What Is ACO REACH: A Look into Risk and Equity

What Is ACO REACH and How Does It Affect Financial Risk and Health Equity?

Improved screening procedures have been implemented by the Centers for Medicare and Medicaid Services (CMS) to ensure that participants in ACO REACH will succeed. Participating providers must make up at least 75 percent of the governing body of each participating organization. Health care providers can maintain their primary role in accountable care through this arrangement. With the majority of the governing body made up of participating providers, they have more freedom to decide how much risk they are willing to assume and take on for beneficiaries.

Increased Gains for Capable Risk Takers

Professional and Global risk-sharing options are available through ACO REACH. It's less of a gamble with the Professional option, which has a lower risk-sharing rate of 50 percent. The Global alternative, on the other hand, is not for those who are easily concerned with uncertainties. It offers a risk-sharing rate of 100 percent, which would provide participants with an advantage when accountable care is properly implemented.

CMS receives a lesser portion of the savings generated by organizations that assume full risk. Consequently, organizations stand to gain more when they provide exceptional care if they opt for Global risk-sharing.

Higher Standards for Those Who Serve Communities at Risk

ACO REACH addresses concerns regarding organizations that misrepresent the severity of their patients' illnesses for financial advantage. The modifications brought about by ACO REACH are designed to prevent the escalation of the patient’s condition in order to obtain higher benchmarks and more funds from CMS. Benchmarks only become flexible when organizations have a positive track record with CMS and a large number of underserved individuals among their beneficiaries.

What is ACO REACH good for in terms of health equity? In this model, all organizations must come up with a plan to find and fix health disparities in a population. The organizations serving the most at-risk patients will be required to meet a higher financial spending target, as their health equity benchmark will be adjusted accordingly. When more organizations reach a higher spending goal, more clinical care is given to communities that need it.

Constant Commitment to Progress

It is clear that collaborators in the industry are interested in the specifics of the model’s participants and beneficiaries. In addition to provider leadership and community health equity goals, CMS also aims to be transparent with the progress of ACO REACH. With that, CMS is committed to sharing the following information:

• Type of participants and their respective organization website
• Chosen risk-sharing alternative
• Preferred payment option
• Enhanced benefits and incentives for beneficiaries who are under their care

A detailed documentation of ACO REACH participants and beneficiaries will help CMS and other healthcare professionals better understand and improve their practices.

Assume Greater Risk with the Right Technological Tools

What is ACO REACH going to contribute to your organization? ACO REACH is a revolutionary model that presents great opportunities to providers and patients. It also necessitates the employment of all available resources. Organizations willing to address the health challenges of communities, particularly the high-risk ones, will require all the assistance they can get. 

While technology continues to advance at a rapid rate, the evolution of ingenious healthcare tools has made it possible to organize everything you need with only a few clicks. As an innovator in the development of healthcare operational software, MedVision has designed QuickCap v7 (QC7) to be a reliable partner in improved healthcare delivery. QC7 provides a secure and efficient system with built-in features and functionalities that you can use for the following processes:

• Analyze the demographic of a health population and validate their eligibilities.
• Manage authorizations and the complete life cycle of claims.
• Receive feedback from patients and coordinate resolutions to their concerns.
• Seamlessly oversee the movement of electronic data interchange files.

Now is the time to implement a secure and effective healthcare administration system.

References:

1. ACO REACH | CMS Innovation Center. “ACO REACH | CMS Innovation Center.” innovation.cms.gov, March 7, 2022. https://innovation.cms.gov/innovation-models/aco-reach.
2. David Pittman, Clif; BS;Gaus, David Pittman BS, and Clif Gaus ScD. “ACO REACH Brings Next Era of Medicare Payment Models.” AJMC. www.ajmc.com, June 9, 2022. https://www.ajmc.com/view/aco-reach-brings-next-era-of-medicare-payment-models.
3. Nelson Mullins Riley & Scarborough LLP. “ACO REACH – a Good Opportunity? | JD Supra.” JD Supra. www.jdsupra.com, April 18, 2022. https://www.jdsupra.com/legalnews/aco-reach-a-good-opportunity-4076312/.

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