ACO Realizing Equity, Access, and Community Health (ACO REACH)

Healthcare Made

Better, Broader, and

More Balanced

Accountable Care Organizations (ACOs) have been quite successful in promoting better health care community, and as such, are often used as benchmarks for new healthcare models. The Centers for Medicare & Medicaid Services (CMS), in its continuous search for healthcare advancement and development, introduced the new ACO Realizing Equity, Access, Community Health (ACO REACH) model in 2022.

The Global and Professional Direct Contracting (GPDC) model are set to be phased out by the end of 2022. As a replacement model,  the ACO REACH model is focused in realizing and increasing the scope equity of health care services to underserved community.

Covering More Populations with Improved Health Management

The new ACO REACH model will necessitate all program participants to develop and enforce strong health equity plans as a means to provide better healthcare coordination, support, and delivery to underserved health of community. By reducing health disparities within beneficiary healthcare communities, the ACO REACH is designed to outline and provide extended healthcare support in a two-pronged approach. The action plans for the program are as follows:

1. Increased Emphasis on Beneficiaries

The ACO REACH seeks to empower underserved community by giving them more access and more active roles in their health care. Expanded benefits are expected to be included, such as telehealth consultations, post-clinical in-person visits, and lowered cost-sharing arrangements.

Inclusive and Extensive Guidelines

At its core, the ACO REACH integrates known best healthcare practices directed towards enlarging health population coverage with additional and amended plans. Five new policies have been crafted to favor health equity plans that meet the program requirements, which are:

• 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

2. Greater Provider Accountability and Advantages

Selected ACO REACH participants are expected to have more enhanced responsibilities, requiring at least 75% controlling interest of the program held by providers. Under this system, the ACO REACH program promotes higher levels of performance, monitoring, and transparency in all aspects of its workflow while ensuring that the program is more inclusive of identified underserved health populations.

Higher Community Reach

Redefining Healthcare Organizations

In realizing the full potential of ACO REACH model, interested participants would need to look into the specific guidelines laid by CMS to be able to serve broader healthcare populations. Three types of groups are allowed to participate in the new program, requiring partial or full capitation risk for providers, which are:

• 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

The ACO REACH model is predicted to mark and define new healthcare tracks based on best practices from previous programs while keeping the current healthcare working flow smooth and undisturbed.