CVS Health and inVio Health Network collaborate on new accountable care organization through ACO REACH program

CVS Health and inVio Health Network Collaborate to Create New Accountable Care Organization

CVS Accountable Care Organization, a division of CVS Health, and inVio Health Network, a collection of over 5,600 providers in South Carolina, have joined forces to establish a new accountable care organization through the ACO REACH program.

The ACO REACH program aims to enhance patient care by offering coordinated, patient-centered services to improve the overall health, clinical outcomes, and satisfaction of traditional Medicare patients. This collaboration will strengthen care coordination for patients by utilizing advanced analytics, value-based care, and population health management services and programs.

inVio Health Network was formed in 2021 when Prisma Health Upstate and Prisma Health Midlands Networks merged. The partnership with CVS builds on their success in the Medicare Shared Savings Program, where they managed Medicare patients effectively, reducing costs by over $81 million while maintaining top decile quality for more than 60,000 patients.

Dr. Bill Gerard, CEO of inVio Health Network, expressed excitement about the enhanced resources and clinical services that will be available across the network through collaboration with CVS Minute Clinic locations in South Carolina. He emphasized the shared goal of improving healthcare quality and outcomes on a regional and national level.

The ACO REACH program replaced the Global and Professional Direct Contracting Model, which faced criticism for potentially privatizing Medicare. In response to stakeholder feedback, CMS announced changes to ACO REACH for 2024 to increase predictability for participants, protect against inappropriate risk score growth, maintain consistency across programs, and advance health equity.

However, ACO REACH came under scrutiny in 2022 when lawmakers raised concerns about alleged fraud within the program. Approximately 20 lawmakers reached out to CMS over suspicions of healthcare fraud involving at least 10 participants in the earlier model.

The collaboration between CVS Health and inVio Health Network represents a significant step towards improving patient care and outcomes in South Carolina and beyond. The focus on coordinated, patient-centered care and advanced analytics highlights the commitment to delivering high-quality healthcare services to traditional Medicare patients.