by Roy Edroso
Experts are getting a closer look at the ACO REACH model CMS suddenly unveiled in February, and it’s looking good for ACOs who don’t have unlimited financial resources, as well as for the advancement of CMS’ health equity cause. After months of controversy over the CMS Global and Professional Direct Contracting (GPDC) model from the Center for Medicare and Medicaid Innovation (CMMI), CMS announced Feb. 24 that, starting in 2023, the program would be transformed into the Accountable Care Organization (ACO) Realizing Equity, Access and Community Health (REACH) model, or ACO REACH. Its participants would be called ACOs instead of Direct Contracting Entities (DCE) (PBN 2/28/22, 3/7/22).
Since the announcement, CMMI has issued a request for applications, which are due by April 22, 2022, and must be submitted by portal (see resources, below). Applicants may include current GPDC entrants who want to remain in the program when it turns into ACO REACH, as well as new groups interested in value-based design.
Take a look at ACO Reach details
Experts have parsed the technical details announced by CMMI. The lowering of the quality withhold from 5% to 2%, for example, is a break for ACOs, especially those who can’t afford to invest too much up front, explains Lauren Patrick, president and CEO of qualified registry Healthmonix in Malvern, Pa. This is meaningful because critics, such as Sen. Elizabeth Warren (D-Mass.), had complained about well-funded private equity interests’ potential domination of the program.
“CMS holds back a percent of the savings to be adjusted based on the quality scores on quality measures that CMMI/CMS have included in the program,” Patrick explains. “For example, the current Global DCE would get 95% of their savings regardless of their performance on the quality metrics. Then the remaining 5% would be based on how well quality metrics are achieved.”