Your Questions Answered
Find out how Jericho REACH is transforming the way healthcare for traditional Medicare beneficiaries and dual-eligibles is accessed, financed, and delivered.
What is Jericho REACH ACO?
Jericho REACH (Realizing Equity, Access, and Community Health) ACO is a new organization designed by physicians for physicians. It was founded by Dr. Lerla Joseph, one of a diverse group of physicians who launched and participated in CVCHIP LLC, a successful MSSP ACO program. Jericho enables physicians to have clinical independence and financial control as they provide whole-person care to Medicare recipients and dual-eligibles.
Jericho is an opportunity to lead positive change in the way healthcare is delivered in your community, practice medicine the way it was taught, and realize substantial financial gain from making the inevitable transition to value-based care now. Its Participant Physicians will retain the sizeable savings earned versus CMS’ benchmark across many care categories, not just Part B.
You can find summary information about Jericho on the Jericho Overview page.
Why are physicians joining Jericho now?
Today Jericho is a physician-led and governed, full-risk, REACH ACO. Its vision includes expanding to be a multi-payer Advanced Payment Model (APM) ACO. Its program puts patients at the center of care and enables physicians to play the leading role in how care is delivered and to share in cost savings. Detailed estimates done by Jericho’s team members have identified potential Medicare Part A savings of 30% in a typical physician’s case mix.
Physicians who participate in Jericho will continue to operate independent practices. Jericho REACH intends to help physicians be successful in the REACH ACO, including by:
Supporting collaborative care across an integrated, multi-specialty network of providers and partners,
Stop-loss protection to minimize downside risk, and
Access to programs such as Chronic Care Management that improve care quality for beneficiaries and financial outcomes for physicians.
In addition to retaining savings realized across Medicare Part A and Part B, with Jericho, participating physicians have access to new revenue streams, experience reduced care coordination complexity and transition friction, and enjoy savings from discounts realized from negotiating prices with aggregated volume.
Because it expects to efficiently deliver holistic, high-quality care to Medicare beneficiaries and, eventually, others, Jericho’s long-term vision includes becoming a Provider-Sponsored Health Plan.
Although Jericho technically can’t add physicians to its list of participant providers, it can add beneficiaries each calendar quarter, and when those beneficiaries voluntarily align with Jericho their physicians will benefit from savings realized in 2023 and become eligible for prospective payments in 2024 (assuming the physicians participate in 2024). CMS recently announced monthly ad hoc enrollment periods in 2023 that enables physicians to become a preferred provider with Jericho.
The value Jericho provides to physicians includes:
An equitable share of the savings realized from Part A and Part B,
Increased fees from Part B professional services (for example, potentially via programs such as a chronic care management program), and
Other investment opportunities.
What are physician leaders saying about Jericho?
‘I have examined many, many innovative payment models in my numerous leadership roles over the past decades. None in my opinion has ever been more promising for physicians—and their patients—than the Jericho Reach ACO concept.
It not only puts physicians in total control of clinical care design and oversight, but for the first time also in real financial control—and not just over Medicare Part B. It covers ACO management of Medicare Parts A and B today and will likely expand to other insurance types over time. Savvy physicians will understand that this model is the best opportunity ever to leverage high quality care for patients without regulatory or insurance red tape, and likewise to be fully and fairly rewarded for doing so.’
- Dr. Jack Lewin, one of Modern Healthcare’s 100 Most Influential People in Healthcare, Chairman of the National Coalition on Health Care. Formerly President & CEO, Cardiovascular Research Foundation; CEO, American College of Cardiology; and CEO, California Medical Association
Who may participate in Jericho?
Any physician who treats Medicare beneficiaries is a candidate to join Jericho.
Jericho envisions being comprised of a cohort of like-minded physicians who care deeply about delivering high-quality care to their patients, bending the cost curve, using data to improve outcomes, and including patients and families in the design and implementation of care delivery. Interested physicians will be asked to sign a shared commitment statement aligning with this vision, which supports the Quadruple Aim of enhancing the patient experience, improving population health, reducing the cost of care, and boosting care team well-being.
All Jericho physicians and network partners will commit to active participation in a virtual health system that both provides outstanding care in good times and is responsive and resilient to events such as the unprecedented COVID-19 public health emergency.
We expect that many physicians will want to evaluate participation in Jericho and see the value of joining, but some may already be participants in another CMS APM program (physicians may only be in one program), may be employed by a hospital, or may have a restrictive covenant in place. Physicians whose situation fits that description should contact Jericho to determine how to best make a change.
Who owns Jericho?
Jericho will be owned and governed by the physicians who are its Participant Providers. There are no current plans for Jericho to be owned or partially owned by outside investors.
When does Jericho expect to begin operations?
Jericho expects to begin operations on January 1, 2023.
What is Jericho’s coverage area?
Jericho plans to operate in the mid-Atlantic region in PY2023.
Who may join Jericho?
Any physician in Jericho’s coverage area who provides services to Medicare beneficiaries or dual-eligibles may join, provided they are not participants in another ACO for PY 2023 or a participant in an overlapping program including: Primary Care First, Independence at Home demonstration, Kidney Care Choices model, Vermont All-payer model, Maryland Primary Care Program, and Medicare Shared Savings Program. There is no sign-up fee, required investment, long-term commitment, or minimum practice size.
What commitment(s) are physicians required to make when they join Jericho?
Jericho does not require upfront payments or long-term commitments from physicians. The commitment is just one year and there are no restrictions on participation in other entities at the end of that year.
How will Participant Providers be paid?
Each month, CMS will pay Jericho one-twelfth (1/12) of the Part A and Part B benchmark for that year for beneficiaries aligned with Participant Providers as of January 1, 2023, adjusted by various factors determined by CMS. In 2023, Jericho will pass those monthly amounts through to the Participant Providers. In 2024, when Jericho receives payments from CMS for savings realized in 2023, Jericho will pay physicians the reconciled amount net of fees due for performing ‘back office’ functions and any direct expenses authorized by Jericho’s physician-governed Board.
When will the realized savings be distributed?
The exact dates are not yet available from CMS. Savings related to the first six months of 2023 will be distributed in the First Quarter of 2024. A ‘Final Payment’ will be distributed in the Third Quarter of 2024.
What care is eligible for savings?
All Part A and Part B care provided to aligned beneficiaries is available for savings.
How does Jericho expect to achieve savings?
Delivering high-quality care is Jericho’s top priority. Jericho’s experts have reviewed the claims history of many providers and see many opportunities for high-quality care to be delivered more cost-effectively. Some of the ways savings are expected to be achieved are by:
Shifting care to less costly, but clinically appropriate, settings
Optimizing primary care, preventive care, and chronic care to reduce need for acute care
Better connecting all involved in patient care to enable better collaboration and coordination
Addressing social determinants of health
What will Jericho’s network include?
Jericho is currently assembling a comprehensive network that includes both clinical care and social determinants of health to improve health outcomes and lower costs. The network will evolve continually over time in response to the beneficiaries’ needs. It is expected to include health systems, home care and hospice providers, nursing facilities, rehabilitation centers, urgent care centers, and new types of network participants including ride-sharing companies, real estate developers, and more.
What is Jericho’s ACO REACH Participant Type?
Jericho is a Standard participant. That means that it is an ACO with experience bearing risk for Medicare FFS lives and must have at least 5,000 aligned beneficiaries in 2023. Jericho has already achieved that number.
What are the criteria for beneficiary eligibility?
To be eligible to align with a Jericho REACH Participant Provider a beneficiary must:
Be enrolled in both Medicare Parts A and B
Have Medicare as their primary payer
Not already be enrolled in a Medicare Advantage Plan, Medicare Cost Plan, or PACE organization
Be a US resident and reside in a county included in the ACO’s service area
Which Payment Model has Jericho selected?
Jericho has selected the Global Track. That means the ACO is eligible for 100% of the savings relative to CMS’ adjusted benchmark and responsible for 100% of the losses.
Which Capitation Option has Jericho selected?
Jericho has selected the Total Care Capitation (TCC) option at the ACO level. Under TCC, 100% of Medicare Part A and Part B provided to aligned beneficiaries are reimbursed through Per Beneficiary Per Month (PBPM) payments. Providers will still submit claims to CMS and will receive payments from Jericho based on the terms of negotiated downstream contracts.
How will Jericho limit Participating Providers’ downside risk?
Jericho is currently exploring options for how to best cost-effectively limit downside risk. Bids on stop-loss policies have been received from private companies and a stop-loss Advanced Payment Option is available from CMS. The decision will be made by Jericho’s physician-led Board.
How will the ‘back office’ functions of Jericho get done?
Jericho will contract with a Managed Services Organization (MSO) to handle all back-office functions, including support for ongoing physician convening, establishing and managing the clinical network, governance (including creating an Advisory Board), care coordination training, infrastructure, data analysis and reporting, communications, and the financial function. The MSO is expected to receive a fee equal to 2% of the benchmark payments.
What reporting support will Jericho provide?
Jericho’s MSO will provide Participant Physicians with reporting support based on CMS’ requirements. The final, specific reporting requirements will be determined when the details of Jericho’s Health Equity Plan are set. MACRA bonus reporting will be part of this effort.
What are examples of the ‘new income sources’ mentioned in the Jericho materials?
Jericho’s MSO will explore and vet opportunities for Participant Providers to increase their income. Examples of potential opportunities already identified are centrally provided Chronic Care Management services and real estate investments in medical real estate, CCACs, etc.
What if I have other questions?
If you have other questions, please contact Geoff Teed by calling (203) 520-9471 or by sending an email to jericho@jerichoreach.com.