CMS Selects 4 States for ACO-Based Rural Telehealth Delivery Model

Four states will receive federal funding to expand telehealth and other services in rural areas through an accountable care organization (ACO) model of care.

The Centers for Medicare & Medicare Services will provide funding to the University of Alabama at Birmingham (UAB), South Dakota’s Department of Social Services, Texas’ Health and Human Services Commission and the Washington State Healthcare Authority to implement the Community Health Access and Rural Transformation (CHART) model. Those organizations will develop telehealth and other services through an ACO transformation tracks that leverages value-based payment models.

“This CHART funding will help test whether improving access to telehealth services and access to adequate transportation for those living in rural areas can maintain or improve care quality and lower health care costs,” Dawson Smith, vice president for affiliate operations and network development in the UAB Health System, said in a separate press release. “This is an opportunity for select rural hospitals across Alabama to redesign how care is delivered in rural areas with the ultimate goal of improving access, quality and health outcomes. Eligible hospitals must be located in a rural county or census tract.” 

“The CHART Model invests in rural areas by offering technical assistance and support as healthcare facilities implement care delivery reforms to serve their populations,” added Irfan Asif, MD, chair of UAB’s Department of Family and Community Medicine, associate dean for primary care and rural health in the Heersink School of Medicine and principal investigator for the health system’s CHART project. “This can include modernizing infrastructure and using technology to eliminate traditional barriers to care, like distance to specialists or transportation issues. Within the supportive framework of the CHART Model, for example, award recipients can expand telehealth to make it easier for people in rural areas to receive care.”

The CHART Model was launched in 2020 through the CMS Innovation Center to address healthcare disparities experienced by the more than 57 million Americans living in rural communities. The model makes use of ACOs, according to CMS, and is designed to:

• Increase financial stability for rural providers through the use of new ways of reimbursing providers that provide up-front investments and predictable, capitated payments that pay for quality and patient outcomes;
• Remove regulatory burden by providing waivers that increase operational and regulatory flexibility for rural providers; and
• Enhance beneficiaries’ access to health care services by ensuring rural providers remain financially sustainable for years to come and can offer additional services such as those that address social determinants of health including food and housing.

The four organizations selected to lead the programs in their states will work with key participants, including Medicaid programs and health systems, to redesign healthcare delivery. According to CMS, those four “are critical to the success of the model because they will coordinate efforts across the community to ensure that access to care is maintained and that the needs of various stakeholders are understood and accounted for in the transformation plan. Lead organizations are responsible for managing cooperative agreement funding, recruiting participant hospitals, engaging the state Medicaid agency, establishing relationships with other aligned payers, convening the Advisory Council, and ensuring compliance with model requirements. Ultimately, the lead organization will oversee the execution and coordination of a transformation plan that outlines the healthcare delivery redesign strategy for the community.”

UAB’s Smith said his organization will spend the next 15 months convening an advisory council, establishing partnerships, recruiting hospitals and developing a plan with those hospitals and their surrounding communities to improve healthcare access.

“The coalition includes healthcare stakeholders from across the state,” he said in the press release. “Our goal with the CHART Model project is to see if we can create a model that will strengthen our rural hospitals and improve overall patient outcomes. If it works, it would be a model that CMS could roll out to other healthcare facilities in Alabama and around the nation.” 

Each organization is getting $2 million for planning and as much as $3 million for meeting milestones over the course of six performance periods. They’ll be part of as many as 20 ACOs selected in spring 2022 to receive advanced payments as part of the Medicare Shared Savings Program.