Earlier this year, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced that the ACO Realizing Equity, Access, and Community Health (REACH) Model will replace the Global and Professional Direct Contracting Model (GPDC) on January 1, 2023. Read on to learn more about how the new model is different, how it will impact providers and patients, and how your organization can prepare for success.
What is the ACO REACH Model?
The ACO REACH Model is the redesigned version of the GPDC Model. It focuses on promoting health equity and addressing health care disparities for underserved communities, continuing the momentum of provider-led organizations participating in risk-based models, and protecting beneficiaries and the model with more participant vetting, monitoring, and greater transparency.
The ACO REACH Model provides tools and resources to empower doctors and other healthcare providers to better coordinate and improve the quality of care they provide for patients in traditional Medicare. This approach affords patients greater individualized attention to their specific healthcare needs while preserving all services and flexibilities beneficiaries enjoy in traditional Medicare.
The goal of the ACO REACH Model is to provide access to enhanced benefits and to increase the availability of high-quality, coordinated care, especially for underserved populations. The goals of the new model are:
Advance health equity
- The ACO REACH Model promotes health equity and focuses on bringing the benefits of accountable care to Medicare beneficiaries in underserved communities. This model will use a new payment approach to support care delivery and coordination for patients in underserved communities. It will also require all participants to develop and implement a robust health equity plan to measurably reduce health disparities.
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.
Protect beneficiaries with more participant vetting, monitoring, and transparency
- CMS will require additional information on applicants’ ownership, leadership, and governing board to gain visibility into healthcare delivery, ownership, financial interests, and affiliations. There will be an increased screening of applicants, robust monitoring of participants, and greater transparency into the model’s progress during implementation.
What is the difference between GPDC and ACO REACH?
The new ACO REACH Model differs from GPDC in many ways, including increased provider governance, a stronger focus on health equity, and improvements to risk adjustment. This model builds on the Next Generation ACO Model to offer higher levels of risk and reward than the Medicare Shared Savings Program (MSSP). The new ACO REACH Model will also require that all participants have a robust health equity plan and increase the benchmark for ACOs serving underserved beneficiaries.
In terms of benefits, patients in ACO REACH will receive more benefits than those in traditional Medicare. Extensive use of telehealth will be allowed, and the three-day inpatient hospital stay requirement before admission to a SNF will be waived. Patients will also receive cost-sharing support and are allowed much more generous use of home visits after they leave the hospital.
How is quality measured?
As part of the CMS push goal of simplicity, the ACO REACH model has significantly fewer quality measures, some of which are reportable by claims, so chart chasing is no longer required. The new quality measures are:
- Claims-based measures
- Risk-standardized, all-condition readmission
- All-cause unplanned admissions for patients with multiple chronic conditions
- Days at home for patients with complex, chronic patients (high needs ACOs only)
- Timely follow-up after acute exacerbations of chronic conditions (standard and new entrant ACOs only)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to measure the quality of patients’ experiences
How can CarePort®, powered by WellSky® help?
Moving forward, health systems that invest in the technologies to advance the objectives of the ACO REACH Model will be best positioned to transition smoothly to the new model — and future models — for the benefit of both patients and the organization.
CarePort can support organizations as they move to ACO REACH with workflow solutions and a robust national network of nearly 2,000 hospitals and 130,000 post-acute providers. CarePort Connect enables disparate providers that share patients across the continuum – hospitals, ACOs and risk-bearing organizations, physician groups, payers, and post-acute providers — to coordinate care through real-time, actionable data. CarePort Insight works hand in hand with CarePort Connect to build and manage high-performing post-acute collaboratives through real-time, risk-adjusted data.
With CarePort Connect and Insight providers can:
- Receive contextual clinical updates and alerts to monitor or redirect patients to the appropriate level of care, prevent readmissions, and support immediate patient interventions
- View additional clinical context and previous utilization history from various settings to help make better care decisions or uncover potential social determinants of health
- Share data and information about patient outcomes to strengthen relationships and connectivity with provider partners
- Leverage real-time and referring source metrics to compare post-acute performance based on risk-adjusted measures
- Determine root causes of rehospitalizations
- Identify gaps in care and opportunities for improvement
Learn more about how CarePort®, powered by WellSky® can help your organization prepare for success with ACO REACH.