The ACO Realizing Equity, Access, and Community Health model is the latest shared-savings model designed by CMS to improve care and reduce costs in traditional Medicare.
Several of the largest payers are stepping further into value-based care by acquiring and expanding provider organizations.
Here are 15 things to know about the ACO REACH model:
Designed to tackle equity challenges
- ACO REACH replaces its previous iteration, the Global and Professional Direct Contracting model. The ACO REACH model program started on Jan. 1 and will run through the end of 2026.
- In 2022, CMS announced it would replace GPDC with ACO REACH in 2023. Per the agency, the updated model will "better reflect the priorities of the Biden-Harris Administration," including adding a stronger focus on health equity.
- One of the main differences between GPDC and ACO REACH is additional incentives to promote health equity. Value-based care models can disincentivize care for underserved populations, who underutilize services compared to need, according to consulting firm Oliver Wyman.
- Adjustments in payments per beneficiary are made based on dual-eligibility status (if a patient is eligible for both Medicare and Medicaid) and data from the University of Wisconsin-Madison Area Deprivation Index.
- Other key differences include requiring organizations participating in the model to be at least 75 percent provider governed.
By the numbers
- ACOs must choose between ACO REACH and the older ACO program, the Medicare Shared-Savings model. More ACOs are choosing the shared-savings model — in 2023, 456 ACOs covering 10.6 million beneficiaries will participate in shared-savings.
- In 2023, 132 ACOs covering 2.1 million beneficiaries will participate in ACO REACH.
- CMS hopes to have all traditional Medicare enrollees in an accountable care relationship by 2030.
Who's who in ACOs
-
Several care organizations owned by payers are participating in the model, including Humana's CenterWell clinics in Arizona, Texas, Florida and Missouri; CVS' Accountable Care Organization; Optum-owned CareMount Value Partners in New York; and Cigna's CareAllies Accountable Care Solutions.
-
Some lawmakers have expressed concern with the participation of some of these companies in the model. In a letter to CMS, the lawmakers named Centene, Clover Health, Humana, Cigna and Bright Health as organizations they were concerned about participating in the new ACO model because of allegations they overcharged the government through Medicare Advantage and other operational issues.
-
CVS' accountable care organization is partnering with Rush University to provide care through ACO REACH in the Chicago-area.
-
CVS Health also acquired Oak Street Health, a provider of value-based care for Medicare beneficiaries. The provider is an ACO REACH participant.
-
Cigna is a minority owner of VillageMD, a major player in the ACO space. Its clinics in 14 states are participants in the ACO REACH program.
-
Bright Health ended almost all of its Medicare Advantage business in 2022, shifting focus to its accountable care organization, NeueHealth, an ACO REACH participant.
-
Clover Health said in November 2022 it would scale back its participation in the model by two-thirds. CEO Andrew Toy said the company was considering shifting to the shared-savings model.