Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model

ACOREACH@cms.hhs.gov

The Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model will test financial risk sharing options, as well as innovative approaches from Medicare Advantage (MA) and private sector risk sharing arrangements. ACO REACH seeks to improve quality of care and health outcomes for Medicare beneficiaries through alignment of financial incentives to promote effective and appropriate care; the promotion of health equity among all model participants; emphasis on patient choice; strong monitoring to ensure that beneficiaries maintain access to care; and emphasis on care delivery for complex, chronically, and seriously ill populations.

ACO REACH has 2 voluntary risk-sharing options. In each option, participating providers accept Medicare claims reductions and agree to receive at least some compensation from their ACO.

• Professional: Lower risk-sharing arrangement—50% savings/losses—with one payment option for participants:
  1. Primary Care Capitation Payment - a risk adjusted monthly payment for primary care services provided by the ACO's participating providers
• Global: Higher risk sharing arrangement—100% savings/losses—with two payment options:
  1. Primary Care Capitation Payment - a risk adjusted monthly payment for primary care services provided by the ACO's participating providers
  2. Total Care Capitation Payment - a risk adjusted monthly payment for all covered services, including specialty care, provided by the ACO's participating providers

ACO REACH is focused on provider-based organizations and offers 3 types of participants.

• Standard ACOs – ACOs comprised of organizations that generally have experience serving Original Medicare patients, including Medicare-only and also dually eligible beneficiaries, who are aligned to an ACO through voluntary alignment or claims-based alignment. These organizations may have previously participated in another CMS Innovation Center shared savings model and/or the Shared Savings Program.
• New Entrant ACOs – ACOs comprised of organizations that have not traditionally provided services to an Original Medicare population and who may rely primarily on voluntary alignment, at least in the first few performance years of model participation.
• High Needs Population ACOs – ACOs that serve Original Medicare patients with complex needs, including dually eligible beneficiaries, who are aligned to an ACO through voluntary alignment or claims-based alignment.

Payment amounts will vary. The first performance year will begin on January 1, 2023 and will run through 2026.

Links to application instructions, and the online application are available on the program website.

Additional guidance:

• ACO REACH Model webinar recording
• In depth model overview webinar recording
• Financial methodology webinar recording
• March 29, 2022 office hours recording
• April 12, 2022 office hours recording
• Fact sheet
• Program graphic
• Program listserv