CMS updates ACO Reach: 5 things to know

CMS will make several tweaks to the ACO REACH model in 2024, designed to make payments from the model more predictable for participants and adjust equity benchmarks. 

The agency explained the updates to the model for 2024 in a reference guide published Aug. 14. 

The ACO Realizing Equity, Access, and Community Health model is a shared-savings model designed by CMS to improve care and reduce costs in traditional Medicare. The model began on Jan. 1, and runs through the end of 2026. 

Here are five things to know about the changes coming to the model for 2024: 

  1. For payment year 2025, CMS will reduce the minimum number of beneficiaries aligned with each ACO from 5,000 to 4,000 for new entrant ACOs, and from 1,200 to 1,000 for high-needs ACOs. Beginning in payment year 2024, CMS will provide a 10 percent buffer for ACOs if their beneficiary counts dip below the minimum number. 

  2. The agency will expand the definition of a high-needs ACO to organizations to provide care to beneficiaries who have used 90 days of Medicare-covered home health services or 45-days of skilled nursing coverage in the past 12 months. 

  3. In 2024, the agency will blend risk adjustment standards for ACO REACH participants. Beneficiaries risk scores will be calculated with 67 percent weighted using 2020 standards and 33 percent using the new risk adjustment model CMS is phasing in for Medicare Advantage. 

  4. CMS will revise its health equity benchmark payments to better account for underserved beneficiaries living in areas with high-costs of living. 

  5. In a statement, Clif Gaus, Sc.D, president of the National Association of ACOs, said CMS' changes address many concerns raised by its members.

    "These include financial protections from midyear changes to benchmarks, additions to the Health Equity Benchmark Adjustment to account for more patient characteristics, and updates to its risk adjustment policies," Dr. Gaus said. "We believe these changes will satisfy many concerns and stabilize future participation." 

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