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CMS Redesigns Accountable Care Organization
Model to Provide Better Care for People with Traditional Medicare
Global
and Professional Direct Contracting Model Transitioning to ACO Realizing
Equity, Access, and Community Health (REACH) Model Building on the Biden-Harris Administration’s
priorities for a better health care system, today the Centers for Medicare
& Medicaid Services (CMS) announced a redesigned Accountable Care
Organization (ACO) model that better reflects the agency’s vision of creating
a health system that achieves equitable outcomes through high quality,
affordable, person-centered care. The ACO Realizing Equity, Access, and
Community Health (REACH) Model, a redesign of the Global and Professional
Direct Contracting (GPDC) Model, addresses stakeholder feedback, participant
experience, and Administration priorities, including CMS’ commitment to
advancing health equity. In addition to transitioning the GPDC Model
to the ACO REACH Model, CMS is canceling the Geographic Direct Contracting
Model (also known as the “Geo Model”) effective immediately. The Geographic
Direct Contracting Model, which was announced in December 2020, was paused in
March 2021 in response to stakeholder concerns. “The Biden-Harris Administration remains
committed to promoting value-based care that improves the health care
experience of people with Medicare, Medicaid and Marketplace coverage,” said
CMS Administrator Chiquita Brooks-LaSure. “To fulfill that commitment, CMS,
through the Innovation Center, is testing new models of health care service
delivery and payment to improve the quality of care that people receive,
including those in underserved communities. The Innovation Center is making
improvements to existing models and launching new models to increase
participation in our portfolio, and CMS will be a strong collaborator to
health care providers that participate in those models.” As CMS works to achieve the vision
outlined for the next decade of the Innovation Center, CMS wants to work
with partners who share its vision and values for improving patient care,
guided by three key principles. First, any model that CMS tests within
Traditional Medicare must ensure that beneficiaries retain all rights that
are afforded to them, including freedom of choice of all Medicare-enrolled
providers and suppliers. Second, CMS must have confidence that any model it
tests works to promote greater equity in the delivery of high-quality services.
Third, CMS expects models to extend their reach into underserved communities
to improve access to services and quality outcomes. Models that do not meet
these core principles will be redesigned or will not move forward. Consistent with these principles, the ACO
REACH Model, tested under the CMS Innovation Center’s authority, will adhere
to the following priorities: a greater focus on health equity and closing
disparities in care; an emphasis on provider-led organizations and
strengthening beneficiary voices to guide the work of model participants;
stronger beneficiary protections through ensuring robust compliance with
model requirements; increased screening of model applicants, and increased
monitoring of model participants; greater transparency and data sharing on
care quality and financial performance of model participants; and stronger
protections against inappropriate coding and risk score growth. The ACO REACH Model builds on CMS’ ten years
of experience with accountable care initiatives, such as the Medicare Shared
Savings Program, the Pioneer ACO Model, and the Next Generation ACO Model.
The ACO REACH Model provides novel tools and resources for health care
providers to work together more closely to improve the quality of care for
people with Traditional Medicare. To help advance health equity, the
ACO REACH Model will require 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, under the ACO REACH Model, CMS will use an
innovative payment approach to better support care delivery and coordination
for people in underserved communities. REACH ACOs will be responsible for helping
all different types of health care providers — including primary and
specialty care physicians — work together, so people get the care they need
when they need it. In addition, people with Traditional Medicare who receive
care through a REACH ACO may have greater access to enhanced benefits, such
as telehealth visits, home care after leaving the hospital, and help with
co-pays. They can expect the support of the REACH ACO to help them navigate
an often complex health system. “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 preventive care that keeps them healthy,” said CMS
Deputy Administrator and Director of the CMS Innovation Center Liz Fowler,
PhD, JD. “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. The bottom line is that ACOs can
improve health care quality and make people healthier, which can also lead to
lower total costs of care.” The GPDC Model will continue until December
31, 2022 and then will transition to the ACO REACH Model. In the meantime,
CMS will operate the GPDC Model with more robust and real-time monitoring of
quality and costs for model participants. GPDC Model 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 first performance year of the redesigned
ACO REACH Model will start on January 1, 2023, and the model performance
period will run through 2026. CMS is releasing a Request for Applications for
provider-led organizations interested in joining the ACO REACH Model. Current
participants in the GPDC Model must agree to meet all the ACO REACH Model
requirements by January 1, 2023 in order to participate. For a fact sheet on the ACO REACH Model,
visit: https://www.cms.gov/newsroom/fact-sheets/accountable-care-organization-aco-realizing-equity-access-and-community-health-reach-model A comparison table of ACO REACH and GPDC is
available at: https://innovation.cms.gov/media/document/gpdc-aco-reach-comparison More information on the ACO REACH Model is
available at: https://innovation.cms.gov/innovation-models/aco-reach More information on the Global and
Professional Direct Contracting Model—including information on model
participants for the 2021 and 2022 performance years, and performance and
quality data for the 2021 performance year—is available at: https://innovation.cms.gov/innovation-models/gpdc-model |
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Monday, March 7, 2022
CMS Redesigns Accountable Care Organization Model to Provide Better Care for People with Traditional Medicare
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