CVS creating new ACO in South Carolina through REACH program

CVS Accountable Care and inVio Health Network, a collection of more than 5,600 providers in South Carolina, are partnering to improve care outcomes for 60,000 Medicare beneficiaries.

The two partners will create a new accountable care organization under the ACO REACH program. CVS will provide the resources and analytical know-how necessary to scale inVio, the groups told Fierce Healthcare.

It is CVS Health’s only ACO REACH partnership in the state, helping advance health equity issues and address social determinants of health.

Mohamed Diab
Mohamed Diab, M.D. (LinkedIn)

“There are a lot of needs of this population after what they’ve been through in the COVID-19 years,” said Mohamed Diab, M.D., president of CVS Accountable Care and senior vice president for CVS Health.

Discussions began between CVS and inVio in early 2023 and the ACO became operational in January. The network will work with CVS MinuteClinics throughout the state

Similar to other Medicare populations, he sees this value-based care partnership as a way to ensure people with chronic conditions and comorbidities receive better care. The partnership, with assistance from a multidisciplinary care team, will help members adhere to medication and seek out primary care providers instead of defaulting to the emergency room.

In 2021, Prisma Health Upstate and Prisma Health Midlands Networks formed to become inVio Health Network. CEO Bill Gerard said they weren’t looking for a partner but realized values and missions aligned. They’re encouraged so far by CVS’ willingness to interact with inVio, not just when pitching the collaboration months ago but to this day.

“This is really a big one for us, and really an eye-opening surprise to me that this is a very honest and sincere team that wants to do the right thing for the patient,” said Gerard. “You don’t think about that when you’re thinking about a payer a lot of times, but they really have changed my point of view.”

Bill Gerard
Bill Gerard (LinkedIn)

He stressed inVio will have better access to data to make the company’s work more “directional” as well as easier access to care managers, clinical documentation specialists and community health workers.

The company is looking closer at ways to accelerate health equity initiatives like access to transportation and addressing diabetic disease complications. Gerard also sees opportunity for delving further into home health initiatives.

ACO REACH has 132 participants. Some insurtechs have chosen to limit its involvement in the program, but Diab says CVS remains committed.

“I’m a believer in the ACO REACH program because it’s the first full-risk model of Medicare fee-for-service, so the accountability is much stronger than in the other models,” said Diab.

Diab said that CVS is in continuous discussions to with the CMS Innovation Center to improve the model. Specifically, he wants to see REACH become more transparent and more stable for providers.

By the end of 2026, the feds plan to sunset the ACO REACH program. CMS has not yet announced whether the program will get extended or is there is a replacement down the pipeline. If a new program is coming, it’s not clear how it overlap with other models in certain geographies. He wonders if CMS may decide to offer a full-risk Medicare Shared Savings Program (MSSP) model, but would like clarification from the feds in the next few months.

“I would love if CMMI always have the provider hat when they think about these models,” said Diab.