What is ACO REACH?

The evolution away from fee-for-service payment systems toward value-based care in the U.S. is now in its second decade. The newest program from the Centers for Medicare and Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI) is ACO REACH, launching in January 2023.

Watch the first segment in our video series about ACO REACH, as Greg Caressi from Frost & Sullivan discusses “CMS’ next step toward capitation,” including what aspects of ACO REACH are similar to its predecessor model, Global Professional Direct Contracting, what is changing, and some of the important nuances that healthcare organizations need to know.

ACO REACH (Realizing Equity, Access, and Community Health) is the first CMS program that approaches cost and quality improvement through the lens of health equity. Organizations in the ACO REACH program will collect key demographic and social needs data about the populations they serve. This information is essential to identify the highest-risk groups and individuals and design services in a way that meets their unique needs.

Unique among ACO programs is CMS’ use of population-based payments, or capitation. The inclusion of capitation introduces challenges and opportunities for current and prospective participants. Success hinges on the ability to deeply understand the risk profile of aligned beneficiaries, act on clinical and financial insights, and streamline capitation claims processing with automated workflows.

Ultimately, ACO REACH will incentivize organizations to achieve the “quadruple aim” of healthcare:

• Lower costs
• Better patient outcomes
• Better patient experiences
• Improved clinical experiences for providers

Many current and prospective REACH ACOs leverage solutions from Cedar Gate Technologies to enable model success. Contact us to learn how we can help you successfully establish and operate your REACH ACO.