ACO Reach now includes financial protections from midyear benchmark changes 

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The Centers for Medicare and Medicaid Services has announced changes to the ACO Reach Model for 2024.

The changes to the Accountable Care Organization Realizing Equity, Access, and Community Health Model were in response to stakeholder feedback, CMS said.

They are designed to improve the model test by increasing predictability for model participants, protecting against inappropriate risk score growth, maintaining consistency across CMS programs and Center for Medicare and Medicaid Innovation models, and further advancing health equity, CMS said. 

National Association of ACOs president and CEO Clif Gaus, said the organization appreciates that CMS addressed many of the concerns raised by NAACOS members. 

"These include financial protections from midyear changes to benchmarks, additions to the Health Equity Benchmark Adjustment to account for more patient characteristics, and updates to its risk adjustment policies. We believe these changes will satisfy many concerns and stabilize future participation."

ACOs would benefit from a full risk option in the Medicare Shared Savings Program, said Gaus, who recommends CMS explore adding features of REACH into a permanent track within MSSP. 

"Using MSSP as a chassis for innovation while infusing lessons learned from Innovation Center models into a permanent program is another path for stabilizing and growing participation in ACOs," Gaus said.

Susan Dentzer, president and CEO of America's Physician Groups also said that APG advocated for many of the changes made by CMS.

"We look forward to working with CMS on additional refinements to the ACO REACH Model that will further improve the healthcare of Medicare patients and the model's financial and operational sustainability," she said.

WHY THIS MATTERS

CMMI has tested other ACO models such as the Pioneer, Next Gen and the Advance Payment ACO Model. All are value-based aimed at coordinating care to achieve better outcomes and lower costs. 

Most ACO models involve a provider taking financial responsibility for their patient population's total cost of care and addressing key quality measures over the course of a year.

The Medicare Shared Savings Program, established by the Affordable Care Act, was the first to be established in 2011.

By 2030, CMS said it expects that 100% of patients with original Medicare will be in value-based care relationships. 

NAACOS, AHIP, and the American Medical Association recently released data sharing best practices for voluntary adoption in a playbook intended to advance the adoption of value-based care arrangements in the private sector.

"Even with nearly two decades of experience implementing value-based care models, the COVID-19 pandemic underscored many of the persistent challenges facing the U.S. care delivery system, such as disparities in care and access, data exchange and availability, and misaligned payment incentives," the groups said in a statement. 

Clinicians need timely, actionable data, Gaus said. 

Work group recommendations include creating an interoperable data ecosystem, sharing more complete data, improving data collection to advance health equity, sharing actionable data and making data context easily available.

The partners are exploring further alignment around payment methodologies, specialty-primary care coordination, actionable quality metrics, patient engagement and care delivery.  

THE LARGER TREND

ACO Reach came under scrutiny in 2022, when an estimated 20 lawmakers reached out to CMS to prevent fraud in the model. 

ACO REACH replaced the Global and Professional Direct Contracting Model. Participants in the GPDC were allowed to enroll in Reach if they met compliance requirements. Lawmakers expressed concern that at least 10 participants in the earlier model had records of healthcare fraud.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org