The Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) is a value-based care initiative designed to improve patient outcomes, lower healthcare costs, and promote health equity.
In this guide, we’ll cover the program’s structure, its duration, comparisons with similar models, and technology strategies for success.
What is ACO REACH?
ACO REACH is a model created by the Centers for Medicare & Medicaid Services (CMS) that advances the goals of the previous Global and Professional Direct Contracting (GPDC) program while emphasizing equity and patient-centered care. The model incentivizes providers to take on financial risk and rewards those who improve the quality and cost-efficiency of care.
How Does ACO REACH Work?
ACO REACH participants, including provider groups and other healthcare organizations, receive a fixed payment to cover the care of assigned beneficiaries. Organizations are incentivized to manage patients’ health proactively by addressing preventive care, reducing hospitalizations, and improving health outcomes.
Financial performance is measured against benchmarks, and providers can receive shared savings if they manage care within or below those benchmarks, rewarding them for efficiency and effectiveness in care delivery.
What is the Duration of ACO REACH?
The first year of the ACO REACH model began on January 1, 2023, and is set to run for four years through December 31, 2026. This longer timeline offers participants time to establish and refine care delivery and management strategies while encouraging continuous improvement and tracking the sustained impact of interventions on cost and quality.
What is the Difference Between ACO REACH and GPDC?
ACO REACH builds upon and replaces the GPDC model, maintaining core concepts while emphasizing health equity, community care, and provider leadership.
Unlike GPDC, ACO REACH focuses more on initiatives to address social determinants of health and engage underserved populations. This model is intended to ensure that value-based care initiatives are equitable and accessible across diverse patient populations.
What is the Difference Between ACO REACH and MSSP?
The Medicare Shared Savings Program (MSSP) and ACO REACH both aim to transition healthcare toward value-based payment models, but they differ significantly in structure and approach.
For example, MSSP uses a traditional fee-for-service payment model, whereas ACO REACH offers more advanced alternative payment arrangements like capitation.
Another difference is that MSSP requires a minimum of 5,000 beneficiaries across all program tiers, while ACO REACH has various minimum requirements, all below 5,000, depending on the program type.
Overall, ACO REACH involves higher financial risk for participants than MSSP, offering more substantial rewards with greater flexibility and accountability in care delivery.
Is ACO REACH Ending?
As of the latest updates, ACO REACH will end in 2026 at the end of its scheduled four performance years. The intention behind ACO REACH was always to be a temporary program, but CMS continues to support and expand the model each year, viewing it as a pivotal component in the shift to value-based care. The emphasis on health equity and outcome-based reimbursements aligns with CMS’s long-term objectives for healthcare reform.
Technology and Tools to Succeed in ACO REACH
Success in ACO REACH requires a combination of advanced technology and strategic collaboration. Organizations can leverage EHR integration and middleware technology, predictive analytics, and patient engagement tools to track and manage care more effectively and achieve key metrics that inform their ACO REACH success.
Vim’s technology intentionally supports providers participating in ACO REACH and other value-based initiatives. Our solutions like Diagnosis Gaps and Care Gaps help providers meet risk adjustment and quality targets, resulting in cost savings and improved care coordination.
Additionally, value-based care enabler organizations such as Management Services Organizations (MSOs) and Accountable Care Organizations (ACOs) offer vital services and support to help providers transition their operations to value-based care models.
These organizations provide essential infrastructure, care coordination, and resource management, enabling providers to focus on patient outcomes. Analytics organizations also play a crucial role in enabling ACO REACH by curating and analyzing data to help provider organizations consistently and systematically address care gaps.
Furthermore, technology solution providers offer innovative tools that facilitate telehealth, remote monitoring, and patient engagement, enhancing care delivery. Payer partners contribute by aligning reimbursement models with value-based care principles, ensuring financial incentives support quality outcomes.
Consulting firms and professional development organizations also assist by providing training and best practices for implementing value-based care strategies. Together, these stakeholders are essential in helping the ACO REACH program scale and succeed in improving patient care and outcomes.
Final Thoughts
ACO REACH allows healthcare organizations to transform care delivery, focusing on patient outcomes and health equity. By embracing innovative technologies and a commitment to value-based care, providers can achieve measurable success under this model.
As healthcare continues its shift toward patient-centered, value-based frameworks, programs like ACO REACH will likely remain instrumental in shaping the future of healthcare.
