The Complete Guide To an Effective ACO REACH Application

Why You Should Go for an ACO REACH Application

ACO REACH provides two risk-sharing options for organizations to choose from depending on their financial structure. The Professional option offers lower risk with its 50 percent shared savings and shared losses arrangement. The Global option on the other hand, enables 100 percent risk-sharing and promotes increased benefits. Businesses that are willing to take all the possible risks stand to gain the most.

The benchmarks CMS sets in place vary from one institution to another. Health equity benchmarks will be more forgiving or even higher for ACOs that provide care to primarily underserved populations. Consequently, these same ACOs will need to meet a higher financial spending target. Care for vulnerable populations also increases as the number of institutions with higher spending goals increases.

What You Need to Know as a REACH Applicant

The promise of competitive advantage that a strong ACO REACH application brings has piqued the interest of many organizations. CMS has released new guidelines to ensure the success of institutions adopting the new model. These new standards are in line with the main goal of CMS to improve health equity and facilitate direct care delivery.

Comply with the Five GPDC Domains

Since the basis of the new system is the Global and Professional Direct Contracting (GPDC) model, organizations must observe its tenets. The five domains account for the vast majority of the criteria CMS uses to select ACO REACH program participants. The associations that aim to successfully join the new model must have a diverse set of providers. These providers must have a great track record of delivering quality care. Having a sizable pool of reliable providers demonstrates the consistency of a business's personnel.

The executive manager and medical director must also be of a certain caliber. They must meet specific criteria in order to make sure that the organization is led by only the best and most qualified. CMS will also look into a company’s total clinical and non-clinical revenues from the previous fiscal year to determine eligibility. In addition to the financial and transactional records, the history of clinical care and patient management will also be reviewed. The screening process may be thorough, but an institution’s advantage will be in adhering to the five GPDC domains.

Exhibit a Proven History of Providing Direct Patient Care

A high level of competence in direct patient care is a requirement for the applicants of the ACO REACH program. It is also  required that at least 75 percent of the organization’s governing body be participating providers. This is to ensure that the primary decision-makers are proficient and have extensive experience with direct patient care. The board's considerable knowledge will inspire the rest of the staff to perform at the same level of excellence.

Demonstrate a Record of Success in Providing Care to Underserved Populations

The main goal of reducing health inequalities necessitates an investigation into how effective applicants have been at serving vulnerable communities. There is an advantage for businesses that already engage with underserved populations. When adopting the new system, they are eligible for flexible or even high benchmarks. With a proven history of providing care to high-risk groups, CMS can determine the potential for succeeding with ACO REACH.

Pass the Program Integrity Review

CMS examines a company’s program integrity along with that of any affiliated entities. Each candidate must list any associate with a five percent or greater ownership interest in the organization. The findings of the program integrity review play a major role in determining an application’s acceptance.

Take Part in ACO REACH with Ingenious Technology

Providers and patients alike can benefit tremendously from CMS’s new healthcare delivery model. When you achieve a successful ACO REACH application, it will have far-reaching effects for both your stakeholders and beneficiaries. With such great stakes, it is imperative that you work with reliable technological solutions in delivering value-based care. For nearly three decades, MedVision has meticulously developed comprehensive software that caters to a wide range of business needs. MedVision’s QuickCap 7 (QC7) is the premier, dependable healthcare delivery partner. With customizable and interoperable features, QC7 will assist you in checking off each requirement in your application. Secure your ACO REACH participation with QC7’s powerful features that enable you to:

• Review annual provider scorecards.
• Manage member risk adjustment (MRA) data.
• Standardize and implement quality measures.
• Record and examine beneficiary yearly costs.

Achieve your ACO REACH goals with a solid healthcare administration system.

References:

1. ACO REACH | CMS Innovation Center. “ACO REACH | CMS Innovation Center,” March 7, 2022. https://innovation.cms.gov/innovation-models/aco-reach. 

2. Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model | CMS. “Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model | CMS,” February 24, 2022. https://www.cms.gov/newsroom/fact-sheets/accountable-care-organization-aco-realizing-equity-access-and-community-health-reach-model.