What ACOs Need to Know to Meet the Demands of ACO REACH and Unlock its Benefits

In an effort to lower healthcare costs and improve quality of care and access to care, the Centers for Medicare and Medicaid Services (CMS) Innovation Center recently cancelled the Geographic Direct Contracting Model and is phasing out the Global and Professional Direct Contracting Models (GPDC) at the end of 2022. Participants that meet requirements will be transitioned to Accountable Care Organization Realizing Equity, Access and Community Health Model (ACO REACH). CMS accepted applications through the end of April, and the new program is slated to begin in January of 2023.

The ACO REACH model was created to improve the focus on three main goals: promoting health equity and addressing disparities in underserved communities, continuing the momentum of provider-led organizations participating in value-based care models and protecting beneficiaries with more monitoring and transparency. While some of the goals and directives overlap with the GPDC model, there are key differences within the two models that should be addressed in order for participants to get the most value and ensure they are meeting all necessary requirements of the new model.

In order to meet the requirements established by CMS, organizations need the right technology that supports an alternative payment model and the new changes for collecting data. With the right technology and focus, providers can unlock the value of ACO REACH for their practice and their patients.

Three Policy Changes Under ACO REACH

1. Advance Health Equity to Bring the Benefits of Accountable Care to Underserved Communities

The new ACO REACH model is one of the first models structured around health equity, and it reflects the Innovation Center’s focus on bringing the benefits of accountable care to Medicare beneficiaries in underserved communities. Participating organizations will be required to draft a health equity plan to identify these communities and implement solutions to reduce health disparities. In addition, participants will be required to collect data on demographics and other specific social determinants of health.

ACO REACH organizations will also be responsible for meeting certain health equity benchmarks. Organizations that serve the most at-risk patients will have higher spending targets that are easier to obtain.

2. Promote Provider Leadership and Governance

As part of the ACO REACH model, CMS has set requirements for more provider participation and governance. Under GPDC, providers were required to make up 25% of governing rights. ACO reach increased that requirement to 75%.

The governing board must also include both a beneficiary representative and consumer advocate and they must be different people. Under GPDC, the representative could be the same person.

3. Protect the Model through Greater Transparency 

Concerns in Congress about coding practices and allegations of plans and providers adding diagnoses to inflate patient’s risk scores to get higher Medicare payments may have urged CMS to provide greater protections through additional monitoring and compliance. The oversight includes assessing whether beneficiaries are being shifted into or out of Medicare Advantage, examining risk score growth to identify potentially inappropriate coding practices, monitoring for misuse of beneficiary data and access to care, auditing Reach ACO contracts and more.

Meeting the ACO REACH Requirements

As CMS continues to focus on health equity and alternative payment models, more changes are likely in store. To meet the current demands of ACO REACH and to be prepared for future changes, organizations need technology that is nimble, efficient and scalable. Under ACO REACH, organizations will need to collect both demographic data and social determinants of health data. The right technology is needed to address population-based payments and ensure the financial benefits of the model. Technology designed for fee-for-service models will not provide the data needed to support the new model.

A cloud-based solution like Salesforce Health Cloud can help organizations stay compliant with the new model and provide the flexibility to scale to meet new demands.

Salesforce Health Cloud provides a cloud-based centralized system for operation and management, as well as 360-degree holistic view of patients, which allows organizations to move into a value-based care model and help meet the demands of ACO REACH. Health Cloud pulls in data from multiple sources for a completely connected experience, captures data and provides analytics for improving the beneficiary experience.

If you’d like to learn more about Virsys12 can help you prepare for ACO REACH, send us a message! We’d love to hear from you.