Extending the REACH of Value-Based Care

CMS announces rollout of ACO Reach. Here’s what you want to know about this news, and how Innovaccer plans to help our customers transition to or participate in this new model and its focus on health equity.

This week the CMS introduced its new ACO REACH model, the next step in its effort to accelerate the industry’s transition to value-based care. ACO REACH is an evolution of the Global and Professional Direct Contracting models (GPDC, or “Direct Contracting” for short), introduced in April 2019.

As a global technology leader helping providers excel at value-based care, we are pleased that CMS and CMMI continue to innovate programs designed to accelerate the transition to value while advancing health equity. We work every day to help our customers deliver high-quality coordinated care, and succeed financially, while also helping to bend healthcare’s cost curve.

As such, we are optimistic about the new ACO REACH model although, like you, we are still digesting its just-announced details. Innovaccer is also committed to supporting our customers who are presently DCEs and plan to transition to ACO REACH, as well as to support providers who freshly apply and are accepted for the ACO REACH program. As such, we will continue to innovate our technology to ensure our customers can excel as members of the ACO REACH program, just as we did when the GDPC was introduced.

We are closely studying the new model’s parameters and requirements, to ensure alignment with our population health management solution and our Best in KLAS data platform’s capabilities. Our commitment to our customers is to always evolve and customize our products to best support new, evolving, and future models—and ACO REACH is no exception.

To that end, we will develop a portfolio of Innovation Accelerators for ACO REACH that are purpose-built to help ACOs and the communities they serve succeed with these new objectives. Our plan is to have these Accelerators ready in advance of ACO REACH’s first performance year of 2023.

These Innovation Accelerators will provide the technology assets—ready-made data models, analytics, dashboards, workflows—required to technology-enable the ACO REACH model. Moreover, we will be working with our partners to offer ACOs the help they’ll need to address the high-level implementation and change management aspects required, including PwC and Microsoft.

For background, Direct Contracting lets providers (known as Direct Contracting Entities or DCEs) accept full or partial capitation as payment for certain Medicare-covered services. Providers eager to move away from fee-for-service in lieu of taking on more risk receive prospectively calculated monthly payments to manage a population.

ACO REACH refines the GPDC model by transitioning and replacing it with a program that aligns with three objectives, according to the CMS: freedom of choice for beneficiaries, greater health equity, and reaching underserved communities.

Introduction of this new model is consistent with CMS’s strategic plan, announced last year. The CMS is including health equity as a key component of the program and will likely pay closer attention to risk adjustment. Participation will likely add significant data collection and integration requirements (race, ethnicity, primary language, other social determinants of health) and analysis by various breakdown elements on participants. Given that ACOs on the Innovaccer Health Cloud generated more than 3X the Shared Savings Growth of other ACOs, our customers are well-prepared to excel at this new data-driven model.

Our current solutions already incorporate social determinants of health. The need to integrate patient data from beyond the health system’s four walls has been a direction that Innovaccer identified long ago as critical for equitable patient care, and is a core piece of our platform and products. We've built our model around value-based, patient-centered, equitable care.

Meanwhile, for time-pressed healthcare executives, we have summarized the key points around the CMS announcement for you here. Please feel free to reach out to your Innovaccer representative with any questions or requirements you might have.

FAST FACTS about ACO REACH

For more information, please contact us.

• The GPDC model will continue through December 2022, after which it will transition to the ACO REACH model.
• Current GDPC participants can transition to ACO REACH if they agree to the new model’s requirements by the start date.
• CMS is canceling the Geographic Direct Contracting (Geo) model. Announced in December 2020, it was paused in March due to stakeholder concerns, CMS said.
• CMS is releasing a Request for Application for provider-led organizations interested in joining the ACO REACH Model. The first round of applications will be accepted in the spring. ACO REACH request for application (RFA) can be made here.
• The first performance year of the ACO REACH model will start January 1, 2023 and run through 2026.
• A minimum of 75% of an ACO’s governing body must be controlled by participating providers or designated representatives, up from 25% in the GPDC model.
• GPDC participants that do not meet model requirements, such as participants that restrict medically necessary care, will face corrective action and potential termination from the model.
• The ACO REACH model is focused on providers and offers three participant types:
  • Standard ACOs: Organizations who are aligned to an ACO through voluntary alignment or claims-based alignment and have experience serving original Medicare patients, including Medicare-only and dual-eligible beneficiaries.
  • New Entrant ACOs: Organizations that have not provided services to an original Medicare population and who might rely primarily on voluntary- or claims-based alignment in the first few performance years of participation.
  • High-Needs Population ACOs: ACOs that serve original Medicare patients with complex needs, including dual-eligible beneficiaries, who are aligned to an ACO through voluntary- or claims-based alignment.
• The ACO REACH model offers two voluntary risk-sharing arrangements. Participating providers accept Medicare claims reductions and agree to receive at least some compensation from their ACO.
  • Professional option: 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.
  • Global option: A higher risk sharing arrangement—100% savings/losses—with two payment options: Primary Care Capitation Payment or Total Care Capitation Payment, a risk-adjusted monthly payment for all covered services, including specialty care, provided by the ACO’s participating providers.
• A GPDC-ACOR comparison grid is available here.
• The official CMS ACO REACH page is here.

For more information, please contact us.