ACO REACH Model Launches, Stakeholders Applaud; CHART ACO Track Ends

On February 24, the Centers for Medicare and Medicare Services (CMS) gave a long-awaited announcement regarding the future of the Global and Professional Direct Contracting Model (GPDC). The existing model will phase out by December 31, 2022 and will be redesigned to create the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) model in its stead.

From CMS Deputy Administrator and Director of the CMS Innovation Center (CMMI), via the CMS press release:

CMS is testing a redesigned model because accountable care organizations make it possible for people in Traditional Medicare to receive greater support managing their chronic diseases, facilitate smoother transitions from the hospital to their homes, and ensure beneficiaries receive preventative care that keeps them healthy. Under the ACO REACH Model, health care providers can receive more predictable revenue and use those dollars more flexibly to meet their patients’ needs — and to be more resilient in the face of health challenges like the current public health pandemic.

As covered by the Hertel Report last Friday, the new model is designed to extend Medicare accountable care to underserved beneficiaries including a focus on transitions of care and expanding additional, creative benefits. Entrants to the program may be more favorable for providers, with more restrictive requirements for ACO REACH entry.

According to Health Leaders Media, ACO REACH is one of the first major changes to accountable care since the CMMI announcement of a “strategy refresh” in October 2021. The refresh included five major objectives, all of which appear as stated components of ACO REACH:

1. Drive Accountable Care
2. Advance Health Equity
3. Support Care Innovations
4. Improve Access by Addressing Affordability
5. Partner to Achieve Health System Transformation

Arizona has 25 DCEs operating in the state. Stay tuned for The Hertel Report’s ACO & Value Based Care Data edition for all the details on this competitive new program.

The original GPDC model was the latest version of “accountable care” drafted by the Trump Administration. It has received criticism from the Congressional Progressive Caucus as well as other liberal Democrat leaders for how closely it holds to Republican beliefs in the free-market and private-sector health industry regulations. Bloomberg Law suggests that the Biden Administration supported the previous model’s expansion of value-based care and uses the foundation of GPDC to further its goal of making healthcare more accessible and equitable for underserved populations.

One of the most significant changes to the pilot program is requiring model participants, called REACH ACOs, to have healthcare providers make up at least 75% of their governing board’s voting members. The old model only required providers to hold 25% of the votes on governing boards. Additionally, the boards are required to include a beneficiary representative and a consumer advocate who cannot be the same person, and each must hold voting rights. From a CMS senior official:

All of the entities that are currently in the program will have to decide to either meet these new requirements or not participate. But we are shifting this program to bring it back to its true moral calling, which is physicians working more with their patients. That will be the heart of what we believe these organizations should be going forward.

CMS also said that ACOs participating in the demo will use health equity plans to identify underserved communities in their beneficiary populations and put in place initiatives to measure and reduce disparities, Inside Health Policy reports. The only other alternative payment model that requires a health equity plan is the Accountable Healthy Communities model. From the CMS Fact Sheet:

The Innovation Center will provide ACOs with a template based on the CMS Disparities Impact Statement created by the CMS Office of Minority Health to identify health disparities, define health equity goals, establish a health equity strategy, and a plan for implementing the health equity strategy and monitoring and evaluating progress to advance health equity for underserved communities.

The National Association of ACOs (NAACOS) was, to put it lightly, delighted. On Friday, the interest group released a lengthy statement attributed to president and CEO Clif Gaus lauding the agency’s decision to expand accountable care and heed the advice NAACOS gave to maintain some aspects of the model while reforming others.

Many of the criticisms against Direct Contracting were a product of great misunderstanding about the model and the overall shift to value-based payment. Instead, keeping the model with additional focus on equity, increased provider governance, improvements to risk adjustment, and other changes is best moving forward.

On Monday, NAACOS launched its own coalition for ACO REACH participants. The ACO Reach Coalition will provide resources and education to interested providers and will support participating providers with press conference sessions and networking events, as well as a dedicated listserv about the model and other benefits. Enrollment is already open on the NAACOS website.

CHART ACO Model Dies

CMS has eliminated a program that was designed to increase the presence of ACOs in rural areas. Last Tuesday, the agency announced that there were “broader efforts underway” as its reasoning for removing the ACO Transformation Track which was part of a payment demonstration within the Community Health and Rural Transformation Model (CHART). Modern Healthcare reports that CMS will likely focus on broader health equity rather than geography in its next attempt to expand ACOs.