Your Questions Answered
Find out how Kenji REACH is transforming the way healthcare for traditional Medicare beneficiaries and dual-eligibles is accessed, financed, and delivered.
What is Kenji REACH?
Kenji REACH (Realizing Equity, Access, and Community Health) is a managed services organization (MSO) designed to create and support a physician-led Risk-Bearing Entity (RBE) that enables physicians to successfully transition to population-based payment models and thrive. Physicians will have full clinical independence and full financial control as they provide whole-person care to their patients. This groundbreaking partnership of physicians coming together to form an RBE allows them to spread actuarial risk across a larger pool and insulate against downside without excessive costs.
Kenji 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.
Why are physicians joining Kenji now?
Today Kenji represents the management infrastructure providing the suite of services to support a physician-led and governed, full-risk bearing entity. Its vision includes expanding to be a multi-payer advanced Alternative Payment Model (APM) RBE. 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 Kenji’s team members have identified potential Medicare Part A savings of 30% in a typical physician’s case mix.
Physicians who participate in Kenji will continue to operate independent practices. Kenji REACH intends to help physicians be successful in their 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 Kenji, 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, Kenji’s long-term vision includes becoming a Provider-Sponsored Health Plan.
Although Kenji 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 Kenji their physicians will benefit from savings realized in 2024 and become eligible for prospective payments in 2025 (assuming the physicians participate in 2024). CMS recently announced monthly ad hoc enrollment periods in 2024 that enables physicians to become a preferred provider with Kenji.
The value Kenji 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 Kenji?
‘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 Kenji Reach 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 Kenji?
Any physician who treats Medicare beneficiaries is a candidate to join Kenji.
Kenji 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 Quintuple Aim of: 1. Advancing health equity; 2. Maintaining clinician well-being; 3. Improving population health; 4. Enhancing the care experience; and 5. Reducing costs.
All Kenji, 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 Kenji 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 Kenji to determine how to best make a change.
Who owns Kenji?
Kenji will be owned and governed by the physicians who are its Participant Providers. There are no current plans for Kenji to be owned or partially owned by outside investors.
When does Kenji expect to begin operations?
Kenji expects to begin its first performance year of operations in January 2025 (PY2025).
Who may join Kenji?
Any physician in Kenji’s initial coverage area may join, provided they are not participants in another ACO for PY2025 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 Kenji?
Kenji 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 Kenji 2.5% of the Part B benchmark prospectively for that year for beneficiaries aligned with Participant Providers in 2025 (adjusted by various factors determined by CMS). In 2025, Kenji will pass those monthly amounts through to the Participant Providers. In 2026, when Kenji receives payments from CMS for savings realized in 2025, Kenji will pay physicians the reconciled amount net of fees due for performing ‘back office’ functions and any direct expenses authorized by Kenji’s physician-governed Board.
When will the realized savings be distributed?
The exact dates are not yet available from CMS. Savings related to the last six months of 2025 will be distributed in the First Quarter of 2026. A ‘Final Payment’ will be distributed in the Third Quarter of 2026.
What care is eligible for savings?
All care under global payment arrangements provided to aligned beneficiaries is available for savings.
How does Kenji expect to achieve savings?
Delivering high-quality care is Kenji’s top priority. Kenji’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 Kenji’s network include?
Kenji 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 are the criteria for beneficiary eligibility?
To be eligible to align with a Kenji 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
NOTE: For commercial payers, contracts will be included as agreements are added.
What payment model will Kenji operate under?
Kenji will seek to enter global risk with all payers. That means the RBE is eligible for 100% of the savings/losses relative to CMS/Payers’ adjusted benchmark. Providers will still submit claims to CMS/Payers and will receive payments from Kenji based on the terms of negotiated downstream contracts.
How will Kenji limit Participating Providers’ downside risk?
Providers are protected from downside risk with stop-loss insurance.
How will the ‘back office’ functions of Kenji get done?
Kenji handles all back-office functions, including administrative support, 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. MSO fees are equal to 3.5% of the benchmark payments.
What reporting support will Kenji provide?
Kenji’s will provide Participant Physicians with reporting support based on CMS/Payer requirements. The final, specific reporting requirements to be determined. MACRA bonus reporting will be part of this effort.
What are examples of the ‘new income sources’ mentioned in the Kenji materials?
Kenji will explore and vet opportunities for Participant Providers to increase their income. Examples of potential opportunities already identified are mixed use real estate investments such as senior living and care and urgent care centers.
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 kenji@kenjireach.com.