Even though the Social Determinants of Health (SDoH) and health equity have received a great deal of interest from the healthcare industry in the recent years, the Biden administration is overhauling the contentious Direct Contracting Model to include additional conditions aimed at addressing the health equity model of accountable care and assuaging progressive legislators’ worries about private equity’s influence.
As the government decided to plan a decade of value-based transformation, CMS and its Center for Medicare & Medicaid Innovation (CMMI) launched a new equity-based substitute financial model dubbed ACO REACH, which stands for Accountable Care Organization Realizing Equity, Access, and Community Health.
The Global and Professional Direct Contracting Model (GPDC) will phase out on December 31, 2022. So, it has been revised by the Administration’s desired outcomes, such as the intention of achieving health equity, stakeholder feedback, and participating member satisfaction. CMS is renaming the ACO REACH Model to reflect better the model’s goal of improving the quality-of-care services for Medicare recipients through effective care coordination, reaching and linking care providers and recipients, including undeserved recipients, which is a primary concern the Biden Administration.
Outlining CMS’s Perception and Doctrine for Accountable Care
Many people wonder what the reason behind this overhauling is. The answer is simple: CMS’s Innovation Center is experimenting with innovative healthcare delivery and payment methods to enhance patient quality of care, particularly for lower socio-economic groups. All model participants will be required to adopt a holistic health equity strategy that identifies marginalized neighborhoods and implements interventions to minimize healthcare inequalities in their recipient groups.
The ACO REACH Model, which will go into effect on January 1, 2023, till 2026, equips clinicians and several other related healthcare practitioners with the skills and resources they need to achieve these objectives. This strategy allows patients to receive more tailored care for their complex healthcare requirements while keeping all of Traditional Medicare’s benefits and provisions.
Is It Beneficial to Recipients?
The purpose of ACO REACH is to deliver expanded benefits to recipients and to boost the accessibility of high-quality healthcare through robust care coordination, particularly for marginalized communities, while also offering patients a more significant say in their treatment and ACO administration, along with more perks like telemedicine, post-discharge home healthcare, and cheaper cost-sharing with no extra burden.
It’s necessary to keep in mind that the ACO REACH Model incorporates all of the essential insights gained from the Innovation Center’s past model testing and applies them in novel and creative ways to Medicare recipients who previously lacked accessibility to accountable care.
Following are five new policies included in ACO REACH:
- Requirement for a Health Equity Plan
- Adjustment to the Health Equity Benchmark
- Requirement for Health Equity Data Collection
- Benefit Enhancement for Nurse Practitioner Services
- Health Equity Questions in the Application and Health Equity Experience Scoring
The ACO REACH Model aims to ensure the best possible care quality and far much better health outcomes for Medicare beneficiaries by synchronizing financial rewards, emphasizing patient participation, and ensuring beneficiaries have easy access to treatment, and focusing on care delivery.
The new model also stresses voluntary alignment, allowing beneficiaries to pick which health practitioner they wish to engage with and promoting stability through deeper patient-physician connections.
Encourage and Support Provider Leadership and Governance
Healthcare Providers will also be given new responsibilities, but with stricter ACO REACH registration, monitoring, performance, and accountability standards. Current GPDC participants must apply for a position in the new system but are not promised one.
Participating providers or their authorized officials must have at least 75% control of each ACO’s regulatory body instead of 25% in the GPDC Model. Furthermore, the ACO REACH Model goes above and beyond previous ACO programs by mandating at least two recipient advocates (at least one Medicare recipient and at least one consumer advocate) to serve on the governing board, both of whom must be able to vote.
Finally, under the ACO REACH Model, applications will be screened more thoroughly, participants will be closely monitored, and the model’s success will be more transparent during successful execution, even before complete evaluation findings are available.
The Bottom Line
Overall, the ACO REACH reforms are favorable and will benefit physicians and the people they are supposed to serve. The new model will be a driving force behind the continuing incorporation of value-based care. It will continue to bring about changes in facilitating healthcare systems and practitioners to thrive in offering the most excellent care for their community members.