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CMS Announces ACO Model With Health Equity Focus

The Center for Medicare & Medicaid Innovation will release a request for applications for the Realizing Equity, Access, and Community Health (REACH) accountable care organization (ACO) model.

The new REACH model is a redesigned version of the Global and Professional Direct Contracting (GPDC) model that focuses on promoting health equity and mitigating health disparities for underserved communities beginning in 2023. The REACH model will include four performance years, ending Dec. 31, 2026. CMS has provided a table for comparison of the REACH and GPDC models.

Details of REACH Model

The REACH model will include three participant types:

  • standard ACOs for organizations with substantial experience serving Medicare beneficiaries;
  • new entrant ACOs for organizations with less experience serving this population; and
  • high need–population ACOs, for organizations that serve small Medicare populations with complex health care needs.

It includes two voluntary risk-sharing options:

  • Professional — a lower-risk option with 50 percent shared savings and shared losses, and primary care capitation payment; and
  • Global — full risk option with 100 percent shared savings and shared losses, and either primary care capitation or total care capitation payment.

A key feature of the REACH model is its focus on health equity, including:

  • a requirement for all REACH ACOs to develop a health equity plan that must identify health disparities and specific actions to mitigate identified health disparities;
  • introduction of a health equity benchmark adjustment;
  • a requirement for all ACOs to collect beneficiary-reported demographic and social needs data; and
  • new benefit enhancement to increase the variety of services that may be ordered by nurse practitioners to improve access.

Additionally, the Centers for Medicare & Medicaid Services (CMS) announced immediate cancelation of the Geographic Direct Contracting (Geo) model. The Geo model was announced in December 2020 and paused in March 2021, and it is being permanently canceled due to stakeholder concerns.

Transparency Provisions

CMS has committed to providing greater transparency in the GPDC model for the remainder of 2022 and to do the same with the REACH model thereafter.

CMS will share information at the participant level, including:

  • type of entity (standard, new entrant, high needs);
  • risk-sharing arrangement (global or professional);
  • payment option (primary care capitation, total care capitation, advanced payment);
  • benefit enhancements and beneficiary engagement incentives (e.g., care management home visits to prevent hospitalization);
  • organization website; and
  • core service area.

CMS will share aggregate information, including the number of aligned beneficiaries and information on quality measures and financial performance, updated quarterly.

The application period for the REACH model opens March 7 and closes April 22. CMS will host webinars for the REACH model; register for the first webinar on March 1 at 4 pm ET.

For questions, email CMS’ REACH model team at ACOREACH@cms.hhs.gov.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Maryellen Guinan is a principal policy analyst at America's Essential Hospitals.

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