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Since Accountable Care Organization (ACO) policy began with the Affordable Care Act (ACA), there have been two main pathways for the development of ACOs: The Medicare Shared Savings Program (MSSP), which remains unchanged, and the development of ACO models by the Centers for Medicare and Medicaid Innovation (CMMI).
Driven by value-based care initiatives, the ACO Realizing Equity, Access, and Community Health (REACH) is CMMI's latest model introduction. ACO REACH is an important innovation that will help organizations meet evolving patient needs. Starting January 1, 2023, ACO REACH replaced the Global and Professional Direct Contracting model (GPDC). Created in part as a response to GPDC model criticisms, ACO REACH was designed “to improve the quality of care for people with Medicare through better care coordination by reaching and connecting health care providers and beneficiaries, including those beneficiaries who are underserved.”
While much of the GPDC model remains intact, ACO REACH advances health equity through this new iteration. According to CMMI, “The ACO REACH model promotes health equity and focuses on bringing the benefits of accountable care to Medicare beneficiaries in underserved communities.” ACO REACH introduces an innovative approach to payments, allowing providers to move away from fee-for-service (FFS) compensation, and will require all participants to develop and implement a detailed health equity plan to understand and address underserved communities.
Importantly, ACO REACH promotes provider leadership and governance. It includes policies that ensure doctors and other health care providers play a key role in accountable care. The GPDC required only 25% of an ACO’s governing body to be held by participating providers. ACO REACH has returned that percentage to 75%, prioritizing provider-led organizations. Additionally, ACO REACH requires at least two beneficiary advocates to be on the ACO’s governing board (consisting of at least one Medicare beneficiary and at least one consumer advocate) that each have voting rights.
What sets ACO REACH apart from previous models is its focus on health equity. By including policies to ensure health equity, ACO REACH prevents communities from being underserved. And by maintaining much of the GPDC model’s design, CMMI allows participants to take full financial risk for Medicare services. This promising evolution will not only result in better community health and more value-focused care but will also provide greater regulatory flexibility and more financial risk and reward opportunities.
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