primary care. Discover how integrating pharmacy services is transforming provider workflows, reducing emergency visits, and improving patient outcomes.

In this episode of The Move to Value Podcast, we revisit the conversation between CHESS President Dr. Yates Lennon and Randy Jordan, Chief Advisor of Impact for Health at Next Stage Consulting and former CEO of North Carolina’s Association of Free and Charitable Clinics. Together, they unpack the evolving landscape of Managed Medicaid, explore innovative approaches to funding care for the uninsured, and examine how healthcare organizations—free clinics, FQHCs, rural health centers, hospitals—can collaborate in a financially sustainable way. From real-world examples in North Carolina to insights drawn from global experience, this conversation sheds light on what it takes to build a true system of care for those often left out.

In this episode of the Move to Value Podcast, we continue our conversation with Julie Quisenberry of Coastal Horizons about what care management looks like on the front lines. Julie shares how her team supports patients facing housing insecurity, food insecurity, substance use, and behavioral health challenges, while also navigating language barriers and limited resources. From expanding Hepatitis C treatment programs to building bilingual services and training staff in cultural competency and trauma-informed care, Julie offers a candid look at the realities of delivering whole-person care. She emphasizes the importance of celebrating small wins, collaborating with community partners, and adapting to constant change in Medicaid and tailored care plans. This episode shines a light on both the challenges and the resilience of care managers working to improve outcomes and support their communities—one patient at a time.

In this episode of Move to Value, we talk with Julie Quisenberry, Director of Care Integration at Coastal Horizons. Serving 56 counties across North Carolina, Coastal Horizons delivers whole-person care by integrating primary care, behavioral health, substance use treatment, and community resources. Julie explains how her team navigates Medicaid standard plans and tailored plans, uses HEDIS metrics to improve outcomes, and works closely with partners like CHESS to keep patients’ needs front and center.

In this episode, Dr. Rob Fields and Rebecca Grandy continue their conversation and focus on data. What’s useful and what’s a waste of time? What data truly drives value and why do so many predictive tools fall flat? You’ll also hear practical strategies such as where to direct focus when resources are tight, how to build an ideal care team, and how to make your value-based programs sustainable—even in a broken fee-for-service world.

In this episode of the Move to Value Podcast, Dr. Rob Fields, EVP and Chief Clinical Officer at Beth Israel Lahey Health, joins host Rebecca Grandy, Director of Pharmacy at CHESS Health Solutions, to unpack the realities of value-based care. They explore why good intentions aren't enough, what data actually drives impact, and how to build sustainable care models with limited resources. From downside risk readiness to team-based care and chronic disease management, this conversation is full of practical insights for anyone navigating healthcare transformation.

Today we revisit an interview with Tim Gallagher, a leading voice in Medicaid transformation and value-based care. With Medicaid policy currently dominating headlines, it is important to hear from someone with firsthand experience as both a policy expert and a parent navigating the system. Tim offers sharp insight into how managed Medicaid can drive equity, improve outcomes, and create sustainable partnerships.

In this episode of the Move to Value Podcast, we take a deep dive into one of the most impactful updates in healthcare risk adjustment: the transition from CMS-HCC Version 24 to Version 28. Our guest, TaSonya Hughes, CHESS Health Solutions’ Manager of Coding and Documentation Education, explains what the shift means for providers, coding teams, and care managers—and why now is the critical time to prepare. CMS-HCC Version 28 introduces new disease classification categories, retires thousands of existing diagnosis codes, and emphasizes greater specificity in clinical documentation. TaSonya walks us through how these changes affect Medicare risk adjustment, the financial sustainability of value-based care, and ultimately, the ability to deliver accurate, coordinated care for patients with complex chronic conditions.

In this episode of The Move to Value Podcast, guests Jennifer Houlihan and Jennifer Gasperini join us for a deep and wide-ranging conversation on the evolving landscape of value-based care. We explore North Carolina’s leadership in Medicaid transformation, the critical role of provider voice, and the infrastructure needed to support long-term success. From navigating administrative burdens to anticipating federal policy shifts, we also discuss how health systems can stay nimble, build smarter data strategies, and engage patients in more meaningful ways. Whether you're a provider, policymaker, or system leader, this episode offers timely insight into where healthcare is headed—and what it will take to get there.

CMS Changes and the Future of Value-Based Care Jennifer Houlihan and Jennifer Gasperini of Advocate Health discuss the impact of new CMS and CMMI leadership, current challenges in value-based care, and the future of ACOs, ECQMs, and Medicare Advantage. A timely conversation for anyone navigating the evolving policy landscape. Welcome to the Move to Value Podcast, powered by CHESS Health Solutions. In this episode, we’re joined by Jennifer Houlihan, Vice President, and Jennifer Gasparini, Director of Policy, from Advocate Health’s Population Health Team. Together, we unpack the implications of the recent administration change, explore what new leadership at CMS could mean for value-based care, and hear their perspectives on the legislative priorities they hope to see take shape. Thomas Royal Jennifer Houlihan, Jennifer Gasparini, welcome to the move to Value podcast. Jennifer Gasperini Thanks for having us. Jennifer Houlihan Happy to be here. Thomas Royal So you both just attended the NAACOS conference? Can you tell us what are some of the hot topics that folks were talking about? Jennifer Gasperini I can get us started. I think it's always great to see colleagues at the NAACOs conference and was also great to see Kim Brandt, who is the deputy administrator and COO at CMS, come and share some of Doctor Oz's priorities. For CMS and I think a lot of those priorities align really well with value based care. So they they really spoke a lot about tackling fraud and abuse. And as you know, ACOs are really the early identifiers of fraud. And so really was pleased to see them talking about that and also using technology and better data really for beneficiaries and providers to advance care. And I think ACOs obviously are very focused on that goal as well. Jennifer, do you have anything else to add there? Jennifer Houlihan Yeah. There, in addition, there were some really good sessions on the new team model, the transferring Episode Accountability model as well as guide and a lot of thoughtful conversation around how to integrate these models into the ACO and a clearer path for outcomes there. So I think there was a great discussion and got to give kudos to Jennifer. She was part of a really well attended and fantastic panel on how ACOs are adapting ECQMs and MIPCQMs and some of the kind of demands and multiple issues that are impacting ACOs on how to do all payer adjustments leveraging some of these requirements. So a lot of really timely topics and I think then the kind of final was Specialty Care integration, I think continued to be a recurring topic that we need to think more deeply about that and and how those get nested within cost, so hopefully we'll see more about that in the future. Thomas Royal So there is new leadership in place at HHS, CMS and CMMI. What does NAACOS think this might signal for the future of value-based care? Jennifer Houlihan Sure, I I can. I can jump in on that one first, so I think you know, looking at Abe Sutton, you know, as as Jennifer mentioned, Kim Brandt was there from CMS. But we've also seen with Abe Sutton's appointment, who's been a strong supporter of value-based care. I think the mood was mostly positive, that there has been sort of a lot of statements, whether it's in some of the confirmation hearings, or direct statements that value-based care and the need to achieve savings is is one of the priorities. I think there's gonna be some different thinking about more aggressive requirements for more savings and as as as we've seen already, some of the model review that's already taking place. The ability to kind of end models early if they're not achieving the outcomes and the savings. So I think the mood in general is Value is still a strong part of CMS and CMMI’s agenda just the way some of the models will shape up and some of the strategic priorities, I think we're still waiting to see what that looks like. And Jennifer, I don't know if you have more to add on that. Jennifer Gasperini Yeah, Ditto on all those points. And of course the new leadership is very focused on MAHA or making America healthy again. and I think value really fits in that lens. And so hopefully we'll see more focus on prevention and Wellness and maybe even some new models that are introducing new concepts around prevention and Wellness as well, hopefully, but we do expect to see more from the new leadership team at CMMI on their strategy in the coming months and that will be really telling, I think, in terms of what their spin on value and their focus will really be. Jennifer Houlihan And I'll just talk. I mean, we did one of the first signals we saw was in the new the the 2026 proposed inpatient rule and team. The team model is is remaining as a mandatory model. And so I think there were, there are some early signals, but as Jennifer said, we're really waiting for that strategic refresh and then more really frankly announcements on any what the, the future model changes will be. Thomas Royal Interesting. So. So my next question is a bit duplicative, but I'd like to know what stands out to you about the new head of CMMI and how do you see his vision shaping programs like ACO REACH? Jennifer Gasperini Yeah. Yeah, I think like you said, you know, I'll be a little repetitive here, but I think well, Abe Sutton, you know does have experience in value models. So that is very helpful and has experience working in the first Trump administration. But I I think his knowledge of value based care will help shape the new strategy at CMMI and the agenda at CMMI and tying that work obviously back to Maha goals is something that we really expect. Jennifer Houlihan I mean, you asked specifically about ACO reach and I think we've been hearing lots of rumors. We've heard everything from the could ACO REACH be extended. Will it be replaced by something like the a revised Geo contracting model? I think there's a lot of what if scenarios right now. So it's hard to say. But as Jennifer said, Abe Sutton does have a lot of experience. He was the architect of some of the kidney care models. And so I think that's where we're wanting to also see what's next for full risk models, but again also with an eye towards how are we thinking about specialty integration and some of these full risk models. And so I think there might be some good alignment opportunity there as well. Thomas Royal So historically, how has leadership turnover at HHS impacted innovation models and payment reform initiatives? Jennifer Gasperini Yeah, I think so, the impact has been pretty minimal in the past. There's always a period of reorganization, of course, when new leadership comes on, they identify new priorities. They typically issue a lot of RFI’s or requests for information to gather feedback from stakeholders, and we're really already experiencing those things now. I do think we'll have a lot of opportunities to share input on future direction and maybe what we feel hasn't been working, especially in the vein of regulatory relief. That's an area they've been really focused on initially, but you know, obviously we are losing some staff that is has a lot of institutional knowledge. And so, I think. Time will tell in terms of, you know what the the true impact is on the programs. Thomas Royal Yeah, 'cause, there's definitely been a wave of layoffs across the healthcare policy space. And so how are these reductions in force impacting value based care programs, especially ACO reach? That's one thing that's that's come up as as we've been out having conversations with folks, boots on the ground and how that's going to be impacted. You have any thoughts about that? Jennifer Houlihan I mean some of the impacts in addition to staffing are coming through changes or directives from the executive orders. So I think that is having an impact and maybe that is to the extent that we're seeing it now, maybe that's a difference between previous administration turnovers and transitions versus now is the amount of executive orders and some of the directives. I mean I think for ACO REACH, I'm not as directly involved with it, and I know Jennifer is more so maybe can speak more directly, but I think some of the staff is definitely still there and they're trying their best to follow like new leadership direction executive you know. Executive order implementation and so I think there was some pause and communications early on, but I don't know, Jennifer, from your standpoint if that seems to have kind of resolved and it’s business as usual, of course. Again, waiting for any, you know that model I suspect is under review. Like all the other models have been under review and we could expect to see more changes. Jennifer Gasperini Absolutely. And you know, like MSSP, they have lost some staff with a lot of institutional knowledge. And so I think there will be a transition period. Will they hire up then and hopefully get some some new smart folks into those roles. They've also done, you know, some pulling back of the ACO coordinator positions in an effort to centralized so most of those positions were in the regional offices, previously and we're seeing CMS move to a more central approach and and therefore we've lost a number of ACO coordinators and so for MSSP and and ACO reach but as Jennifer mentioned, I think we're starting to see things level back out and I hope to see some return to normal programming. Thomas Royal Only time will tell. What do you see as a major driver, particularly in MA and MCR from a policy and financial standpoint? Jennifer Houlihan Yeah. So I mean MA I think has is one of those hot policy topic areas where we're watching. We know some of the new policy leadership within CMS has a lot of experience and thinking around how MA should evolve and this administration is also considered to be very MA friendly. But that being said, there have been some signals, such as doctor Oz mentioning in his Confirmation hearing that up coding is a key factor in cost, and we know that medpac their latest report shows that MA enrollees spend more than traditional Medicare. And then of course, we can't forget denials and some of the big concerns that we're seeing across health systems and down coding and denying both on and patient and AD perspective. So there's a lot of swirling, I think policy within that MA space and that's where we're trying to understand even within the new rule making there were a lot of pieces deferred. So what will this mean for the future of some of CMS or CMMI models? Will we see more alignment between traditional Medicare and Medicare Advantage? Will we see some significant changes around some of the coding intensity? Benchmarking risk capture methodologies. I think all of those seem to be up for conversation. And again, I think time will tell of of how the administration continues to move forward on that. We we do know for some of the policy briefs out there through groups like Project 2025 and Paragon, who've written extensively on MA that there are a lot of proposals to strengthen MAs presence in the healthcare landscape. So at this point, what we're doing is kind of watching and waiting and looking for signals such as, you know, the the recently reduced rules and and what we might expect. And Jennifer, any anything to add on your end? Jennifer Gasperini I think just that, you know, Jennifer mentioned earlier the geographic direct contracting model that we saw under the the first Trump administration, which is very MA friendly and we we do expect to see a resurgence of that type of thinking or that type of model in this administration as well. Thomas Royal Well, as, as we're all aware, there's been quite a flux in the economy recently, do you think the current economic pressures, or reshaping how health systems think about pop health investment? Jennifer Houlihan You know, we're we're still in a time of I hate to use the phrase two canoes, but given all the progress we've made, we're we're still in my opinion, in very much in a fee for service world with fee for value but fee for service still very much dominating the the reimbursement space. And I think we're also just in general in a time of, you know, tremendous change and transition with so many other policy lovers outside of pop health impacting where healthcare systems may be going, site neutral changes on the horizon potentially around Medicaid space. So I think I think in one hand pop health is viewed as still as the future forward of how do you get away from Fee for service. But on the other hand, we're we're still sort of a component in a very large health system that has a large footprint of hospitals and we have to balance between the revenue models. Thomas Royal Well, so looking back at ACO reach, under the current administration's first term, what progress was made and what programs or policies do you expect will be continued or changed under the second term? Jennifer Gasperini That's a great question. So, you know, I mentioned that the first Trump administration originally released that Geo Direct contracting model. It came under a lot of scrutiny and and was later cancelled, you know, under the Biden administration as a result of that scrutiny. And I think there was a lot of pushback. I think it's likely will see a return of a similar model under this administration. What that looks like exactly, I do not know. I think there's a a lot of questions unanswered right now around that, but I do expect I think a lot of others expect return of a similar type of model under this administration. Thomas Royal Well, can you tell us about the legislative efforts to reinstate and extend bonuses for providers participating in risk based models? And they view these incentives as essential for sustaining and expanding value based care? What is the latest? Do you think this push has any momentum? Jennifer Houlihan I it was definitely one of our policy priorities and there was, I guess, was at the end of last year, Jennifer, Bell introduced to extend the APM bonus? But the latest that we were hearing again, this could now be outdated information was that it is not currently part of reconciliation, but that it may be brought back up in the fall, Jennifer, I don't know if you've had any latest updates, so it's it's still out there as a priority, but overall not seen a lot of traction right now. Jennifer Gasperini Yeah. And I know it was devastating to see that bipartisan agreement come together end of last year and then really fall apart at the at the last moment and not get passed so that the bonus has expired as of today. But it is still a really big priority for Advocate and for a lot of stakeholder groups like NAACOS and others. I think there are spending pressures in Congress that are really going to make it difficult given the current environment. But I do think Congress is still committed to tackling the issue of broader reform of incentives and payments for value. Even the MIPS program is something that has been highly criticized over the years, is not living up to its intended goals, and, you know, having a lot of regulatory burdens associated with it. So I think there is appetite for broader reforms, but the timing for this year in particular I think are going to be difficult, so. But I am hopeful that maybe in the in the coming years we'll see a turn to attention on a broader reform. Thomas Royal That's great. Well, back in January, bipartisan legislation titled The Health Care efficiency through Flexibility Act was introduced in the US House, and this bill proposes delaying the mandatory ECQM reporting requirement for ACO’s until January 1, 2030. What's your take on this delay? Is it necessary breathing room or a missed opportunity? Jennifer Gasperini Yeah, that's a great question. And I know Advocate has committed a lot of resources to making ECQms a reality it takes an enormous amount of time and money and work, even ongoing work to to to do this. And in talking to other ACOs, I think there are a lot of ACOs that do need more time. And what dawned on me at the NAACOS meeting is that I think frankly, we're still debating the details because there were many very smart people at NAACOS. And some discussion and differing opinions about how can you report ECQMs the technical details of you know what the file has to to be, for example, and what constitutes data completeness. So as some examples, I think this really signals there's still some confusion out there and lack of clarity around these requirements. So I think having a backup or more time is not a bad thing for anyone. Given the uncertainty. However, I think it's important that we don't lose momentum since so many people, including Advocate, have already invested a lot into making this transition. And I do think looking to a less manual, more digital quality reporting process is a good goal for the future and we want to continue to make those. Investments. So it's about getting the details right, making sure there are reasonable expectations, so exclusions that allow for, you know, really kind of common sense exclusions that allow for things that we can expect to happen during the year, like transitioning to a new EMR or other challenges that do pop up realistically to not really take down your whole effort. Thomas Royal Was quality reporting broken? I mean, what's working? What's not? How do we fix it? Jennifer Gasperini So I can I can start here. I think so quality reporting is extremely costly and time intensive. Even when you're reporting ECQMs. So I think there are a couple of camps of thinking on this topic, though some think we should move to a REACH approach or model where ACOs are only evaluated on a small number of mostly administrative claims measures. Those don't revolve involve any reporting. But others think that that wouldn't accurately measure the quality of care that we're providing to patients. So I think yes and no. Is it? Is it broken? I think it can be improved for sure. How to fix it? I don't have those answers, but I I do wanna note that the proposed 2026 inpatient rule did include an RFI on this topic and so I think that signals that CMS is open to hearing what's working now. What some of these challenges are and and where we think we wanna go in terms of the future, and I'm really interested to see what the new leadership at CMS is thinking on this topic. Thomas Royal Well, we've come up against time, but there's still so many unanswered questions that I have for the both of you. Would you be willing to stick around for a few more minutes so that we can continue this conversation? Jennifer Gasperini Sure. Jennifer Houlihan Yeah,...

In this episode, Kari Curry, Medicaid Care Coordination Hub Supervisor at CHESS Health Solutions, shares how CHESS delivers high-touch, high-impact care management within a Medicaid Clinically Integrated Network (CIN). Kari walks us through a patient journey that highlights how CHESS uses real-time data from NCHIE, comprehensive social determinants of health (SDOH) screening, and structured care planning to reduce ED utilization and improve health equity. She also covers CHESS’s success with AMH Tier 3 audit readiness and payer collaboration—proving that value-based care in the Medicaid space is not only possible, but measurable.

In today’s episode we continue our conversation with  @American_Heart  Senior Advocacy Advisor of Health System Transformation Melanie Phelps, who was integral in the recently published study on the benefit of Accountable Care Organizations. The findings support that managed care provided by ACOs not only improves outcomes for the medically complex patient, but also benefits every patient, family caregiver, provider, and healthcare team member. www.heart.org/bettercare Yates Lennon Melanie Phelps, welcome back to the move to Value podcast. So let's try to pick up where we where we finished last time. Melanie and I wanted to go back to really to sort of the heart of your research in the medically complex patient. So we know these folks require hard higher touch and really need coordinated, managed coordinated care. And, wanted to talk about why it's crucial for the American Heart Association to understand and advocate for better models of care for this patient population. And then we'll after that, we'll follow up on sort of how we can work together to do that. Melanie Phelps Yeah. So medically complex patients are of course more complex and more costly. They require a lot more services and the burden of navigating a fragmented fee for service system adds to their already very stressful lives and the chances of things falling through the cracks or delayed care is pretty high in a payer fee for service system, the ACO provides those extra layers of support, communication and enhanced access that really do lead to better outcomes, reduce stress on the patient and their caregivers, which is pretty important. We also believe they are more likely to get the most up to date care under these arrangements because the incentive to do better is there and that is not there in the case of fee for service. So, we all know that there is a pretty significant lag between new innovations and evidence-based solutions and adoption or implementation in reality, and we see ACOs as a vehicle for expediting adoption of those. The other piece on medically complex patients, why we wanted to focus on those is when talking to other patient and consumer advocacy organizations, which is a key target audience of this of this study, there was a lot of apathy and even skepticism about ACOs, OK. They're not involved in the advocacy. They're not steeped in the details and they are very suspicious of ACO’s of value based care. They're thinking there's a lot of stinting going on. They think that they're being, you know, medically complex patients are being denied care and being kicked out of ACO’s. And that certainly was not my experience when I worked with the ACO’s in North Carolina. So, one of the reasons we focused on medically complex patients was to be able to say, OK, you know, are they getting the care that they need? What do they have to say about it? And that's why. I mean these are the people that really need the extra care and support and the results really showed that they were getting much better care and support, which should be important to everybody. Yates Lennon Yes, absolutely. That's that's interesting. I never would have. I guess I never would have thought about that kind of skepticism from consumer advocacy groups around value based care, and certainly my experience has been the exact opposite is the ACO model is a ideal model to have those patients in because you have the sustainable, a sustainable path to provide these wrap around services to both, both the provider and the patient and their families. I can think of multiple instances where these like in our NextGen days and our ACO REACH nursing facility waiver as an example. And while that is great for patients, I think we've had more comments from caregivers and family members about the benefits of that program than we have from patients themselves. It's really interesting that it's another layer of skepticism that we need to breakthrough. So, going a little bit further then, so how can ACO’s, provider groups working with inside ACO’s, how do we get past that skepticism barrier, so to speak? How can we work together with organizations like the American Heart Association to promote ACO’s and the benefits for patients, families and care helping providers? Melanie Phelps So one of our challenges and it was a pretty significant challenge was the fact that to recruit study participants, particularly the patient and caregivers, how do you do that when somebody doesn't even know what an ACO is or that they're assigned to an ACO? I mean you know there are a lot of regulatory requirements around that, and they're not particularly helpful to meaningful communication and meaningful understanding. So how can patient and consumer advocacy organizations help communicating the benefits, communicate the benefits of these this model and similar models? And it's through research like this that comes from, you know, a neutral patient advocacy group that folks can give or use to help communicate the benefits of in a way that is relatable to folks. You know so often we talk about ACOs from the provider perspective, well, providers get paid differently to do that and you know that's not what's going to resonate with patients or their caregivers or their advocates. What does it mean for them? And until we really do a better job of doing that, I don't think we're gonna have a huge cry from patients and consumers and community advocates. And it's a shame because people should be demanding this kind of care, right? Not running from it or not ignoring it. We should be working together to improve a very good and solid model. So that's, that's where we would like to go with that. Yates Lennon Yeah. No, I think you're right. We want to create a Stampede almost for patients demanding access to these kinds of programs. But you're right, folks don't know what they are, and they don't know unfortunately, they don't know when they're in one. They don't know when they're not in one, it's just not obvious. And the communication options sometimes are onerous and restrictive and don't allow sort of the free flow of information back and forth between the providers that are in these models and the patient. So that that's a real challenge. Melanie Phelps You guys are restricted in what you can communicate. We're not. Yates Lennon Right. You're not. You're right. Melanie Phelps So so we are a huge untapped resource and we being the patient and community and consumer advocacy community. But most of us, you know, there's only a handful of us that are engaging in these policy discussions. And so we really need to grow that that table. Yates Lennon So Melanie, given the American Heart Association's clear role in guiding heart health recommendations, does this study suggest that ACOs are a model that should be used to promote these preventive health recommendations more widely for all patients, first of all, but then, particularly as it relates to those who have cardiovascular disease? Melanie Phelps Yeah, simple answer is yes. I think we'd say all patients, including those with CVD or cerebrovascular conditions, should reap the benefits of ACO and similar models. So, but it shouldn't just be patients with CVD or cerebrovascular issues. All patients, especially those medically complex patients, will reap the benefits of these models. Yates Lennon Yeah, I think what we have to be mindful of, I've been thinking about this a lot lately myself is that we need to make sure that the value based care movement, if you will, doesn't get mired down in becoming a chronic disease management solution, only right how do we leverage the infrastructure and the data, the tools, the technology we have to prevent chronic disease, right? We just, I think the fee for service world has just turned into a sick care system, not a healthcare system. And we need to be mindful that we don't allow the value-based care movement to get to become that same to be captured by that same mindset, if you will. Well, as we as we start to round home here, what do you hope that health systems, policymakers and other patient advocacy organizations which you've mentioned take away from this research and how can the association help drive change based on your findings in this study? Melanie Phelps So I hope that all the groups that you mentioned will have a better understanding of what ACOs do, what they are, what they mean to those on the front lines of receiving and providing care. That's the patients, their family, caregivers and all the members of the health care team and how it improves the care they receive, their quality of life. How it saves money by catching things early and avoiding costly trips to the ED and duplicative services. And, of course, its focus on prevention. And finally, you know, again, we really need to see more people, patients, caregivers and healthcare team members in these arrangements. Yates Lennon Yeah. So, what are your next steps for the American Heart Association? More research? Further explanation, I mean, I'm sorry exploration of how ACOs can impact cardiovascular and other health outcomes. Where do you see the Heart Association going next? Melanie Phelps Yeah. So we don't currently have plans to explore the impact of cardiovascular outcomes, at least not to my knowledge. That would be a different section of AHA. That doesn't mean we won't. It just means that I don't think it's been discussed or has not been shared with me. And So, what else is there? Well, there's an outline of a heart failure model that we published in as part of our value in healthcare. Initiative back in 2020 with Duke Margolis. I've heard that there's some interest by the current administration in that, but you know, we haven't been contacted directly about that. We do have a huge food as medicine initiative. It's called healthcare by food, we’re putting millions of dollars into research on food is medicine. And there's I think we might be exploring how food is medicine can be utilized in this these models. How successfully it can be utilized in these models. And then regarding this research, we do hope to further engage and educate other patient and consumer advocacy groups and then work with them and other stakeholders on elevating the patient consumer voice in these models so that they can truly be person centered, right? I mean, we talk a lot about person centered care, but really the patient hasn't been part of those discussions. How do we make that more integral at all levels of decision making on value-based care. Yates Lennon Yeah, absolutely. So that's interesting. Food as medicine. There is a lot of interest I know today around what's called functional medicine and a big emphasis on healthy foods, and it's just so important. And I know from my own my own lifestyle, it's just it's challenging to sometimes know what to eat or how to prepare what to eat. But that's really good to hear that you're working on that. You know the last question I'll ask you, Melanie, is one. I usually come to at the end of any interview and that is we've talked about a lot today, but is there anything that we've not covered today or I've not asked you that will be relevant to this conversation that you'd like to share with our audience? Melanie Phelps I can think of two things. First of all, I think your listeners would be really interested to know that we conducted 29 semi structured qualitative interviews with 31 individuals and that means that two of the interviews included the patient and their caregiver spouse. That's how we got to 31, but we only were able to include in the data analysis, 27. So two interviews with the patient, with individual patients, had to be discarded because there was something was wrong with some of their responses that made me think they were not in an ACO. So after the conclusion of the interview, I was able to go and trace back through their PCP and their PCP practice, whether they were in an ACO or even some other primary care arrangement. And they were not, OK. So how did that happen? And well, first of all, the giveaway why I suspected they weren't in. Well, there were two reasons. The first one, neither one was managed right? And so all the other medically complex patients that I had interviewed, they were managed and these two weren't. They also happened to be sisters, and they were also cousins of the care manager who is helping with recruitment, right? So we had to change. We had a lot of trouble getting patient and caregiver study participants and so we had to change our research protocol. So instead of the healthcare organization getting a HIPAA authorization to give us contact information, we gave them a flyer that they could hand out to appropriate patients to call and you know, on their own, asked to be part of the study and there was $100 visa gift card that was assigned to it anyway. So we had a little this overzealous care manager was giving them out to friends and family. So yeah, so we had to regroup and you know, change again, but it was very interesting that I could tell that they weren't in an ACO that I mean, I would not have expected that. The other issue that I think was really interesting is that you know, at the end of the each interview we asked, you know, if they had any suggestions for improvement? And so the patients for the most part didn't have anything that was particularly helpful. We had one patient that said that they didn't like their primary care had inadequate parking. Another one didn't like their primary care provider, but knew they needed to change. And then the only other suggestion for improvement was from the patients was that external providers who were not in the ACO, there was a little bit more difficulty communicating. No big surprise there, right? So that that was all we got from the patients. So then, but then you go to the healthcare team members and what was really remarkable is there was a cry for more education and communication about the benefits of these models. Not only for their peers, but for patients as well. And they wanted more patients in these models. And one even lamented not being able to provide the same services to patients not assigned to that the ACO. And then we did hear challenges with data sharing with external providers. I mean, not a surprise there, right? There was also calls for multipayer alignment because of all the different contracts and rules and oversights and concerns about the ratchet effect over time of the benchmarks, right? That's being a problem. And then finally. Enhanced payment for primary care services was mentioned, and that didn't even come from the primary care docs. And I probably should let you let you know that on the as far as the care team members are concerned, I did I interviewed four primary care physicians, a specialty physician, a nurse practitioner, four care managers, nurse care managers, two community health workers, two social workers, and a pharmacist. So I had a pretty good diverse make up of. Yeah sample so that's that was pretty interesting, I thought that was pretty interesting to capture that information. Yates Lennon Yes it is. Well, Melanie, thank you so much for joining us today. It's been an intriguing conversation. I look forward to hearing more from you and thank you for joining us. Melanie Phelps Thank you for having me.

Today we hear from Melanie Phelps, Senior Advocacy Advisor of Health System Transformation for the American Heart Association, who shares with CHESS President, Dr. Yates Lennon, the motivation and detailed findings of a new study conducted by the AHA which found that ACOs provide better care and outcomes for patients and a better practice experience for members of the health care team than traditional fee for service. www.heart.org/bettercare Yates Lennon Melanie Phelps, welcome to the move to Value podcast. Glad to have you with us today. Melanie Phelps Glad to be here. Thanks for having me. Yates Lennon Sure, of course. So Melanie, recently the American Heart Association, released a study called Understanding Patient Family Caregiver and Health Care team member ACO experiences. Can you talk to us a little bit about what motivated the American Heart Association to conduct this research? Melanie Phelps Happy to. So the idea for the study arose out of a desire to be able to talk about ACOs in a more relatable manner to people who are not steeped in the technical jargon around ACO and value based care generally. We thought the best way to do this was to hear directly from patients, their family, caregivers and healthcare team members who receive or who provide care through ACOs. So from those who are on the ground receiving and providing care, and our hope is to use this information to better explain the benefits of ACOs in a way that's more understandable to more people. Yates Lennon Yes, certainly that, that sounds good. I know. ACO is an acronym that I think everyone of our listeners would be familiar with but when you get outside of the healthcare team member and even within in some settings, it's something people don't understand. Well, the study compares patient experiences in ACOs to the more traditional fee for service models. What were some of the key differences that stood out in terms of patient's experience first? Melanie Phelps Well, the results showed that. The care that's provided through these ACO models is just better in terms of quality and access, because there's a usual source of care through a primary care provider, whether that's a MD or an advanced practice provider. And there's usually a dedicated care manager as well as a team of people to ensure that all their needs, physical, mental, emotional and health related social needs are addressed. So essentially their experience is that they receive better, more timely and coordinated care with added supports that they wouldn't get in a pure fee for service arrangement. And I heard more than a few times that it's better than what we had before. And I also heard that my friends don't get the same level of care, and even some of the healthcare team members who lamented the fact that they can't provide this level of care to all their patients, especially those who are not assigned to an ACO, so. Yates Lennon Yeah. And I can echo that experience. I think some of our care team providers share with us stories of patients they interact with and we certainly hear that same story and even I have family in a different part of the state than the triad. And I can say from personal experience, I wish they were in these models. The American Heart Association conducted interviews like you said, just talked about among patients, caregivers and these healthcare team members. What were the what were their common themes? You just mentioned some common themes among patients, but if you expand that, what were some of the key findings or common themes across all three of those groups, patient, caregiver, and healthcare team member? Melanie Phelps Yeah. So in a nutshell and at the highest level, our study found that patient and caregiver study participants, OK, they believe that the care they receive through an ACO model is better for patients and then the care team member study participants believe that providing care through an ACO model not only is better for patients, but it's also better for the healthcare team members. And before I break this down, I just wanted to make something clear. I think this will be helpful. This doesn't mean that all the ACOs that I interviewed are performing at the highest levels, and in fact there was some variation and level of services and supports that the different study participants reported. I'd say some of the ACOs were really sophisticated. And then there were others that had some room for improvement. But even those that I would say have room for improvement Weren't quite as sophisticated. They had much better supports and services for their patients than someone would receive in a traditional fee for service arrangement. So anyway, now let's go ahead and break this down and I'll start with the patient and caregiver interviews. While the care and services provided across ACOS varied, there were still several common themes that emerged, including that patients in ACOs they received better care and support through a number of factors. OK. And these factors include a dedicated primary care relationship. So all study participants had a relationship with the primary care provider, and those relationships were overwhelmingly positive. We only had one patient who had some issues with their PCP and recognize the need to change, but otherwise they were very positive. Then there's the team of healthcare professionals who helped provide enhanced care and support and that always included a care manager who helps the patients and their caregivers navigate issues and connects them to needed services and supports. The next theme was improved access to care and support, and this included assistance with emergent or urgent issues. Timely responses and connection to needed resources. The next theme enhanced patient engagement. Which includes more time spent with patients as well as co-developed care plans. Then another theme, there were quite a few in this group, trusting relationships that made patients they felt heard they felt understood and they felt valued as a person. Almost all patients reported that they primary primarily relied on their providers for referrals and all the patients and the caregivers interviewed said they primarily relied on their providers for information about their medical conditions and treatment, and then the other two themes. The next one was improved communication, access and coordination with patients and their family caregivers as well as with all the healthcare providers. And then finally, that more holistic approach to care that addresses physical, mental, emotional health, as well as those non-medical barriers to health. For things such as access to healthy food, transportation, housing related issues, financial assistance and other services that contribute to improved health and enhance quality of life. So that's what the study found as far as the patients and the caregivers. Now with respect to what the healthcare team members had to say, let's focus first on why they thought it was better for patients to receive care through an ACO. So all the healthcare team members that interviewed it was unanimous. They agreed that care provided to patients, especially those who have multiple health related conditions, was better because of the extra time, extra attention and the extra support that they were able to provide through the ACO, which led to improved outcomes. So the supports that they mentioned, the themes that emerged was. You'll recognize some of these. Having that regular source of care through a primary care physician or advanced practice provider such as a PA or a nurse practitioner, having a multidisciplinary team based approach to care which really brings in different areas of focus and allows that extra attention, the extra care and support to be deployed to those patients, especially those with the greater healthcare needs. The whole person approach to care. That means the healthcare team can look at all the factors that impact a patient's health and well-being. And they're able to then connect them to needed healthcare related resources and assistance. And then finally that enhances this one's pretty packed enhanced patient engagement education. This includes things that there's greater emphasis on effective communication. Building trust, understanding the patient as a person and the tools that are used or things like motivational interviewing, shared decision making, regular assessments, care plan o-development. It also included greater attention to populations and communities that have historically had access challenges and being able to connect them to resources and assistance with, with need when needed. The other piece which this one I wasn't necessarily expecting, but it came through loud and clear, is that the healthcare team members agreed that providing care through an ACO model was better for members of the healthcare team for health care professionals, and why is that OK? Well, they liked having that team approach to care because it allows different professionals to work together to provide optimal care to patients. It expands access to care by providing additional resources and support to care for those patients that need it the most, and with doing so without overburdening the provider, the, the doctor or the Nurse practitioner or the PA. And then finally it they really felt like it allowed them to be better at that job. So that professional satisfaction that is so often missing. Was quite evident and was mentioned by all of them so. Yates Lennon Yeah, I was hoping you would get to that last one because I I really do think that oftentimes in the old fee for service model providers don't ask questions because they know they don't have, they know the answer, but it puts them in a situation where they don't have solutions and it creates almost like this moral injury kind of conundrum that care team providers are in, I think sometimes particularly physicians PAs and nurse practitioners, so that's very interesting and sounds a lot like the quintuple aim. Does it not? The things you just described as ACOs? Melanie Phelps Absolutely. And you can throw the yes. Yates Lennon Yes, go ahead. Sorry. Melanie Phelps All, all five absolutely definitely hit. Yates Lennon Yep. Melanie Phelps On in. Yeah, that that came out loud and clear. Yates Lennon Yep, Yep. Well, you know the the American Heart Association, I think would be primarily, well known for its work in cardiovascular health and disease prevention, it's interesting that you all focused on medically complex patients for this model as opposed to just, you know, patients with CHF. Can you talk to us a little bit about, you know, how you went about assessing what population you would try to interview? The population of patients and caregivers you would try to interview? Melanie Phelps Yeah. So a lot of people don't realize this, but the American Heart Association also includes the American Stroke Association. So we also have a major focus on brain health. Our mission is to be a relentless force for a world of longer, healthier lives, and our vision is advancing health and hope for everyone everywhere. So it's it's pretty broad, right? Yates Lennon Right. Melanie Phelps And it includes efforts to improve health from all the way from primordial prevention to the, to the end of life and includes everything you know in between. So that's, you know, with respect to why we did not focus on heart or even stroke patients. Our goal was to be able to talk about these models more broadly. And so we wanted medically complex patients, but we wanted them from, you know, covering a diverse population of you know disease conditions. And all the demographic variations that was our goal to get as broad a picture as possible of how these mod this model impacts overall health. Yates Lennon OK, great. And sort of thinking more about the American Heart Association. Its its purpose, its mission, what has been the this sort of a two-part question. So what has been the stance of the American Heart Association as it relates to value based care? How does it align with the organization's broader mission, which you just described? And then lastly, does this research alter your stance the association's stance on value based care is it put fuel on the fire sort of address that for us as well. Melanie Phelps Yeah. So the American Heart Association has published pretty extensively on this topic. And we support efforts to transform to a more effective system that recognizes and pays for better care and outcomes over the volume of services rendered right? We support a health system that is person centered, that focuses on improving individual as well as population level experience and health outcomes that promotes equitable health and rewards our healthcare workforce for how well they do as opposed to how many billable services they can provide regardless of outcome and through value based care and all that it entails including its focus on prevention. We believe it furthers our mission of a world longer, healthier lives and our vision of enhanced of enhancing health and hope for everyone everywhere. And you're the third part of that question I have forgotten. Yates Lennon Does does the research alter the association stance on a value based care? Melanie Phelps Yes. No, I don't think so. I think it further supports our stance, yeah. Yates Lennon Well, you just mentioned you've mentioned preventive Care now. I think with the last couple of comments you made a couple of questions. Was there anything you learned in particular about preventive care in the ACO model that would did it vary among the groups that you assessed and, just talk a little bit more about the AHA's perspective on preventive care. Melanie Phelps With respect to the study findings, I think across the board. From the healthcare team member perspective, they all mentioned the focus on closing gaps in care and that is that is huge. We didn't have a question that really delved into preventive care on the patient caregiver side. You know, but generally they felt better cared for, but as far as the AHA on the focus on prevention is really key. OK? And ACOs are just better at closing those gaps and intervening early and fee for service just failed to do that well, right? So we're big believers in the need to focus on life's essential 8. That means eat better, be more active, quit tobacco, get healthy, sleep, manage weight control, cholesterol, manage blood sugar and manage blood pressure. So under an ACO, these are more likely to get the attention that they warrant. Yates Lennon Yeah, that's right. And I want to, The first one you the first of your eight was I think 8 better. In reading through the study, I may have missed it, but did you have any ACOs that provided like nutritionists or nutritional support? Melanie Phelps That that had diabetes educators and dieticians. But there wasn't a question that asked them to enumerate everybody on the on the care team. So there were some that were really, you know, sophisticated and have a deep bench. And then there were others who did not have such a deep bench of a of healthcare professionals. Yates Lennon Right. So how is the American Heart Association advocating for the transition to value based care? Like, are there certain policies you all are supporting and what strategies are you employing to sort of promote this move to value based care? Melanie Phelps We really strive to ensure that patients have access to the most effective services possible, but in order to for that to happen, patients must first have access to health insurance coverage and that's the priority. This is the Nice to have, right? So access to care and especially access to effective and efficient care theoretically should improve affordability, which should improve access. But that is a step removed from the focus on access to coverage and with some of the changes that have taken place recently, I think that there will be a double downing. We and similar patient and consumer advocacy organizations will be doubling down on efforts on that. Protecting access to coverage. So this might take a step back. Unfortunately. Yates Lennon Well, Melanie, thank you for joining us on the Mood Value Podcast today. I wonder if you would be willing to stick around for a few minutes for us to continue our conversation. Melanie Phelps Of course, I’d be happy to.

Today we continue our ACO REACH conversation with Kim Williams, who discusses how this model facilitates enhanced care for the patient. She also shares insights on measuring success, engaging providers, and the broader impact of ACO REACH on healthcare equity and value-based care Thomas Royal Kim Williams, welcome back. Thanks for sticking around so we could continue our conversation here today. Kim Williams Thank you, Thomas. I'm happy to be back and ready to continue our conversation. Thomas Royal So last time you know, we discussed a lot of the nuts and bolts of ACO reach. You know what it is, how it helps us, the various entities that are involved. One of the things that I want to talk about a little bit is the is the patient. So we, you know, previously you mentioned a HealthEquity plans sdoh screenings. What beyond that and including that specific advantages, does ACO reach offer to the patient compared to traditional fee for service models? Kim Williams Yes. So, in ACO reach the advantages for patients are actually quite substantial. Especially in care delivery through waivers or what they call benefit enhancements and incentives. So, for example, with the public health emergency coming to an end, a lot of the telehealth flexibilities that existed during the pandemic are no longer an option after March of this year. So if you were if you are an ACO reach, this is still an option through the telehealth waiver, which removes geographic restrictions and allow patients to get care from their provider regardless of where they are. So you know they can be in their living room doing a check in visit. It is so beneficial for rural communities and patients with mobility issues. I've had site visits with providers that really stress the importance of telehealth because they are in a more rural setting where it's not, you know, good for the patient with mobility issues to go back and forth to the offices. So I think that's definitely a huge plus for those types of population. There is also a financial benefit play that patients can take advantage of, and that's through the cost sharing for Part B services. Now this one allows reach ACOs to reduce or eliminate cost sharing for Part B services and remove financial barriers for things like a primary care visit or your chronic care management, even preventative services. So for instance, CHESS has it set up right now to where we can waive chronic care management co-pays. And so the hope is that. If we're able to waive those co-pays, patients will be more willing to seek intervention. And really participate in chronic care management programs when you know they're not too worried about those co-pays. Chronic care management is just super important in this model, alongside of transition of care management because it focus on preventions. And so I think again this is a win win situation for both providers and patients and also ACOs alike. Thomas Royal Well, that's fascinating. I so I I know that when we talk about there's options of care and financial efficiency for the patient, how does the program ensure patient receives more coordinated and personalized care? Kim Williams Yes, so care coordination plays a huge role in ACO reach. And you heard me mention earlier that implementing the HealthEquity plan requires coordination from everyone. But I want to specifically highlight the great work that care coordination teams put into personalizing the care for our traditional Medicare patients in this population, right? So first the the outreach to the patients are beyond the normal amounts and I'm I'm using our HealthEquity plan as an example here because our care management teams spend more time on the phone with patients, really to better understand why. Why are they not getting their cancer screenings, for example? And often we get clues to help us solve the next piece of the puzzle. So for example, through these phone screens, we learned that one of our patient refused to get a cancer screening because they were scared and it might sound simple, but we didn't know that because typically you will look in the chart and you see that the patient declined but you don't know why. And they weren't sure. In this instance, the patient was not sure that the cancer screening, what that entails, they wanted to connect with their providers more. So, they made, you know, the care management teams really made sure that that patient got that proper visit to where their providers can set aside time to explain to them the importance of this cancer screening and how that impacts the patient's care. And and another, you know, another patient that we found just really wanted someone to go with her to get her mammography screening. So, and that's just from a moral support standpoint. So, you know we reach out to family members, we reach out to some church members and sometimes even utilize our community health workers to just be there for moral support. And that's I think how you move the needle in care from this perspective. And that's just a couple examples from that one initiative. There are much more great work care managers do for patients on a daily basis when it comes to transition of care. And I think particularly under REACH, again, transition of care is just key to preventing readmissions and unplanned admissions in the quality measure domain, but you have to remain proactive with these patients. You have to offer social support and going back to the goals. In our REACH acronym because access and equity is part of this model. There are personalized efforts that we have to do for these patients in order for them to receive the right care at the right time and at the right place and I think REACH really shines a light on how we personalize some of those care for our patient populations Thomas Royal That's great. That's a lot of good investigation, discovery and support that's happening for the patient. Kim Williams Yeah, for sure. Thomas Royal I think that that's awesome. Kim Williams It was a lot of leg work in the beginning, but definitely worth it. Thomas Royal Yeah, it's great. It's great to hear those patient stories that really that really makes it real. A lot of times we get we get caught in some of the conversations about how things work and financial benefits and hearing, hearing the impact on the patient. Kim Williams Mm hmm. Thomas Royal I mean, that's why we do this. Kim Williams That's right. Thomas Royal And so does the provider. So, let's move on to what the key steps are for a provider or a health system interested in joining an ACO REACH program. How would they join and and what advice would you give to providers or systems considering participation in ACO reach? Kim Williams Yes. So, for providers who are interested in joining, let me just walk you through both the practical steps and the financial considerations. So for ACO REACH, there are no more application periods. If you want to be in this model, you would have to join an existing REACH entity like CHESS Genesis. I think this is also beneficial to know that you have to understand what appetite you have for taking on risk. So you want to assess your practice or network situation. Are you more advanced in risk taking? Do you know how to take care of traditional Medicare patients and do it well? Next, you would want to weigh your options. So there are two risk tracks in ACO REACH. The first option is the professional track, which takes on 50% upside and 50% downside. And then there is the global option that is full risk and that is 100% upside downside. And so for CHESS, we offer the professional track. So, if you're newer or not yet comfortable with being in a risk aggressive model and and ready to take on 100% of the risk. Then the professional track is a great option for you and that's something that we offer. But beyond the dollars, my advice is really to look at your patient population, your quality metrics, and your care coordination processes. Do you have success stories? Do you have those transition of care programs that you're comfortable with? Do you know what gaps you have in your network that you may want to use those upfront payments to achieve, and I really encourage you to reach out to us for more information, any of our CHESS subject matter experts can supply you with more information and run through different payment scenarios with you. Once you feel like you're ready, we have an awesome team of dedicated staff and compliance experts that can get you signed up into the model and work with you to implement it from from start to finish. Thomas Royal That's great. So. I'm a provider, right? I'm not. But let's let's just metaphorically say that I am for the sake of this argument, 'cause I can have I can assure you that a lot of people will confirm that I am not. So I'm a provider and I'm willing to take on risk and invest in new achievement and transformation. What resources or tools are available to me to ensure successful implementation and and how does, you know, specifically, CHESS support my practice or the health system that I work for in navigating ACO REACH. Kim Williams Well, one thing that's really impressed me about REACH is the support system. In contrary to other traditional Medicare models, we get a lot of reports for ACO REACH participants and we're able to do some really cool things with those reports over time. So here at CHESS, we've built an ACO REACH quality dashboards that looks at provider level performance month over month trends and it even has patient level information that we send out to our what we call our value partners on a regular cadence. We have predictive analytics tools that also identifies those rising risk patients and patients within various risk categories, whether it's high, medium or low. And we have that specifically for care coordination efforts, right. We can supply those to your care coordination team, or if you want us to hub your services, then we can definitely help prioritize which types of populations to target for gap outreach and just where to prioritize your work. We also do financial modeling. So again, if you're interested in joining ACO REACH, we model those financial scenarios for you. We will look at your historical performance and tell you how you could perform in the model and I think another important thing to call out is the claims reimbursement support because of the innovative payment structure that you heard me mention earlier. That requires some setting up to do, and so we have subject matter experts that can work with you to get these advance payments to your ACH account. We help you build out the workflows to ingest the files and be able to have this ongoing support from a revenue cycle perspective. And so I think we're also open to innovative payment structures at the NPI level. So if you think that you want something more innovative and want to incentivize certain NPIs, we can definitely work with you to build that out from a revenue cycle perspective as well. Thomas Royal That's great. Well, OK. So now I'm I'm in and I'm doing the right things. I'm I'm I have an open mind for new workflows et cetera. All of the things that that I'm I'm doing to transform my practice. So now how do I measure the success? What milestones should I look for, should I aim to achieve for this? Kim Williams So I think achieving shared savings is part of the equation, but because the model is so comprehensive, you heard me talking about SDOH. You heard me talking about HealthEquity planned. I see success in ACO reach really beyond hitting the financial targets. We look at the quality measures, were we able to avoid utilization? Did we perform in line with our peers when it comes to preventing readmissions and unplanned admissions? If yes then check I define that as quite successful, the HealthEquity plan, Needless to say, if you are moving the needle on your targets, even if it's just 1% or 2%, I think that is successful because that is a start. We are going somewhere and our patients in these vulnerable geographic locations are getting the care that they need. So that's a win in my book. For CHESS, we're celebrating the fact that we hit our goals this year in the HealthEquity plan and increasing our breast cancer and colorectal cancer screening rates by 3%, so I think it just it depends on you know what is it that's important for you, your patients and your community and that's how you measure success in, in, in this program. But there's several levers that you can pull to define success and you can start with some of these. Thomas Royal Yeah. I think to me that sounds like true success because that that's when everyone wins, especially the patient, and I think that's awesome. Kim Williams Yeah. And I also, Thomas, you know, I also think about provider engagement. I think about our wonderful provider champions and how they were with us every step of the way in implementing this type of program. You know, they had invested interest in HealthEquity from the beginning. A few even volunteer to go through the leads list and call every patients on the list so we can achieve our goals. We had providers that encouraged us to look at a different perspective when it comes to timely follow up visits because they knew that their offices are booked and so access was going to be a challenge. Well, if access is a challenge, how can you get patients that are timely follow up right? And so they push us to think about telehealth options and these are the things that makes me love what I do. And I love that the ACO REACH program really sparks conversations around things that matters to the patient. So I think any of those things can be defined as success and wins. Thomas Royal Agreed. That's that's very collaborative model. I really like this. OK. So let's pivot a little bit here if I may. I want to. I want to know more about what you think, so I'm going to use the old crystal ball metaphor, if you don't mind. If you had one. If you had a crystal ball, Kim, what do you see in the future for ACO reach and if it does go away, what lessons did we learn from it that can be applied to other value-based care models? Kim Williams Yes. So, with ACO reach, it does run until 2026, but I see the principles of ACO REACH becoming more ingrained in how we deliver healthcare regardless of what they decide to call the model in the future, right. The lessons we're learning about addressing HealthEquity coordinating care beyond the clinical settings and also focusing on those preventative measures are all fundamental shifts and those things are here to stay. So even if the model evolves these core principles, in my mind, you know the equity, the access, the Community health, I think we will continue to see components of this in future iterations. I also think that under the new administration we will see CMMI try and add additional values and additional levers, maybe giving us more waivers to create a more Medicare Advantage competitor in the traditional fee for service market. So I could see some of these models, maybe not an ACO REACH, but others becoming mandatory, assuming that the new administration wants to get every beneficiary or patients in a value based care model by 2030 and that's, you know, that's been the goal that the CMMI and CMS has had for a very long time is to get these patients into a value based care model by 2030. Thomas Royal Fascinating. Well, we'll see. I'm very confident in your accuracy because of your expertise. So what's one thing you wish more people understood about the potential of ACO REACH Kim? Kim Williams Well, I think we touched on this, but with the right collaboration, it has the potential to really disrupt the fee for service game and it has to be felt from top to bottom, right. Everyone would have to understand how this is driving change to the national culture of reimbursement model that's been in place for decades, and I'm talking about that fee for service. So, ACO REACH is, you know, it's just that pathway to practicing medicine the right way. And how we've always wanted our health systems to do this, and now we have the flexibility to address the root cause and do something about it, but we need to do it together and in much more collaboratively. Thomas Royal Agreed. Well, well, Kim, I always like to end with asking what's something that I haven't asked? What questions am I missing in in terms of the nuts and bolts of ACO REACH, the impact on the provider, the system, the patient, the payer, what's one thing that you want everyone to know or to touch on before we wrap up today? Kim Williams I think we've highlighted all of the operational levers and the financial impact of this model, but I also, you know, encourage everybody to think about this from the patient perspective, especially if you are, you know providers within a system. Think about where Healthcare is going, right? There's been a lot of different models over the years. Now we're looking at a new administration, so we're expecting for things to change, but you don't want your patients to kind of fall behind. And so as you are thinking about participating in ACO REACH, just know that there are so many substantial benefits that patients can receive from this type of model. And you definitely have support teams at CHESS that can help walk you through what that could look like for you. Thomas Royal Outstanding Kim, this has been great. I appreciate your time today. Kim Williams, thank you for joining us today on the move to Value podcast. Kim Williams Thank you, Thomas. It was a pleasure to be here. Thanks for having me.

In this episode we hear from Kim Williams, Senior Manager of Government Programs at CHESS Health Solutions about the value of ACO REACH. She shares her expertise on what it is, why it was created, and how it benefits the patient and provider by being a care collaboration model that improves quality while incentivizing health equity. Kim Williams, welcome to the Move to Value podcast. Kim Williams Yeah. Thank you so much for having me. It's really a pleasure to be here. Thomas Royal So Kim, today I want to explore some of your knowledge that you have and your expertise. So let's talk about ACO reach first. Can you explain what ACO reach stands for and how it differs from the other ACO models? Kim Williams Sure, I'm happy to. ACO REACH stands for realizing equity access and community health. And really, the differentiator of this model is in the name itself. It's looking at HealthEquity and getting patients access to care in a timely fashion, but it's also looking at social needs and also working with community health providers to have a more coordinated approach in the patient's care journey. And so a lot of the programs requirements that we see are centered around those core principles. And this is a huge shift away from your traditional fee for service model, where everything is based on quantity of services to now looking at value. Now we are looking at not just at the bigger picture. We're looking at the entire picture. We're looking under the rugs and we're addressing root causes in this ACO reach model, also part of what makes this model unique is in the innovative payment structure and that is what I call a capitation-like model. So this means that CMS will give us a prospective payment upfront and providers have the flexibility to structure that payment however they want to do that in a multitude of different ways. So one option is that a provider can elect to do a fee-for-service pass through where you are paid 100% of what you Bill to Medicare. Or you can elect to get 90% of what Medicare pays you. With an option to earn back bonus payments. Or if you don't want any of those options, you can also say, hey, just pay me a per member per month payment upfront. So that's called pmpm. Pay me that amount monthly or however they want to structure that arrangement with the ACO. So there's a multitude of different ways that you can go about this, and really the idea is that if the provider knows how much they're receiving up front to care for their beneficiaries, then they will be motivated to stay under that threshold and that benchmark. And that's really where the shared savings comes in. So I think the ability to select these payment options based on what you're comfortable with is not something you typically would see in other models outside of ACO reach. Thomas Royal Oh, that does sound pretty unique. Kim Williams Yeah. Thomas Royal So he touched on this a little bit, but I'd like to dig a little bit deeper and and if you could tell me what are the core goals of ACO reach and how does it align with the broader shift towards value based care and how does this model prioritize Health Equity and patient centered care in its design? Kim Williams Yeah. So, earlier you heard me mention that the goals of this model are centered around Health Equity access and community health. And so I want to camp on certain components of those levers. So I want to expand on why that matters and talk about the Health Equity for example. So as we're moving away from again the traditional fee for service and moving towards value based care, you see more and more payers prioritizing patient, HealthEquity and social determinants of health. Or SDOH initiatives that are designed to impact care outside of the clinical settings. And that's because we know if a patient does not have transportation or if they have food insecurities, for example, well, they may not be interested in going to get their cancer screenings or their medication refill and so this impacts their health and it contributes to the total cost of care that we don't want in our healthcare system today. And so as we shift to value based care, we have to look at the whole picture. We have got to solve for social issues and to figure out what that means for your community. You do have to look at the inequities within your region and the ACO reach model. Really prioritizes this mindset. So the Health Equity plan, for example, that is a requirement under this model that allows us to target the problems in our backyard that we know exist today. But because of the lack of resources or conflicting priorities, even the processes that we have today to take care of our vulnerable patients and these populations has not been maximized to its fullest potential, right. The Health Equity plan in itself is very patient centered, and it's crafted with specific solutions to what we know about our patients today. But that's going to require that you do your research to figure out what disparities you have, so that means looking at the data, figuring out solutions for what you want to solve. And under this requirement, they're going to ask us to write up an implementation plan that tells CMMI how you plan to make your health disparities better. What types of resources do you think you're going to use? How are you planning to mitigate risk of further exacerbating this disparity and and how do you want to measure and define success, right? So if you think about all of that, it's not a one-size-fits-all approach and it's not something one person or one organization can accomplish. The Health Equity plan is not going to be very successful. If you don't engage your executive teams, your community leaders and your physician champions. So it's going to require that everyone from the top down prioritize and collaborate together to make this happen. And that's what chess has had experience in doing in ACO reach. We knew we wanted to impact patients in certain geographical settings really in those vulnerable territory. So, you know, think about. Your low income housing zones. Your flood zones. Think about the areas that has a lack of access to transportation, and so we brought all of this data. All of this information to our physician leaders and our executive leadership teams. And we said, well, here's the data. Here's what we know. Now, how do we want to work together. What types of interventions do you think are best for our patients? And so I think it it all begins there when we're wanting to target Health Equity. Now thinking about the broader shift to value-based care. Here I also think it's important to call out again that innovative payment delivery that this model offers. So I think the model creators know that there are communities who face significant risk factors like the ones in our Health Equity plan and and probably more outside of that as well. And so that's where they will give you this upfront payment so you can invest in resources to help wherever you think may be helpful, right? Maybe you want to invest in a risk stratifying tool to figure out who's in the high risk or rising risk category. With this upfront payment you can implement these tools, or if it's not technology that you need, you can hire more social workers and or care management teams to support whatever it is you think can further your journey and value based care and is best for your patients. So I think REACH is really designed to sustain transformation and population health and now we're tackling deep rooted issues that would otherwise be swept under the rug by maybe a lack of resources or lack of awareness, and that's really going to reshape how we deliver care today and in the future with this model. Thomas Royal That sounds really beneficial for the patient, Kim. That sounds like it's it's a shift away from. You know how things have been going as far as the determinants? I think that's really important. And I heard you talk about the upfront payment. Kim Williams Yeah. Thomas Royal So I mean you, if you include that in, how does participating in in the reach impact a day-to-day operations of the provider? And what are some other key financial incentives for those participating? Kim Williams Yeah. So I want to break that down into two different buckets of how that's going to impact the providers and the practices, right. Thomas Royal OK. Kim Williams One from an operations standpoint and one from a financial impact standpoint. Operationally I think of ACO reach as a care collaboration type of model in one area that the collaborative effort comes into play is how we impact the three claims based quality measures in this program. Thomas Royal Alright. Kim Williams Now, in MSSP and other contracts, we see more clinical quality measures that were being held accountable to. But in Reach 3 out of the four measures has to do with keeping patients out of the hospital, preventing readmission and unplanned admissions and getting patients their timely follow up visits, post discharge and so operationally, providers and staff, they do need to work together to help their patients avoid these hospital visits. But we also want providers to do those comprehensive disease management programs, those transition of care. But we want providers to lean on their care management Staffs and their teams because those transition of care supports are just really, really critical in the success of this program. And strategically, CHESS has had experience in implementing strategies that really target these utilization types of measures. And so yes, we do want providers to help us see the patients and and open their schedules for these patients to come in, but we also want to help we from the ACO level can really help build an infrastructure in place that could maybe alert offices that their patients have been admitted in discharge. We can evaluate your admission, discharge and transfer data feeds to see if there are blind spots and come up with solutions to make sure we don't miss the opportunity to reach out when these patients are, you know, in their most vulnerable points because that's how well how you do well in this model, right? Thomas Royal Hmm. Kim Williams And so that's operations, but from a financial perspective and I think I alluded to this earlier, but ACO REACH offers that upfront payment if for some providers that stability in payments offers a predictable income upfront and you don't have to wait for your fee for service claims to be processed sometimes that takes a while. And So what you could do is potentially use this upfront capital to invest in resources for your practice, so you could use some of this capital and hire more care coordination team members or community health workers. From a financial perspective, the hope is that if you know your allowance for this patient is, let's say, $500.00 for example. You'll try to take care of them for less than that amount, so just don't go over that 500 and that's where your shared savings is going to come in. That's your incentive for participating. Thomas Royal Well, that's that's very interesting. And and you know when we talk about the benefit to the provider, we talk about the benefit to the patient you know and when you mention utilization and access. So how does that how does ACO REACH create those opportunities for health systems to enhance those value based care initiatives and and in what ways does it help address cost while maintaining or improving quality metrics? Kim Williams Yeah. So in REACH there is this benchmark methodology that looks at communities that serves more complex and or underserved patients. And so there is this benchmark play that reflects that reality. So what they do is CMS will allocate more dollars to the benchmark for those providers with high need patients to take care of them. So that in itself gives health systems opportunity to expand care to more traditional Medicare patients. Maybe they're in rural settings and you know, maybe they're in those Health Equity population setting that I spoke to earlier in the flood zones and areas where there's a lack of resources, but again, receiving those prospective payments upfront, for example, if you know that you have a large population of patients with diabetes within your health system, where you can use those prospective payments to invest in diabetes education, you can hire a nutritionist or partner with one in the community and maybe do some type of incentive plans that can better coordinate the care for your patients across their care journey. And there's just so much flexibility in how you want to spend the funds. And the model understands that sometimes the best medical intervention isn't necessarily medically related. So think about your social determinants of health infrastructure, and maybe allocating dollars to those types of programs we know. Thomas Royal Hmm. Kim Williams SDOH can help address the cost of care and really improve our quality metrics. But it also improves our patient's quality of life. And so I think from my perspective, it's just a win, win situation if you spend these dollars wisely and ACO reach gives health systems the flexibility to do that and and really make it work for your network and only health systems know that best. Thomas Royal Agreed. Well, we we've talked about patients, providers, the health system. But we haven't talked about the payer. How does the program promote collaboration amongst all of these groups amongst the health system, payer and the provider? Kim Williams Yeah. So I think REACH really breaks down the traditional silos in healthcare. So in the ideal world you would have what I like to call a medical neighborhood where your primary care providers, your specialists, your community based organizations, or CBOs as they're called, they all talk to each other, so while we're not quite there, where everyone can communicate in the same platform. You know, this model gets you thinking about these things, both from a health system perspective, both from a payer perspective. So these medical neighborhoods and really getting to think about why it matters to the patient. So one of the area that I think promotes the most collaboration in this model is the requirement to screen SDOH and we also see this in the Health Equity plan that we talked about earlier but with social determinant of health screenings, because this model requires you to screen all of your patients every year there has been sparks of conversations from providers on how to get help for patients who has a positive SDOH screening. So for example, if a patient is identified as having food insecurities, we're seeing more provider engagements and making sure that they communicate to the social impact teams to their social workers to get help for for these patients. And sometimes it could be a referral to community based organizations and then the community based organizations would send, you know, community health workers to the patient's homes. They'll bring them food and they'll do their health screenings then and there, right? So I think we're in this building block phase right now where this is all new, but we're seeing a lot more questions, a lot more “well, what if this scenario happened?” And I think that's really exciting to solve for and I think the goal of ACO REACH is to get those conversations started. So meaningful change starts with meaningful conversations, and I think even from a payer perspective, we're helping them collect this SDOH data. So they can evaluate resource needs that they would need to help implement in order to move the needle in value-based care. Because if you think about our CBOs, I mean, they're great. They're willing to work with patients that screen negative for these social needs, but they are also limited on funding, and so the data that we collect can again start those conversations from a payer perspective on how much resources are needed, where and why, and I think I think that's a beautiful start and I think we're also going to see some similar concepts from ACO reach being kind of translated into other payer programs and future model iteration and the participation in ACO reach for providers is really just going to propel you forward of you know, what's the common in value based care in the future. Thomas Royal Outstanding. Kim, we've we've come up against time, but I I'm hoping that you can stick around for a little bit and we can have some more conversations around ACO REACH and perhaps delve into what it benefits for the patient. Would you be willing to stick around with us? Kim Williams Absolutely super happy to be here.

In today’s episode, we revisit our episode with Josh Vire, Vice President of Value-based Operations at CHESS Health Solutions, where he discussed what has been learned during the move to managed Medicaid in North Carolina and what CHESS brings to the table with its all-patient solution. Josh Vire, welcome to the Move to Value podcast. Thank you, Thomas. Thanks for having me. Pleasure to be here. So, Josh, let's talk about managed Medicaid. First, can you tell me what is managed Medicaid? Sure. It may be easiest to start by sort of describing how traditional Medicaid works. In traditional Medicaid, typically this operates under what's called a fee for service payment model. This model is going to reimburse providers directly for every service that they provide to Medicaid beneficiaries. And generally the upside to this model is that it's going to allow for the flexibility and provider choice for the beneficiaries. But what we often see is that this leads to fragmented care and ultimately the incentives in this fee for service type model really incentivizes the volume of services over outcomes. So, in contrast to that, Managed Medicaid utilizes alternative payment models including capitation and what are called value-based payments. And the way that the capitation works is that a managed care organization or a MCO as they're referred to will receive a fixed monthly payment per Medicare beneficiary that's going to cover all their health care needs. And then that fixed payments are paid regardless the amount of services that are provided. And then those MCOs are going to use those funds to incentivize providers to be more cost effective in their care as well as incentivize sort of tighter coordination of the care. And then what they can layer on to those, as I mentioned, is the value-based care payments which are intended to reward providers based on the quality and outcomes of care rather than just the quantity of services provided. And so in theory, right, this would encourage more efficient, high-quality delivery of care. In addition, managed Medicaid may employ other payment models that are along that continuum of value based care payments, which could be like pay for performance or bundle payments. But really the goal there is to align the incentives to focus on driving down total cost of care as well as improving health outcomes for beneficiaries. Well last December North Carolina made the transition to managed Medicaid and Chess spent the year prior to that establish establishing the infrastructure and beginning to make preparations to offer this service. Can you tell me why this decision was made and a little bit of the story about how Chess built this service line. Absolutely. CHESS has a decades plus long history of working with providers to transform care delivery to value based care. And historically our focus has been on traditional Medicare, Medicare Advantage and commercial contracts. But as we went through our engagements with our value partners and then as we began to have discussions with providers across the state, we heard consistently that one of their pain points was the need to work with of having to work with multiple enablement companies to serve all their patients. So some enablement companies only work with MA or maybe the traditional Medicare options or commercial. But no one was really acting as sort of a one stop shop in in serving the entire patient population for these providers. So our decision to expand our services to include Medicaid was really driven by our desire to be what we call an all-patient solution, which essentially just means we want to be able to align incentives across the provider's entire patient population. And really that's because we believe this is how true transformation can and will occur, not in certain segments, but by treating all patients with an eye towards that cost containment and better outcomes. Now we were fortunate that we had a sister company that focused solely on Medicaid for a number of years. So over the last year, our focus has been on adopting the knowledge, building the care management capabilities, the platform, our data and analytics capabilities of our senior of our sister company into the CHESS environment. And so I'm actually pretty excited to announce that that transition was completed earlier this month. So Chess has now reached our goal of being an all patient solution for practices in North Carolina. That’s outstanding. Congratulations. I know that there there's a lot of hard work that went into that. A lot of hard work, a lot of hard work, a lot of lot of commitment from a lot of great folks on our team. It's been, it's been a journey but we're super excited about it Outstanding. So Josh, formerly Medicaid, let's talk about delegation for a second, so Medicaid practices were delegated as Carolina access one and two and now practices are called advanced medical home or AMH. So what are the differences in the AMH tier 1-2 and three and how would a practice move from 1 tier to the next and is it possible for practices to be downgraded? Sure. The answer, short answer is yes, it is possible. And when we look at the AMH tiers, there are kind of two factors really to look at. One is who's primarily responsible for the care management and then there's the level of care management service that's actually being delivered. So if you look at tier one, which is the lowest tier, health plans are primarily the ones responsible for ensuring that patients receive care management services. And on that continuum of care management intensity, this offering just tends to be more broad and generally targeted. So looking at getting folks in for annual Wellness visits and follow-ups, but generally more less targeted. for Tier 2, typically the health plan continues to remain primary responsibilities for care management, but the interventions tend to be a bit more targeted to specific populations. And then there's Tier 3, which is the highest tier and that's where we really want practices to be because it allows for practices to assume primary care management responsibilities either directly or through a partner such as CHESS. And then Tier 3 also allows the practice to receive higher payment than the other tiers. But the requirements are more stringent. So for example, practices have to be able to receive claims, meet data and security requirements. They have to be able to risk stratify patients, provide complex care management and provide transitional care management. So while it is the where we want to get practices to in terms of the tier, there's a lot of requirements that come with that. And so that's sort of the determining factors. And so yes, a practice could work with either build internally the capabilities or again work with a partner's CHESS to reach to Tier 3 or if they choose to not receive those Tier 3 payments, they could pare down and move to a up and down that Tier to a Tier 2 or to Tier 1 performance category. Interesting, Josh, in your mind, what has been the biggest hurdle you've seen in entering the managed Medicaid market and how has chess overcome these challenges or these barriers? Yeah, it's, I would say there's many little hurdles as opposed to one big hurdle and a lot of it has to do with just sort of the newness of managed Medicaid and that transition. So as we've been working with the multiple health plans, the PHPS to get into this space, what we're learning is that communication is, is challenging because they all sort of talk about things in a different way. There doesn't seem to always be a cohesive way in which they're talking about their contracts and how they're set up. There's also then a lot of administrative burden that is placed in, in doing managed Medicaid. There's requirements that are pretty stringent that cause sort of operational challenges. But in general though I again as I mentioned before we've been very fortunate that we had the sister company that who has been dealing in Medicaid for a number of years and being able to transfer those people, those resources, that knowledge into CHESS to be able to enter into this market has been a been a huge benefit for us to overcome. And I think is what is allowed me to say that we don't have a big hurdle they're just little minor hurdles that we're working through as we're entering into this market. That's great. Well, what are the three core services that CHESS offers? Yeah. So in speaking with practices, what we learned is that as they as they have sort of evaluated their services in in getting to Tier 1, Tier 2, Tier 3, where they should, where they should be going, what they should be putting in place that there's specific gaps that they that they faced that didn't allow them, that may not allow them to maximize the opportunities available in the managed Medicaid program. So what we've tried to do is to design our offering around these specific gaps. So just quickly the first gap that a lot of practices said that they would have in in entering into managed Medicaid is information systems and data aggregation capabilities to be successful when managing their Medicaid populations. And so we offer a comprehensive population health platform that manages all data integrations including those from the payer and other disparate data sources. And this platform is designed to meet all the AMH Tier 3 requirements, so we can handle that for practices or licensing that to them. Another area we heard that practices lack the ability is to staff the full scope of care management services that are required for the Medicaid population. So what we've built is a full care management delegation offering where CHESS staff leverages our again decades of experience in care management, care coordination, and transitional care services and apply this to the Medicaid population. And then finally we heard that the administrative burden on practices from the contracting, the payer relationships, the routine auditing is, is a gap that practices have. So we're so our offering is to help to support practices through our CHESS Medicaid CIN, where in this offering CHESS not only does the negotiation & holds the contracts with the with the payers but we're also then on behalf of those practices can meet with the payers and joint operating committees and act as the liaison to solve any of the hiccups or issues that may arise between the providers and health plans. So I think those are really the three core services that we offer in Medicaid that we feel will really fill those gaps for practices that are engaging in managed Medicaid. That's great. You know I know that CHESS has been an innovator and a leader for many years in in a lot of the components of population health. So, I I'm curious as how chess is supporting those big three components of population health for Medicaid and of course this includes reporting, data, and care management. I know you just spoke to that a little bit, but I'd like to hear more about the support that's provided. Yeah, absolutely. So again, this gets a little bit more into our, our comprehensive population health platform that I referenced a minute ago. And so if we start with data, our data activation platform leverages a myriad of data sources. If I'm recalling correctly, I believe it's somewhere around 200 prebuilt connections to IT vendors that that we have that we can integrate together and while providing the highest level of data and security per HIPAA and the state regulation. So we can offer that and then offer advanced analytics that can drive insights that can improve health outcomes and reduce that total cost of care. And a little bit deeper then in the reporting is when it we offer an analytics tool that allows for you know data visualization, risk stratification of the population, also allows for any SQL data and retrieval manipulation if so needed. And our platform allows practices to drill down then at the practice physician and patient level and there's several built in dashboards that that we can report out on performance from the providers, total cost of care drivers, network lease leakage, contract performance and medication management just to name a few. So very robust reporting suite and offering that we have in our platform. And then of course our platform supports the documentation and delivery of the important care management information including assessments and care plans. And we have over 20 plus assessments that assess physical, behavioral, social determinants needs. We can also identify care gaps and can help coordinate the proactive interventions by utilizing a pre-existing library of customizable assessments and care programs. So this comprehensive platform really kind of is intended to focus on those big areas of data reporting and care management because we know those are what's really important to drive improvement in the health of those Medicaid population for those providers. I know that that's really helpful on the provider level navigating some of those really big hurdles and overwhelming things that that folks are having to go through with Medicaid. So, if a provider group is interested in getting support with Medicaid, what are the engagement opportunities? Yeah, it's a great question. And one of our sort of overall goals at CHESS is you know, we often say we're not a rip and replace shop. We try to meet providers where they're at, leverage the existing capabilities and staff that they have if they're happy with those. And so we've designed our engagement opportunities, our engagement models within Medicaid to fit that, to fit that thinking. So the first and sort of basic offering is a licensing of that population health platform that I just mentioned. So with that provider could have access to the to the platform which has all the IT and security requirements. We then handle also the any full delegation of the audits that are required. And so that's really beneficial for those who have built the care management capabilities. But to get to those level or that Tier 3 payment requirements really need a robust platform that meets all of the requirements that are recall required by the state Medicaid program. The next option is our full care management delegation. So in that instance practices would have their own contracts with the with the health plans and then they would delegate care management activities to CHESS care managers. And of course we utilize our platform to document, provide the assessments, the care plans and everything I mentioned before and manage those patients, all the patients within a providers panel. And then we have what we also call our CIN model which is essentially very similar to the care management delegation engagement model I just mentioned with the primary difference being that in this model Chess would negotiate and hold the contracts on behalf of the practice with the PHPS. Care management is delegated to CHESS staff and we will manage that population. But then we also go further in helping to support and be that liaison between the practice and the health plan in providing panel and roster management support and again any support with issues that may arise. And then also create a learning collaborative with other providers in the state to collaborate and discuss what's working well, what's not working well, where there's some ability to collaborate and to help manage the populations better. So those are our three primary engagement models for Medicaid. That sounds pretty comprehensive. Josh, you've been doing this a long time, and you know you you're well known throughout our industry as being an expert. So, I would like to get some free advice from you for myself and any of those who would be listening. And as you, you know your deep immersion over the last few years into the Medicaid space here in North Carolina, what advice do you have for practices who are looking to get into the managed Medicaid space or for that matter, value-based care in general? Yeah, I so thank you first for the for the kind words. I appreciate that. And having been on you know in practice management being on the practice side, I would say my advice is for practices to really do your due diligence and make sure that you're whatever path you're seeking to go on that you understand what the requirements are so that you're really maximizing the opportunities within the managed Medicaid program. Because the intent there again as I mentioned, as we talked about the payment models really is to create and incentivize better ways to manage those populations. But they do come with requirements. So you need to know those. You need to be really do your due diligence and if you decide to work with a company like CHESS to support you on this journey, just make sure that you're working with somebody who's really acting as a partner. So make sure that they're providing you with regular touch points and discussing the patients, what are they doing with them, what are they seeing, what are they in need of and sharing that back with your with your physicians and your providers, that they're providing regular reporting to address those social determinants and those needs of the patients and that they're supporting you in managing those relationships with the health plan. There's again one of the hurdles that we have found as I mentioned is really that communication and understanding how the how one health plan is talking about something and what their goals are versus another health plan and you really need it can be a daunting task to really have to manage that on your own and so I'd say you know while it can be daunting you don't have to go it alone or settle for a less than optimal support. There's options out there obviously being CHESS I think we do it as well if not better than anyone else out there and I'm happy to help them support and provide that advice to practices whether they end up going with us or not. We want to be there and be a support for the practices in North Carolina. Outstanding. Josh Vire, thank you for joining us today on the Move to Value podcast. Thank you, Thomas.