Complex Care Alliance is a group of geographically diverse participants in the High Needs ACO program and partner organizations supporting this important work. We are committed to improving models of care for the sickest Medicare beneficiaries to meaningfully improve quality of life and reduce program spending.
Members
Partners
Issue Statement
The High Needs model was designed to provide high-quality, coordinated care for Medicare’s most complex and vulnerable patients. Originally part of the Global and Professional Direct Contracting model launched under the Trump Administration and now part of ACO Realizing Equity Access and Community Health (REACH),the model is currently set to expire in 2026. Given the promising early signals that it is improving outcomes and reducing costs for high need patients, it is critical that the Centers for Medicare & Medicaid Services (CMS) and the Innovation Center take swift action to ensure that patients have continued access to high-needs focused accountable care beyond 2026.
Accountable care models are essential for high needs patients because they enable the pro-active, team-based care that is impossible to deliver under a fee-for-service payment system. To support high need beneficiaries and their specialized care providers, accountable models must include flexibilities and design elements that are tailored to the unique needs and characteristics of these patients.
Results Show Cost Savings and Improved Care
The High Needs ACO program has already demonstrated promising impacts on utilization and cost. A recent evaluation showed gross savings of 3.5% and reduced emergency department visits and hospitalizations.
Resources
House Call Providers is a home-based primary care and hospice organization in Oregon using a team-based model of care to care for patients with serious illnesses.
Read how PSW helped a woman in her early 80’s struggling with frequent emergency department visits due to unmanaged anxiety and depression, improve her overall health through their accountable care efforts.
See how a partnership with agilon health and Central Ohio Primary Care meet the challenges of patients by providing value-based care dollars to provide palliative care at home.
Read how SOFHA applied funds generated through the Medicare Shared Savings Program to get this patient the care she needed in our “Accountable Care in Action” case study.