CMS Announces Changes to ACO Reach Model

Last week the Centers for Medicare & Medicaid Services (CMS) released a number of changes to the ACO Realizing Equity Access and Community Health (REACH) model. Changes aim to further advance health equity and increase participation in the payment model.

Key changes include lowering enrollment minimums for ACO organizations, which allow providers to form groups to manage care and costs, as well as increasing the money ACOS must reserve to mitigate risk. Risk methodology has also been updated to align with the Medicare Advantage program.

There have also been updates to Health Equity Benchmark Adjustments that aim to better allocate funds to ACOs using their health equity score. CMS will provide an extra $30 per person to ACOs with the highest-need beneficiaries. 

The ACO REACH Model, which started in January of this year, is a redesign of the CMS Medicare direct contracting model. It aims to advance health equity, ensure providers continue to play a primary role in accountable care, and protect beneficiaries through participant vetting, monitoring and transparency. Currently the model has 132 participants.