CMS Tests New Models of Health Care Service Delivery

To better reflect the goal of creating a health system that achieves equitable outcomes through affordable, high quality, person-centered care, the Centers for Medicare & Medicaid Services (CMS) recently announced a redesigned accountable care organization (ACO) model.

According to CMS, the ACO Realizing Equity, Access, and Community Health (REACH) Model addresses stakeholder feedback, participant experience, and administration priorities—which include CMS’ commitment to advancing health equity.

“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,” stated CMS. “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.” 

The ACO REACH Model is a redesign of the Global and Professional Direct Contracting (GPDC) Model and per a CMS press release, the Geographic Direct Contracting Model that began in December 2020 and paused in March 2021 due to stakeholder concerns, has been cancelled effective immediately.

With these changes, CMS intends to promote value-based care and improve the health care experience for people with Medicaid, Medicare, and Marketplace coverage.

“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,” said CMS Administrator Chiquita Brooks-LaSure. “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.” 

The agency noted its desire to work with partners who share its vision and values for improving patient care and outlined 3 key principles to guide the vision which include the following:

• “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.”

The ACO Reach Model will begin on January 1, 2023, and the performance period will run through 2026. To participate in the new model, any participants currently in the GPDC Model must agree to meet all requirements of the ACO REACH Model by January 1, 2023.

Reference:
CMS redesigns accountable care organization model to provide better care for people with traditional Medicare. Centers for Medicare & Medicaid Services. February 24, 2022. Accessed February 25, 2022. https://www.cms.gov/newsroom/press-releases/cms-redesigns-accountable-care-organization-model-provide-better-care-people-traditional-medicare