Revolutionizing Health Care With ACOs: Vytalize Health's Role in Value-Based Care

Vytalize Health, as an ACO REACH entity, assumes full risk for the cost and quality of care, sharing upside incentives with primary and nonprimary care providers based on predefined metrics. Faris Ghawi offers insights into how ACOs like Vytalize contribute positively to value-based care.

Please introduce yourself by stating your name, your title, your organization, and any professional experience you have.

Faris Ghawi: I'm Faris Ghawi. I'm the co-founder and CEO at Vytalize Health. Vytalize is a value-based care enabler that focuses on Medicare patients. We've been doing this at Vytalize for 9 years now. My background is in engineering and finance, and I was brought in by my co-founder, who’s the internal medicine physician and chief medical officer, Dr Amer Alnajar.

Vytalize Health has garnered considerable recognition for collaborating with many health care providers to enhance value-based care for patients. Can you provide a detailed explanation of what Vytalize Health offers its clients?

Faris Ghawi: Value-based care refers to a new payment model for health care that focuses on outcomes, lowering unnecessary health care costs and paying for value versus volume of services.

Typically, from a patient perspective, especially on the Medicare side, value-based care is centered around the primary care physician. So, the attribution of the patients is centered around primary care.

Vytalize works with primary care physicians. To start with, we bring a set of technology capabilities, data, analytics, clinical teams, practice engagement, and unique reimbursement models to help practices make the transition from a fee-for-service environment into a value-based care environment without it being too disruptive to how they like to practice medicine. The practices we work with remain independent. We come in as a partner to help them be successful in the transition to value-based care. We've seen really great results over the past few years that we're really excited about, and we are building a lot of momentum.

A popular topic in health systems and health care today is back-office work. Whether it's connectivity issues between practices, medical records, or even hospitals, what your company is bringing to the table is really what the industry needs right now, mainly because a lot of what everyone's doing is very dated.

Faris Ghawi: I appreciate the system and the complexities involved. But whether it’s technology processes or financial incentives —it’s all been revolving around fee-for-service. When you change the foundation of the entire system, there's a trickle-down effect where you have to change a lot of things that have been in place for a long time.

Would you characterize the platform as an end-to-end solution?

Faris Ghawi: Absolutely. We say that value-based care involves 100 different problems. There's no magic wand. You really have to work on a lot of dials to make sure that the practice is successful in value-based care. So, what we’ve seen is that as we were developing Vytalize, the technology alone isn’t enough. Technology is extremely important, but technology alone doesn't do it. Timely data is also really important, but timely data alone doesn't cut it.

Financial incentives, similarly, are critical to allow the investment and make the transition to value-based care. But money alone doesn't cut it. All these things are absolutely needed, but they are all needed together. If any one of them is missing, typically, you really end up with poor results. So, the challenge is, how do you put all these pieces together in a solution that is digestible to the physician, the office manager, the practice staff, and does not disrupt that relationship with the patient, but actually strengthens it?

Again, we’re talking about the primary care setting. But a lot of work also happens outside of the primary care setting. As an enabler, we also do a lot of work with the payers on the contracting side to help make sure we're aligning their goals with what primary care practices are doing day-to-day, but to also work out with the rest of the delivery network, whether it's specialists, post-acute care providers, and health systems, to make sure that the value-based care concepts, incentives, data, and technologies are working outside of the walls of the practice. So, it is end-to-end. We wish it was easier, but it's not. It’s a privilege to be doing all these pieces to move toward a collaborative value-based care future together.

Vytalize Health is doing the leg work of many facets of what's needed to make a substantial change like this. It's a one-stop shop. All they have to worry about is getting the service from you, and then they're set up. Problem solved.

With all that said, the Realizing Equity, Access, and Community Health program (REACH) and the performance for 2022 revealed many cost savings per beneficiary. How did those results compare to the 2023 results? Have you reviewed those yet?

Faris Ghawi: The reason we are sitting here in January 2024 talking about 2022 is because in value-based care there’s a lag in claims. It takes quite some time for all the claims and everything to filter through the system for the final results to come out.

We’re really excited about the latest results which are the 2022 results that you alluded to. They showed not only a high performance on savings, but also high performance on quality and patient experience.

Do you foresee any prospective partnerships with your solution system? Or are you focusing on operating independently at the moment?

Faris Ghawi: We partner a lot. On every piece that I mentioned, we have a lot of partnerships that we've developed. Whether it's on the technology side, the financial incentive side, the network side, or the network partners that we work with. We also have our own clinical teams as well that provide support in some markets. We also partner with others to bring some of those capabilities where we are looking to scale in certain markets. Vytalize is in 36 states. To ensure we can scale properly and quickly, we do a lot through partnerships. There's something magical about aligned incentives that allows the system to work really well through partnerships. And probably one of the most exciting and surprising things to me personally, where once we went out and started working with the non-primary care network, was how responsive that market was to value-based care. We were expecting a lot of resistance from health systems and from specialists because they're comfortable with their services. But the reception has been really positive.

At the end of the day, there's a human on the other side that understands that health care can be better and everyone has probably gone through some sort of personal experience that has been less than ideal, so they understand that a new way is better. And that's been awesome to see—that the human side; the personal side has been at the forefront of people who really want to innovate and want to drive change. That was really cool to see and helped build up our optimism.

It's amazing to see that there is something on the market that can make things easier for the facility, the hospital, and the patient. It allows doctors to spend most of their time caring for patients, which is what they should be doing. But, with current health systems, that's not the case due to the other tasks on their plates.

Faris Ghawi: That's right. There's a lot of waste in our system, whether it's medical cost waste or operational waste. And that's the value of better systems and better technology—you eliminate waste, and everybody benefits from that. And then you can use the resources in a way to further everybody's goals. It's been really great.

We're still very early in the transition. This is still the early days of value-based care but the signs are very encouraging, and I think it's unstoppable at this point, given the positive results and momentum.

It's been said that Vytalize Health is the next evolution of value-based care due to the payment arrangements, and when considering the Medicare ACO REACH program, could you provide any insights on those payment arrangements and how to incentivize folks who are part of these vulnerable beneficiaries?

Faris Ghawi: The ACO REACH program is a Medicare program focusing on the traditional Medicare or original Medicare fee-for-service. It is the next evolution after the Medicare Shared Savings Program (MSSP). The REACH program started in 2021 under the name Direct Contracting. It launched under the Obama Administration and the Trump Administration doubled down on it, and so did the Biden Administration. So, both sides of aisle agree that we can do better and need to do better and have been promoting this program.

Some of the key features of the ACO REACH program is that it allows entities like Vytalize to take full risk on the total cost of care. It also has some capitation involved, there's different flavors within it. But it is a really important program that has shown great success, not just for Vytalize, but the program itself.

And I think it's the first time that we see CMMI and CMS providing some leeway and flexibility for physicians to drive care the way it's supposed to be driven.

It removes a lot of the unpredictability of some of the other programs. There’s a lot of transparency in the data, and that's important, for entities like us. You need the system to be transparent so that it can function properly, and REACH provides a lot of transparency, which is key. But also giving the flexibility to providers to operate health care the way they want, creating partnerships with the network.

I would say another important factor of ACO REACH is that it goes much further than the Medicare Shared Savings Program and allows partnerships between primary care providers and the rest of the health care network.

ACO REACH also involves full risk so Vytalize as an ACO REACH entity takes full risk and is responsible for the cost and quality of care. We then share upside with our primary care and non-primary care providers based on certain metrics. We've been doing this even under the MSSP program, we set up certain targets for providers, KPIs, we call them Vytal Signs, for the practice, and if the practice hits these targets and is consistently moving the needle on these Vytal Signs that improve the patient care and keep patients out of the hospital due to preventive care, they get paid on a monthly basis from Vytalize. The incentives help them continue to make that investment and essentially benefit from value-based care.

We pay for the things that we believe or have proven to help reduce costs and improve health outcomes. And when Medicare does the final reconciliation, like we did a few months ago, we get a bonus check, and we share that with our primary care and non-primary care practices.

Vytalize also emerged as a top performer in the Realizing Equity, Access, and Community Health (REACH) program, with over $1,343 in savings per beneficiary and a gross savings rate of 7.7%. Average shared savings payment exceeded $100,000 per Reach Practice.

Vytalize Health was also one of 5 Standard REACH ACOs in the top quartile for each Triple Aim measure: reduced capita cost of care, improved population health, and improved patient experience. Of those 5 ACOs, Vytalize was the only 2022 starter to achieve these results.

To their credit, what CMS and CMMI really incorporated into the issue REACH programs is the emphasis in health equity, which is relatively new to CMS. They want ACOs like Vytalize to pay attention and help achieve the goal of health equity by supporting practices that serve under-served areas dealing with complex social determinants of health (SDOH). It's actually built into the calculations of the financial upside, making sure that we’re targeting these areas and helping close the gap in health equity. So that's exciting, and the industry has really run towards this issue. It’s a good example of a private and public partnership.

When Vytalize receives these what we'll call bonus checks, you're not pocketing it; you're giving back to help reduce hospital stays, readmissions, and follow-up appointments. It saves a lot of burden on the hospital system, especially for folks who have to go to multiple appointments. Vytalize is mitigating that.

Faris Ghawi: That's right. It really is a win-win-win. If you sit down with the partner and understand what they're paying for, there's always something you can craft that generates a win-win. It's a great program. We think of it as sort of like Medicare Advantage. But run very close to the physician practices. We see a lot of more parity to these programs over time. And hopefully, for the benefit of the patients.

What's one thing you want the audience to walk away with after reading this interview?

Faris Ghawi: If there's one thing I'd leave the audience with, it's an optimistic message that there are very clear solutions to the problems we have in health care.

It's a bit complicated, or very complicated, so the implementation takes time, but the near future is bright and we’re seeing the positive results firsthand.

There's alignment from the regulators to the health care providers to the business interest, to the patient advocates on what needs to happen. And it is happening. It's just happening on a slightly small scale. Vytalize is trying to scale it. Others are trying to do that as well. It's going to get fixed, and it's probably going to be the best thing that's ever happened to health care and change our relationship with it. I think the future is extremely bright.