Accountable Care Organizations Realizing Equity, Access and Community Health (ACO REACH) is a federal program funded by the Center for Medicare & Medicaid Innovation (CMMI). ACO REACH aims to simplify navigation of the healthcare system for the most vulnerable populations through enhanced care coordination, improving access to benefits and minimizing unnecessary care. ACO REACH encourages health care providers to form accountable care organizations (ACO) and deliver higher quality, well-informed, coordinated care to their beneficiaries. For PY2024, there is additional focus on the following areas:

• Greater focus on advancing health equity (including social determinants of health)
• Encouragement of provider leadership and governance
• Protect beneficiaries by additional participant vetting, monitoring and transparency

Providers: Primary care providers (physicians and mid-levels)
Patients: Medicare Fee for Service (FFS) beneficiaries

ACO REACH provides beneficiaries greater attention to their individualized health needs and enhanced care coordination across their providers, while maintaining services and flexibilities beneficiaries value in Medicare FFS. The enhanced care coordination is deployed based on a process to take stock of the current state of the provider’s capabilities, and then supplementation with additional infrastructure via Belong Health. ACO REACH also allows many beneficiaries to take advantage of benefits that they may not have been aware of, or that are unique to the ACO REACH program.

ACO REACH allows providers to form communities across practices to collaborate and hold one another accountable for performance. Sharing management and costs across an ACO allows participating providers to utilize tools and resources to better coordinate, manage and improve the quality of care they can offer their Medicare FFS beneficiaries. These tools include actionable data and reporting, care management, and beneficiary engagement processes, among others.

At the end of each program year, ACO REACH participating providers are eligible for an additional surplus payment based on performance throughout the year. The surplus payment is determined by the cost of care savings for the population of aligned beneficiaries and performance on key quality measures that align with the four applicable quality measures CMS has instituted for the ACO REACH program:

• All-cause unplanned admissions for patients with multiple chronic conditions
• Risk-standardized all-condition readmission
• Timely follow-up after acute exacerbations of chronic conditions
• CAHPS (Consumer Assessment of Healthcare Providers and Systems)

Providers will be engaging with their existing Medicare panel, with special attention to Annual Wellness Visits, the needs of highest risk members, and fulfilling the focused quality measures of the REACH program. PCPs will have additional support through the ACO’s care management, care coordination services, and action-oriented data insights. As a result, participation in ACO REACH should have minimal impact on primary care workload.