CMS Announces Updates to ACO REACH for 2024

CMS announced changes for 2024 to its latest accountable care organization (ACO) model, ACO Realizing Equity, Access, and Community Health (REACH). The revisions were in response to stakeholder feedback and are expected to improve the test model by adding predictability and stability, and advancements for health equity, according to CMS.

In a statement, Clif Gaus, ScD, president and CEO of National Association of ACOs (NAACOS), expressed appreciation for the improvements to the model. In May 2023, NAACOS had published recommendations to improve the model that the organization had shared with CMS.

ACO REACH was created to replace the Global and Professional Direct Contracting model and put a strong emphasis on health equity. ACOs in the model have to develop a plan for how they identify health disparities in their community and specific actions to address them. This year is the first year of the model, which is slated to run through 2026.

The changes fall into 3 categories:

• Increase predictability for model participants by:
  • Reducing escalation of beneficiary alignment minimum for new entrants and high needs population ACOs
  • Adding a 10% buffer on alignment minimums for all ACO types
  • Refining eligibility criteria for alignment to a high needs population ACO
  • Modifying the financial guarantee policy
  • Updating the provisional settlement to reflect 12 months of performance experience instead of 6 months,
  • Applying 3 symmetric risk corridors the retrospective trend adjustment
• Protect against inappropriate risk score growth and maintain consistency across CMS programs and Center for Medicare and Medicaid Innovation (Innovation Center) models by:
  • Revising the risk adjustment methodology by using 67% of the risk scores under the current 2020 risk adjustment model and 33% under the revised risk adjustment model
• Further advance health equity through:
  • Revisions to the composite measure utilized for the health equity benchmark adjustment (HEBA) to incorporate Low-Income Subsidy status and State-based Area Deprivation Index
  • Expanding access to the HEBA to increase the impact of it
  • Adding pulmonary rehabilitation to the nurse practitioner and physician assistant services benefit enhancement

“We believe these changes will satisfy many concerns and stabilize future participation,” Gaus said.

NAACOS is also encouraging CMS to add features of ACO REACH into the Medicare Shared Savings Program (MSSP), which is the permanent ACO track. In July, the organization published that it had been advocating for CMS to offer a full-risk track in MSSP to provide a better bridge to the ACO REACH model. NAACOS is calling this suggested track Enhanced Plus.

“Enhanced Plus could imbed some elements only available in Innovation Center models into MSSP, allowing more ACOs to innovate themselves and deliver higher quality patient care,” David Pittman, director, communications and regulatory affairs, NAACOS, wrote in a blog post. “In ACO REACH, providers are allowed to make home visits more easily to patients after their discharge from a hospital, provide home visits for chronic care management to help with high-needs patients, and offer cost sharing support, among other waivers.”

CMS did include a request for comment on the idea of a higher risk track in MSSP as part of the proposed Medicare Physician Fee Schedule rule, he noted.

“Using MSSP as a chassis for innovation while infusing lessons learned from Innovation Center models into a permanent program is another path for stabilizing and growing participation in ACOs,” Gaus said.