National Rural ACO

News, commentary and opinion on the ongoing transformation of our health care systems.

Latest Posts

Seeking Bids to Optimize EHR and Health Data Exchange Function for Small Clinics – CLOSED


Functionality of electronic health records systems poses a major challenge for small and rural clinical practices looking to move to value-based payment models and succeed under Medicare’s Quality Payment Program.

This was a major lesson from the National Rural Accountable Care Consortium’s (NRACC) four years of working firsthand with 2,700 of these clinical practice locations nationwide.

In response, NRACC is calling on electronic health records and health information exchange-support companies to help us finish our grant-funded program strong by supporting and sustaining our clients’ clinical practice transformation work via targeted recommendations to enhance clients’ EHR and health data exchange processes. Notably, this work must be completed on a very aggressive timeframe

Please Respond to Our RFP – CLOSED

This RFP is now closed.

The National Rural Accountable Care Consortium would like to invite you to submit bids for two requests for proposals totaling almost $4 million — one addressing data and analytics support and the other for exemplary practice writers.

These opportunities stem from recent approval NRACC received enabling us to draw down program resources that were unexpended in earlier years, to support achieving of our program commitments.

National Rural Accountable Care Consortium Honored by CMS for Excellence in Patient Engagement

The National Rural Accountable Care Consortium (NRACC) was recognized on Aug. 3 by the Centers for Medicare and Medicaid Services (CMS) for supporting a culture of person and family engagement within their enrolled clinical practices.


This award is a strong endorsement of NRACC’s clinical-practice coaching that targets meaningful integration of patient and family voices into clinical operations, and improves patient experience by regularly capturing and discussing data on patient satisfaction.

The honor was awarded during the National Expert Panel clinical practice transformation conference in Columbia, MD, by the CMS Director of Quality Improvement Dennis Wagner, TCPI Director Robert Flemming and Dr. Paul McGannCMS chief medical officer (CMO) for Quality Improvement. The award also acknowledged and honored the leaders of an exemplary clinical practice enrolled with NRACC, Jeremy Bradley, MD and their patient representative.

NRACC, through its Practice Transformation Network, has employed innovative strategies since 2015 to engage people and families in mostly rural health care practices to improve the quality of health care. Engagement is at the heart of NRACC’s work. Specific successful techniques include distributing computer tablets to our practices to streamline patient satisfaction survey administration. NRACC also has a strong track record educating practices on a shared decision-making model between clinicians and their patients – directly supporting a patient and family centered culture.

The NRACC serves more than 8,000 clinicians nationwide through a four-year grant from the Centers for Medicare and Medicaid Innovation (CMMI). The NRACC PTN is part of the CMMI Transforming Clinical Practice Initiative (TCPI) and works with clinicians to improve the quality of patient care and clinical processes, and to prepare them for value-based healthcare payment models.

National Rural Accountable Care Consortium Approved for $3.2 Million Beyond Original Budget

The National Rural Accountable Care Consortium was approved for $3.2 million in federal funds beyond its original 2018 budget to expand its work preparing clinical practices nationwide for new reimbursement models.

The so-called carryover award from the Centers for Medicare and Medicaid Inn ovation (CMMI) targets a more personalized level of service for clients. For example, the funds will allow the organization to offer more on-site visits with clients and enable the hiring of additional practice-improvement staff.  Other service enhancements include practice-level support for quality-data extraction and interpretation of quality results.

The National Rural Accountable Care Consortium’s (NRACC) practice-transformation program is grant-funded and therefore offered at no cost to enrolled clinical practices. The Transforming Clinical Practice Initiative (TCPi) that houses the program is responsible for offering clinical practices technical support for Medicare’s Quality Payment Program/ Merit-based Incentive Payment System (MIPS).  NRACC’s staff offers enrolled practices expert consulting on MIPs that is tailored toward the practice’s specific needs and goals.

NRACC is ‘open for business,’ and actively recruiting and enrolling eligible primary and specialty care clinical practices nationwide.  To be eligible for enrollment, clinical practices must not already be participating in an a Medicare Accountable Care Organization (ACO) or the Comprehensive Primary Care Plus (CPC+) program, and they must not already be enrolled in a a competing Transforming Clinical Practice Initiative Practice Transformation Network.

NRACC’s grant-funded services include being matched with a dedicated practice-improvement coach, one-on-one monthly coaching calls, training to set up a billable care coordination service, population health software, plus proven curriculum for redesigning clinical workflows to manage population health and ensure financial sustainability.

Contact NRACC’s director of network and strategy Maeve McClellan or (916) 542-4590, for more information about enrolling your clinical practice or click here to apply now.

Caravan Health Announces Registration for the Accountable Care Symposium

Registration is now open for the Caravan Health Accountable Care Symposium, December 6 and 7, 2017 in Phoenix, Arizona.

The Accountable Care Symposium will build upon last year’s remarkable event, where more than 700 leaders from dozens of ACOs across the country convened to share best practices and learn about new population health programs. The two-day event brings together health care leaders, executives and physicians to explore the complex challenges of value-based transformation. Nationally recognized subject matter experts will discuss and share key strategies to help practices thrive under Accountable Care Organizations (ACOs), Comprehensive Primary Care Plus (CPC+), the Transforming Clinical Practice Initiative (TCPi) and the Quality Payment Program (MACRA). The meeting will focus on real world experience and practical information.

“Caravan Health is committed to empowering clinicians to succeed under Advanced Payment Models,” stated Lynn Barr, CEO of Caravan Health. “The symposium will give doctors and hospitals the operational framework and resources required to achieve outstanding results for their patients while earning recognition and rewards for their efforts.”

Caravan Health’s Accountable Care Symposium will dive deep into evidence-based solutions for topics  including: Advancing Care Information, Behavioral Health Integration, MACRA, healthcare reform and physician engagement. There will be specialized tracks for current and future ACO, CPC+ and TCPI participants.

Registration is now open to the public and is available through the Caravan Health website  Attendees may take advantage of early bird pricing if they register by August 31, 2017. Early bird rates are $199 for current participants of Caravan Health and the National Rural Accountable Care Consortium; $399 for non-participants. Registration rates after August 31 are $299 for participants of Caravan Health and the National Rural Accountable Care Consortium; $599 for non-participants. The program includes an awards ceremony and dinner, two breakfasts and lunches, speakers, break-out sessions, networking meetings, and access to the Pointe Hilton Squaw Peak Resort’s world class amenities.

The Importance of Care Coordination Beyond Cost Containment, and the Use of Health Analytics to Reach the Magic Quadrant

Care coordination has been successful in many cases where applied in U.S. health care, but direct association with cost containment is not necessarily one of them. Care coordination is frequently associated to cost containment, especially when discussing advanced payment models and shared savings, but the two should be considered separately, and on their own merits: care coordination is in pursuit of enhanced patient care, while cost containment is best associated with reduced spending on care opportunities. Cost containment is essentially juxtaposed to care coordination as cost containment must imply reducing provisioning of services, while care coordination increases them.

The takeaway here is not that either care coordination or cost containment should be pursued, but that both are important in achieving better patient care and lowering operating costs for your practice. In many cases, especially for rural practices, the two are related and symbiotic. In theory, cost containment can be achieved by redirecting patient services to less costly services with equivalent outcomes: reducing emergency room (ER) visits is an excellent example where patients can receive better care from visiting their primary care physician (PCP) than from visiting the ER for many situations. Effecting such a change may be difficult or impossible without the use of care coordination. The PCP may simply be too busy providing “primary care” to instill the importance of the change to those high cost patients. Having care coordination in place is where the two concepts converge, entering that magic quadrant of better patient care and lower cost of care.

Care coordination is often associated with lower costs in the romantic conversation of doing more for our patients will lead to lower costs. Economically, such an equation is impossible. But care coordination is not strictly an economic equation, it is at its foundation, a response to populations that need a higher level of care to thrive. Responding to that need is in the highest and best interest of the patient. Unfortunately, the reality of most practices does boil down to an economic equation, and for these practices the word “triage” is a familiar term. Enter health analytics and informatics. Use of advanced analytic tools such as Lightbeam Health is one of the fastest ways to reach the magic quadrant. Care coordinators are put to their best use by addressing the patients that need care the most, and simultaneously reducing the cost of care by effectively rerouting the most expensive patients to high value care opportunities and away from wasteful spending.

Is your practice engaged in care coordination? Are your care coordinators making the best use of their time and your dollars by reaching the highest cost patients who need the most care? Engage with Caravan Health’s clinical practice leadership to find out what you can do to increase your practice’s effectiveness of care.

Screen Shot 2017-05-02 at 11.51.45 AM

Contact information:
James Foster
IS Supervisor
Caravan Health

McWilliams, J., Cost Containment and the Tale of Care Coordination, 2016, New England Journal of Medicine, 275, pp 2218-2220

Impact of Successful ACO Participation on Rural Hospitals

Lynn Barr, CEO of Caravan Health, was joined by panelists Lee McCall, CEO of Neshoba Hospital & Nursing Home, & Don Wee, CEO of Tri-State Memorial Hospital, as they explored the impact of their 2016 Medicare Shared Savings Program participation as part of the Magnolia-Evergreen ACO. Mr. McCall and Mr. Wee discuss how their ACO appeared to save Medicare almost $11 million, including reduced inpatient utilization by 17.7%. Watch the full presentation below.

Impact of Successful ACO Participation on Rural Hospitals


Caravan Health Extends Deadline for 2018 ACO Participation to April 30, 2017

April 19, 2017 – Kansas City, MO – Providers who want to take advantage of value-based reimbursements and avoid MACRA penalties in 2018 must act fast – Caravan Health, the market leader in Accountable Care Organizations (ACOs), has extended its deadline for consideration in a 2018 ACO to April 30, 2017.

Caravan Health urges providers to visit their website – – and fill out a non-binding letter of interest (LOI) to begin the ACO process. Once providers submit an LOI, they will have until June 30 to complete the application process.

“Filling out the non-binding LOI is the first step in transitioning away from volume to value-based care,” says Lynn Barr, MPH, CEO of Caravan Health. “Caravan Health has a 100% application success rate and our expert team will provide guidance every step of the way.”

Ms. Barr states that 124 providers have submitted LOIs to Caravan Health this year and expects up to 200 by the April deadline.

“Our data shows ACO participation is the best option for transforming primary care, increasing revenue and earning MACRA bonuses,” says Barr. “Providers are realizing that they can’t risk waiting another year – the time to join an ACO is now.”

Caravan Health is holding an informational webinar the next two weeks to provide an easy to follow roadmap and address pressing questions. The webinar will take place Friday, April 21 and Friday, April 28 at 8:30 a.m. PT/10:30 a.m. CT/11:30 a.m. ET.  Participants may register at


About Caravan Health
Caravan Health helps providers implement population health programs with affordable, end-to-end solutions that achieve outstanding results. More information regarding Caravan Health can be found on our website at or email

ACO Participation Can Increase MACRA Performance Scores by Thirty Percent

Kansas City, MO – March 29, 2017 – With the first performance year for the new Merit-Based Incentive Payment System (MIPS) underway, eligible clinicians must strategize payment implications under the program. Unlike the Physicians Quality Reporting System, Meaningful Use and the Value-Based Modifier, MIPS places the performance of each clinician on a curve, and adjusts payments based on their precise location in the distribution compared to others.

Lynn Barr, MPH, CEO of Caravan Health, and LeeAnn Hastings, JD, MPH, Compliance Officer for 23 Medicare Shared Savings Program ACOs, have released an issue brief, Impact of ACOs on MIPS Payments for All Eligible Clinicians, comparing MIPS payment adjustments of ACO participants versus non-ACO participants. The brief illustrates that Medicare Shared Savings Program (MSSP) participation will enhance MIPS performance and increase the likelihood of receiving the exceptional performance bonuses. Exceptional performance bonuses are only available the first five years of MIPS and, depending upon the number of exceptional performers, could receive up to ten percent in addition to the maximum positive payment adjustment, which is up to three times the penalty for the first five years of the program. Taking into account CMS’s scaling factor and the exceptional performance bonus, a top-performing practice could theoretically earn up to a 25% payment adjustment in the 2018 performance year.

According to Ms. Hastings, “MACRA requires that 30% of the MIPS score is based on Resource Utilization. Track 1 ACO participants, however, are held accountable for cost in their ACO and not MIPS. As a result, Track 1 ACO participants can more easily achieve high scores compared to other MIPS participants, increasing the likelihood of avoiding MIPS penalties and earning the exceptional performance bonus.”

To predict MIPS bonuses, Barr emphasizes that clinicians must know both their performance score and estimate the score of the rest of the providers in the MIPS pool. Up to 40% of eligible clinicians in the pool are expected to be participants in Track 1 Medicare Shared Savings Program ACOs. Those ACOs will receive special scoring causing most other MIPS-eligible clinicians to receive lower adjustments in comparison.

Barr states, “Small practices should consider joining an ACO to avoid penalties for generally lower scores due to lack of infrastructure, and providers in rural areas may want to join ACOs to avoid MIPS penalties due to their higher cost structures. Community hospitals can earn high bonuses and support their community physicians, particularly specialists, by enrolling them in their ACO, protecting their incomes and reducing their administrative burden.”

Caravan Health, who currently supports 160 community hospitals and 250 practices in 23 Medicare Shared Savings Program ACOs, is holding weekly webinars to help providers navigate the ACO process and fully understand how to maximize their incentive payments. Participants will receive step-by-step financial guidance on how to calculate potential penalties and bonuses under MACRA.

Webinars are held on Fridays at 8:30am PT/10:30am CT/11:30am ET. To register, visit

The full brief, Impact of ACOs on MIPS Payments for All Eligible Clinicians, is available for download at

About Caravan Health:
Caravan Health helps providers implement population health programs with affordable, end-to-end solutions that achieve outstanding results. More information regarding Caravan Health can be found on our website at or email


Media Contact:
Sage Beard
Marketing Manager, Caravan Health | 916.542.4564

New Administration Sends Positive Smoke Signals About Value-Based Payments

Last week, the CMS announced a delay in publishing the final rules regarding the new mandatory cardiac and joint bundled payment programs. Significantly, the CMS did not dethe start dates of those programs, put them on hold, or cancel them all together. The new bundled payment programs will begin as scheduled, but the new administration will have a chance to make minor tweaks prior to the July 1 start date.

In spite of Secretary Price’s previous objections to mandatory CMMI programs, the green light from CMS foreshadows a continued commitment to value-based payments. A strong case can be made that the delivery system reforms instituted under the Affordable Care Act are a unique example of successful government intervention. There is compelling evidence to show that these programs have improved the quality of care for millions of people, saved hundreds of thousands of lives, and reduced spending by billions of dollars.

The pressure to reform will continue. Every provider needs to engage in value-based payment models today and begin the learning process. Currently, 30% of providers are engaged in value-based models. Provider engagement is expected to increase to 50% by 2018.  Now is the time to move forward or risk falling behind half the providers in America.

Several companies offer low-cost, supported participation in the Medicare Shared Savings Program for the third of physician groups who do not have 5,000 Medicare lives on their own. These companies include Collaborative Health Systems, Aledade, and Caravan Health.

Applications for 2018 are due to CMS on July 31st, with CMS letters of intent due by May 1st. Please reach out to us at if you would like to learn more.