The Centers for Medicare & Medicaid Services (CMS) has redesigned its current GPDC model into the brand new ACO REACH model. REACH stands for Realizing Equity, Access, and Community Health. CMS hopes that this new model will improve the quality of care for people with Medicare through “better care coordination, reaching and connecting health care providers and beneficiaries, including those beneficiaries who are underserved.”
Advance Health Equity
This model will require participants to develop and implement a robust health equity plan to identify underserved communities and implement initiatives to measurably reduce health disparities within their beneficiary populations.
Promote Provider Leadership and Governance
Old: 25% control of each ACO’s governing body generally must be held by participating providers or their designated representatives during the first two Performance Years of the GPDC Model.
New: 75% control of each ACO’s governing body must be held by participating providers or their designated representatives. Requires at least two beneficiary advocates on the governing board (at least one Medicare beneficiary and at least one consumer advocate), both of whom must hold voting rights.
CMS will ask for additional information on applicants’ ownership, leadership, and governing board. This is to ensure that ACO participants’ interests align with CMS’s vision for better patient care.
Three types of Participants:
Standard ACOs are organizations that have experience serving Original Medicare patients. They have previously participated in another shared savings model and/or the Shared Savings Program. If you’re a new organization, you must be composed of existing Original Medicare providers and suppliers. This is to ensure that any participating clinicians will have substantial experience serving Original Medicare Beneficiaries.
New Entrant ACOs
New Entrant ACOs are comprised of organizations that have not traditionally provided services to an Original Medicare population. They can also be organizations who may rely primarily on voluntary alignment in the first few performance years of model participation. Claims-based alignment is applied here.
High Needs Population ACOs
High Needs Population ACOs are ACOs that serve Original Medicare patients with complex needs, including dually eligible beneficiaries, who are aligned to an ACO through voluntary alignment or claims-based alignment.
- These participants are expected to use a model of care designed to serve individuals with complex needs, such as the one employed by the Programs of All-Inclusive Care for the Elderly (PACE), to coordinate care for their aligned beneficiaries
Professional – Lower risk-sharing
50% savings/losses—with one payment option for participants: Primary Care Capitation Payment, a risk-adjusted monthly payment for primary care services provided by the ACO’s participating providers.
Global – Higher risk-sharing
100% savings/losses—with two payment options: Primary Care Capitation Payment (described above) or Total Care Capitation Payment, a risk-adjusted monthly payment for all covered services, including specialty care, provided by the ACO’s participating providers.