ACO REACH: A Guide for Healthcare Providers and Practitioners

The ACO Realizing Equity, Access, and Community Health (ACO REACH) Model helps underserved communities receive higher quality care while addressing health disparities. Unlike the traditional fee-for-service model, which promotes quantity over quality, accountable care organizations (ACOs) can use the ACO REACH Model to improve health outcomes using coordinated care. This also helps reduce healthcare spending due to repeat services and emergency room visits for chronic illness.

 ACO REACH Participants

The ACO REACH Model can be broken into three types of participants:

• Standard ACOs: organizations with experience serving Original Medicare patients and have previously participated in another CMMI shared savings model
• New Entrant ACOs: organizations who have not provided services to Original Medicare populations
• High Needs Population ACOs: organizations that serve Original Medicare patients with complex needs

The Standard ACOs are aligned to an ACO through either voluntary alignment or claims-based alignment. New Entrant ACOs primarily rely on voluntary alignment for the first few performance years of model participation. High Needs Population ACOs align to an ACO through voluntary or claims-based alignment.

Unlike Standard and New Entrant ACOs, High Needs Population ACOs are expected to use a care model that serves patients with complex needs to coordinate care for aligned beneficiaries. In addition to serving Original Medicare patients, High Needs Population ACOs also include dually eligible beneficiaries.

Options for ACO REACH Participation

There are two options available under the ACO REACH Model that participating providers can use to receive compensation from their ACO. These options are:

• Professional
• Global

Professional refers to lower risk-sharing arrangements, in which there is 50% savings/losses and use one payment option for participants. This payment option is the Primary Care Capitation Payment, which uses monthly risk adjustments for primary care services.

Global refers to higher risk-sharing arrangements, in which there is 100% savings/losses and uses two payment options. These payment options are the Primary Care Capitation payment used in the Professional option and the Total Care Capitation Payment, in which monthly risk adjustments include all covered services, including ones beyond primary care, such as specialty care.

Benefits of ACO REACH

The ACO REACH Model brings ACO benefits to underserved communities. This helps provide patients in underserved communities with higher quality care through coordinated care services. In turn, it can lead to higher patient satisfaction, reduced healthcare spending, and avoidance of repeat services and emergency room visits. Both patients and ACOs can benefit from the ACO REACH Model, which moves away from the traditional pay-for-service model. Through the ACO REACH Model, ACOs are compensated for higher quality care that they give to patients, putting a higher focus on improved patient health outcomes.

The ACO REACH Model also promotes transparency and holds ACOs accountable for providing quality care to patients. It allows ACOs to receive better visibility into health care delivery and aligns participants’ interests with that of CMS’ vision. The transparency in the model’s progress during implementation also serves to benefit both patients and participants.