What is ACO REACH?
Beginning January 1, 2023, Centers for Medicare and Medicaid Services (CMS) is implementing its ACO REACH Model which it announced in March earlier this year. In addition, this transition will see the phasing out of the Global and Professional Direct Contracting Model (GDPC). This was done in response to the Biden Administration’s priorities, including its commitment to advancing health equity, stakeholder feedback and participant experience. The ACO REACH model is an acronym for Accountable Care Organization and Realizing Equity, Access and Community Health.
Key Dates and Milestones for the program
February 24, 2022: Applications Posted and Announcement made.
March 7, 2022: Announced: Applications were accepted for Performance Year (PY) 2023. Final date for submission was April 22nd.
June 30, 2022: Application decision letters were sent to applicants.
August 15, 2022: CMS announced its list of provisionally accepted applicants.
According to the Biden Administration the ACO REACH will enable CMS to test an ACO model that can inform the Medicare Shared Savings Program and future models by making important changes to the GPDC Model in three areas:
Advance Health Equity to Bring the Benefits of Accountable Care to Underserved Communities
Promote Provider Leadership and Governance.
Protect Beneficiaries and the Model with More Participant Vetting, Monitoring and Greater Transparency.
“Under the ACO REACH Model, health care providers can receive more predictable revenue and use those dollars more flexibly to meet their patients’ needs”
“CMS is testing a redesigned model because accountable care organizations make it possible for people in Traditional Medicare to receive greater support managing their chronic diseases, facilitate smoother transitions from the hospital to their homes, and ensure beneficiaries receive preventive care that keeps them healthy,” said CMS Deputy Administrator and Director of the CMS Innovation Center Liz Fowler, PhD, JD. “Under the ACO REACH Model, health care providers can receive more predictable revenue and use those dollars more flexibly to meet their patients’ needs — and to be more resilient in the face of health challenges like the current public health pandemic. The bottom line is that ACOs can improve healthcare quality and make people healthier, which can also lead to lower total costs of care.”
Comparison of REACH and GDPC
CMS views ACO REACH as a progression from models but in many ways it is similar to the past Direct Contracting Models. There were 99 participants in the GDPC model and CMS is hopeful that REACH will expand their provider network with “New Entrants.” Some of the differences between REACH and its predecessor can be seen here. Below are some of the key differences between REACH and GDPC:
ACO REACH will contain a stricter policy on the amount of provider-led governance. For instance, direct contracting required providers to make up 25% of governing or voting rights, but ACO REACH will require providers to comprise 75%.
Each model requires the ACO to have separate beneficiary and consumer advocate representatives on their board, according to senior administration officials. The current model allows the representatives to be the same person.
Additional monitoring and compliance efforts using analytics will be deployed to ensure the integrity of the program.
The Quality withhold is reduced to 2% in the REACH model from 5% in the DCE model.
Application Domains were expanded from the original five (organizational structure, leadership and management, financial plan and risk-sharing experience, patient centeredness and beneficiary engagement and clinical care) to also include the following additional domains:
Demonstrated strong track record of direct patient care.
Demonstrated record of serving historically underserved communities with positive quality outcomes.
Program integrity risks posed by REACH ACO ownership/parent companies.
GPDC participants must agree to meet all the ACO REACH requirements by January 1, 2023, to continue participating in ACO REACH.
Another important area that changes were made was to the "Risk Score Growth Cap" to further mitigate potential inappropriate risk score gains:
• Adopt a static reference year population for the remainder of the model performance period.
• Cap the REACH ACO's risk score growth relative to the DCE's demographic risk score growth, so the +/- 3% cap is appropriately adjusted based on demographic changes in the underlying population over time. Currently risk score cap is based on HCC growth—this would cap HCC growth relative to demographic growth.
Community Support and Reception
The National Association of Accountable Care Organizations (NAACOS) has expressed its support for the ACO REACH model.
“Today’s announcement by CMS to keep the Direct Contracting Model, albeit with numerous changes and a new name, is the right decision for both traditional Medicare patients and the future of value-based care. Many of the criticisms against Direct Contracting were a product of great misunderstanding about the model and the overall shift to value-based payment. Instead, keeping the model with additional focus on equity, increased provider governance, improvements to risk adjustment, and other changes is best moving forward.” Clif Gaus, Sc.D., President and CEO of the NAACOS.
“Many of the criticisms against Direct Contracting were a product of great misunderstanding about the model and the overall shift to value-based payment”
Progressive members of Congress are less supportive. CMS will continue to work on the evolution of its “innovation” programs that create value for patients that improve patient access, satisfaction and clinical outcomes.
For ACO REACH participants, calendar year 2022 is the time to establish the Risk Adjustment Factor benchmark score for their patient population. ForeSee Medical assists in perfecting RAF scores, helping to establish a fair benchmark.
Perfecting the benchmark RAF score assures organizations they will have the proper amount of resources to care for their ACO REACH attributed lives for the contract period. But time is running out! As you know, in subsequent years, the ACO REACH Model caps risk score growth to 3%.
This year ACO REACH participants have a one-time opportunity to establish a fair and accurate RAF benchmark.
In our analysis of other ACO REACH organizations, claims data alone (used by CMS to set benchmarks) may not be an accurate representation of your population’s true disease burden. Given the financial exposure created by the ACO REACH model’s 3% risk score cap, can your organization afford to have your scores under-represented?
Organizations like yours are leveraging the capabilities of ForeSee Medical’s disease suspecting software with natural language processing (NLP) capability to help establish a fair benchmark.
Click to learn how ForeSee Medical is enabling ACO REACH organizations to mitigate risk while enhancing care.
Blog by: The ForeSee Medical Team