ACO REACH

The Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model is announcing a coordinated set of changes starting in performance year 2025 (PY 2025) in response to findings from the PY 2022 Global and Professional Direct Contracting Model Evaluation Report and feedback from interested parties. The changes include adjusting the financial methodology to reduce net losses to CMS as described in the PY 2022 Evaluation Report, improving the accuracy of benchmarks in response to feedback, and strengthening operational flexibility and risk management. For more information please visit the ACO REACH Model Performance Year 2025 Model Update Quick Reference.

Model Overview

The ACO Realizing Equity, Access, and Community Health (ACO REACH) Model provides novel tools and resources for health care providers to work together in an accountable care organization (ACO) to improve the quality of care for people with Traditional Medicare. REACH ACOs are comprised of different types of providers, including primary and specialty care physicians. To help advance health equity, the ACO REACH Model requires all participating ACOs to have a robust plan describing how they will meet the needs of people with Traditional Medicare in underserved communities and make measurable changes to address health disparities. Additionally, the model uses an innovative payment approach to better support care delivery and coordination for people in underserved communities.

The ACO REACH Model makes  important changes to the previous Global and Professional Direct Contracting (GPDC) Model in three areas: 

  1. Advance Health Equity to Bring the Benefits of Accountable Care to Underserved Communities. The ACO REACH model promotes health equity and focuses on bringing the benefits of accountable care to Medicare beneficiaries in underserved communities. ACO REACH will test an innovative payment approach to better support care delivery and coordination for patients in underserved communities and will require that all model participants develop and implement a robust health equity plan to identify underserved communities and implement initiatives to measurably reduce health disparities within their beneficiary populations.  
     
  2. Promote Provider Leadership and Governance. The ACO REACH Model includes policies to ensure doctors and other health care providers continue to play a primary role in accountable care. At least 75% control of each ACO's governing body generally must be held by participating providers or their designated representatives, compared to 25% during the first two Performance Years of the GPDC Model. In addition, the ACO REACH Model goes beyond prior ACO initiatives by requiring at least two beneficiary advocates on the governing board (at least one Medicare beneficiary and at least one consumer advocate), both of whom must hold voting rights. 
     
  3. Protect Beneficiaries and the Model with More Participant Vetting, Monitoring and Greater Transparency. CMS will ask for additional information on applicants’ ownership, leadership, and governing board to gain better visibility into ownership interests and affiliations to ensure participants’ interests align with CMS’s vision. We will employ increased up-front screening of applicants, robust monitoring of participants, and greater transparency into the model’s progress during implementation, even before final evaluation results, and will share more information on the participants and their work to improve care. Last, CMS will also explore stronger protections against inappropriate coding and risk score growth. 

Highlights

  • The health care system can be challenging to navigate, particularly for patients with chronic conditions and those who receive care from multiple providers who do not communicate with each other. These patients often receive unnecessary, repeat diagnostic tests or conflicting treatments for their different health conditions, and their primary care physician, if they have one, may not have a full picture of the treatment received by other providers.
  • The ACO Realizing Equity, Access, and Community Health (REACH) Model encourages health care providers — including primary and specialty care doctors, hospitals, and others — to come together to form an Accountable Care Organization, or ACO. ACOs break down silos and deliver high-quality, coordinated care to their patients, improve health outcomes, and manage costs. 
  • Patients in a REACH ACO get help navigating the health system and managing their conditions. They may have greater access to enhanced benefits, such as telehealth visits, home care after leaving the hospital, and help with co-pays. 
  • The model also requires all REACH ACOs to have a robust plan for meeting the needs of their patients with Original Medicare in underserved communities and make measurable changes to address health disparities.

 

Select anywhere on the map below to view the interactive version
Source: Centers for Medicare & Medicaid Services
Graphic explains "reaching" beyond GPDC model transition

Please see the ACO REACH GPDC Comparison Table (PDF) for a comprehensive set of policy updates.

Model Details

The first Performance Year of the redesigned model began on January 1, 2023 and will run for four Performance Years: Performance Year 2023 (PY2023) through PY2026. CMS has released a Request for Applications (RFA) for organizations interested in beginning participation in PY2023. Accepted applicants will have the option of participating in an Implementation Period leading up to PY2023, which runs from August 1, 2022 through December 31, 2022. Current GPDC Model participants must maintain a strong compliance record and agree to meet requirements for the redesigned model by January 1, 2023 in order to continue their participation.

The ACO REACH Model is focused on provider-based organizations and offers three types of participants:

  • Standard ACOs – ACOs comprised of organizations that generally have experience serving Original Medicare patients, including Medicare-only and also dually eligible beneficiaries, who are aligned to an ACO through voluntary alignment or claims-based alignment. These organizations may have previously participated in another Center for Medicare and Medicaid Innovation (Innovation Center) shared savings model (e.g., Next Generation ACO Model and Pioneer ACO Model) and/or the Shared Savings Program. Alternatively, new organizations, composed of existing Original Medicare providers and suppliers, may be created to form a Standard ACO. In either case, clinicians participating within these organizations would have substantial experience serving Original Medicare beneficiaries.
     
  • New Entrant ACOs – ACOs comprised of organizations that have not traditionally provided services to an Original Medicare population and who may rely primarily on voluntary alignment, at least in the first few performance years of model participation. Claims-based alignment will also be utilized.
     
  • High Needs Population ACOs – ACOs that serve Original Medicare patients with complex needs, including dually eligible beneficiaries, who are aligned to an ACO through voluntary alignment or claims-based alignment.
    • These participants are expected to use a model of care designed to serve individuals with complex needs, such as the one employed by the Programs of All-Inclusive Care for the Elderly (PACE), to coordinate care for their aligned beneficiaries.
       

Participation Options

There are two voluntary risk-sharing options under the ACO REACH Model. In each option, participating providers accept Medicare claims reductions and agree to receive at least some compensation from their ACO.

  1. Professional. A lower risk-sharing arrangement—50% savings/losses—with one payment option for participants: Primary Care Capitation Payment, a risk-adjusted monthly payment for primary care services provided by the ACO’s participating providers. 
     
  2. Global. A higher risk sharing arrangement—100% savings/losses—with two payment options: Primary Care Capitation Payment (described above) or Total Care Capitation Payment, a risk-adjusted monthly payment for all covered services, including specialty care, provided by the ACO’s participating providers.

Information for REACH ACOs

For future performance years under the ACO REACH Model, CMS intends that ACOs, Participant Providers, and Preferred Providers will receive the same scope of protection currently available for PY2021 and PY2022 of the GPDC Model under the CMS-sponsored model safe harbor at 42 CFR 1001.952(ii).

For reference, the following language appears on the GPDC Model webpage: CMS has determined that, beginning April 1, 2021, the anti-kickback statute safe harbor for CMS-sponsored model arrangements (42 CFR § 1001.952(ii)(1)) is available to protect certain DCE financial arrangements between or among the DCE, one or more DC Participant Providers, one or more Preferred Providers, or a combination thereof, provided that such arrangements comply with the requirements set forth in Section 3.04.M.1 of the GPDC Model Performance Period Participation Agreement (“Participation Agreement”). (Unless otherwise specified, capitalized terms have the meaning set forth in the Participation Agreement. Further, CMS has determined that, beginning April 1, 2021, the anti-kickback statute safe harbor for CMS-sponsored model patient incentives (42 CFR § 1001.952(ii)(2)) is available to protect certain in-kind patient incentives and Beneficiary Engagement Incentives furnished by a DCE, DC Participant Provider, or Preferred Provider to a Beneficiary or DC Beneficiary (as applicable), provided that such incentives are furnished in a manner that complies with the requirements set forth in Section 5.08.B of the Participation Agreement.

Please refer to the ACO REACH Model RFA (PDF) for additional details. 

Participant Selection

The application period for Performance Year 2023 closed and information on the selection process, including lists of organizations that have been accepted to participate in the Model starting January 1, 2023 and the subset participating in the optional Implementation Period (August 1, 2022 through December 31, 2022), is included on this webpage. 

Information for Interested Stakeholders

If you are interested in receiving CMS Innovation Center updates, including about the ACO REACH Model, subscribe to the CMS Innovation Center listserv.

If you are interested in receiving additional information and updates specifically about the ACO REACH Model, please subscribe to the ACO REACH Model listserv.

For any questions, please email the ACO REACH Model team at ACOREACH@cms.hhs.gov.

Transparency and Data Sharing 

CMS recognizes that stakeholders are interested in information about models, including greater insights into the participants, what they are doing to improve care, and impacts on quality and costs in advance of evaluation results being published. CMS is committed to providing greater transparency into the ACO REACH Model. 

For the ACO REACH Model, CMS will share the following information, regarding each REACH ACO participating in the model:

  • Type of entity (Standard, New Entrant, High Needs),
  • Risk-sharing arrangement (Global or Professional)
  • Payment option (Primary Care Capitation, Total Care Capitation, Advanced Payment),
  • Benefit enhancements and beneficiary engagement incentives they have selected to use (e.g., care management home visits to prevent hospitalization, waiver of the Medicare homebound requirement for access to home health services, Part B cost sharing support),
  • Organization website, and
  • Core service area.

CMS will also share aggregate information for all REACH ACOs on quality and financial performance based on operations data and financial benchmarks, not evaluation, which will be updated quarterly. It is important to note that the quality information presented will be for two claims-based measures—All Cause Readmissions and Unplanned Admissions for Multiple Chronic Conditions. In addition, information will be shared on the payments being made to REACH ACOs on a quarterly basis.

More information can be found on the ACO REACH Model archived materials page.

Financial and Quality Results

Methodology Papers

A series of methodology papers will be published for the ACO REACH Model in the summer of 2024. These papers will be updates to the GPDC Model methodology papers, including all financial papers, which are available on the GPDC Model webpage. 

Webinars

Sign up for the ACO REACH listserv and continue to check this site for additional updates. 

Where Health Care Innovation is Happening