The New ACO REACH Model Expands Healthcare Horizons

As an innovative payment approach intent on providing better support care delivery and coordination of care for patients, the ACO REACH model will require all model participants to design and implement robust health equity plans. These plans will be used to identify underserved communities and realize initiatives that are meant to measurably reduce health disparities within the beneficiary health population.

Improved Focus on Beneficiaries

The ACO REACH outlines several provider and beneficiary benefits along with stricter requirements than before. The new model is designed to provide extended Medicare benefits to underserved populations, giving them a more active role in their care and possible expanded benefits such as telehealth consultations, post-clinical home visits, and reduced cost-sharing.

ACO REACH will be focused on health equity designed to favor Medicare members through these five new policies:

• Health equity plan requirement
• Health equity data collection requirement
• Health equity benchmark adjustment
• Health equity questions in application and scoring for health equity experience
• Nurse practitioner services benefit enhancement

As a new healthcare model, ACO REACH is set to mark new and defining healthcare footprints using the best practices gleaned from previous healthcare models without disrupting current working approaches.

Increased Provider Responsibilities and Privileges

The new ACO REACH programs will allow current GPDC participants to apply for a spot in the new program, which has more stringent requirements in entry, performance, monitoring, and transparency. Chosen ACO REACH participants will have more enhanced roles, with providers having at least 75% controlling interest in the program.

ACO REACH will require downside risks for providers, which are associated with partial (50%), or global (100%) capitation. These three types of groups are allowed to participate in the new program:

• Standard ACOs with Medicare experience
• New entrant ACOs with lesser experience, such as GPDC models
• High-needs population ACOs with excellent track records of quality care delivery to smaller, complex health populations 

ACO REACH is aimed to provide improved tools and better resources to empower healthcare providers to facilitate better coordination of care while increasing the quality and delivery of care for individualized patient attention.

What can Current GPDC Participants Expect?

There are currently 53 GPDC participants, known as Direct Contracting Entities (DCEs), that can apply for ACO REACH once the GPDC model phases out. Many DCEs and ACOs have voiced their support for this program, which they believe will empower many providers and encourage more participation of many facets of the healthcare system and health population.

ACO REACH represents a major accountable care change since the announcement of a strategy refresh from CMS in October 2021. The strategy refresh has five objectives which are anticipated to be components of ACO REACH and these objectives seek to:

• Drive accountable care
• Advance health equity
• Support care innovations
• Improve access by addressing affordability
• Partner to achieve health system transformation

Interested healthcare organizations are expected to begin applying for ACO REACH participation slots starting March 7, 2022 until April 22, 2022.

The opening of ACO REACH participants heralds wider healthcare horizons, with many organizations eager to participate in improved and enhanced models. Like its predecessor, the GPDC direct contracting model, the new ACO REACH is predicted to tread into uncharted territories, with some possible hiccups along the way. As a new, untested healthcare model, the ACO REACH will need to use all available resources and tools to successfully navigate the ever-changing healthcare landscape.

Supporting healthcare programs for nearly three decades, MedVision has been tirelessly developing value-based integrated healthcare administration solutions to streamline operational workflow needs. With DCE-OS, customizable modules with interoperability functionalities transform administrative healthcare processes into simple, intuitively seamless operations from start to finish. DCE-OS successfully incorporates essential ACO healthcare administrative operations such as:

• Authorization supervision
• Case administration
• Capitation planning
• Credentialing framework
• Claims life-cycle management
• Reports generation
• Other vital operational aspects in running a highly effective healthcare organization

MedVision is a proud supporter of many successful ACOs that utilize DCE-OS to affect impactful and positive healthcare outcomes in their communities.

Align your operational ACO REACH needs with exceptional value through DCE-OS.

References:

1. https://www.cms.gov/newsroom/fact-sheets/accountable-care-organization-aco-realizing-equity-access-and-community-health-reach-model
2. https://www.hcinnovationgroup.com/policy-value-based-care/accountable-care-organizations-acos/article/21258924/naacos-creates-advocacy-group-to-promote-new-reach-aco-model
3. https://innovation.cms.gov/strategic-direction
4. https://www.naacos.com/press-release--naacos-launches-aco-reach-coalition

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