Understanding ACO REACH Program Requirements

Have you officially been accepted to participate in the new ACO REACH Model? If so, congratulations! Whether your organization is an existing DCE, an MSSP, ACO, or a new entrant, this initiative will introduce significant changes for you and your patients.

The goals of ACO REACH are straightforward: improve care and population health for underserved communities and lower healthcare costs while addressing inequity in the system. This model is an exciting opportunity to enhance care coordination and ensure your most vulnerable patient populations receive proper access to high-quality care.

With the new cohort set to begin on January 1, 2023, now is the time to review the model’s requirements and understand how they may affect your organization and how to use the available tools to come into compliance with the model’s health equity adjustment.

Health Equity
Extending care to traditionally underserved communities is at the core of ACO REACH. To meet CMS’s requirements, ACOs will need to complete the following equity-focused initiatives:

  • Health equity plans: Starting in Performance Year (PY) 2023, each REACH ACO will need to develop a plan to identify health disparities in their market and explain the specific actions it will take to mitigate the identified health disparities.
  • Data collection: Under the new model, CMS requires participants to collect two types of data: demographics and social determinants of health. ACOs must submit the necessary data outlined in the United States Core Data for Interoperability Version 2, including race, ethnicity, language, gender identity, and sexual orientation. In PY2023, CMS will offer an upward-only quality score adjustment to ACOs for successfully reporting data. However, in future years, CMS may institute a downward adjustment for an ACO’s failure to report.

ACO Governance
One of the most significant changes under the revised ACO REACH model is the governing body requirements. Providers will now be required to have at least 75% of the governing board voting rights, compared to GPDC’s requirement that participating providers hold only 25% of the governing board voting rights. Additionally, each governing board must include a beneficiary representative and a consumer advocate, and they must be two separate people.

Delivering CCM Under ACO REACH
A critical element of the revised model is enhancing care coordination within health systems for patients with chronic diseases. ACOs have already been working to improve chronic disease management by enacting smoother transitions from hospitals to homes and facilitating preventive care to maintain patient health. Other enhancements such as cost-sharing waivers for Part B services, for example, can help reach the overall goals of making healthcare more equitable, accessible and affordable. For those who qualify, Engooden can help manage those waivers on behalf of physicians and ensure underserved individuals are seeing their provider in a timely and affordable manner.

With better payment models, ACOs can pursue better patient care and improve the health of their patient populations.

At Engooden, we see ACO REACH as an exciting opportunity to improve the health of your most vulnerable patient populations. We have a proven track record of helping customers develop chronic disease management programs that allow them to manage equity, quality and waivers, remaining compliant and competitive. As you prepare your organization for ACO REACH, our team can help you make the most of operating under this new model.

REACH for Success
Join us on Tuesday, July 12 at 1 p.m. ET for a one-hour webinar with David Ault, former CMS CMMI Director, Division of Financial Risk and current counsel at Ropes & Gray, and Ryan Atwood, Engooden VP of Payer Relations and Regulatory Affairs. Registration is now open.

Contact us today and learn how Engooden can help you make the most of the REACH model and deliver quality care to your patient populations that need it most.