The Center for Medicare and Medicaid Innovation (CMMI) recently announced its list of participants in the redesigned version of the Global and Professional Direct Contracting program, now known as ACO REACH.
The functions of this dynamic program are two-fold. For providers, ACO REACH is designed to encourage and accelerate the adoption of value-based care metrics and performance levers in service of Medicare Fee-for-Service beneficiaries. For Medicare beneficiaries, ACO REACH offers access-enhanced supplemental benefits beyond the standard Medicare Part A and B benefits that cover professional, outpatient, and hospital services.
Across all of these efforts, ACO REACH maintains a sharp focus on health equity that differentiates it from value-based payment models of the past. Whereas providers who care for underserved communities have often been penalized in those “one-size-fits-all” payment programs, providers recognized by ACO REACH work to heal, rather than widen, health disparities across communities.
Such novel and humanistic principles aren’t just at the heart of ACO REACH — they’re fully aligned with Belong Health’s mission to create local and community-oriented healthcare systems. Our shared sense of purpose is just one of many reasons why Belong Health is proud to have been chosen for participation in ACO REACH.
Over the months and years to come, we look forward to partnering with payers (in this case, CMS) and providers in delivering compassionate and patient-focused care to those most in need.
Now, let’s explore how to leverage ACO REACH to complement an overarching strategy for Medicare and government programs — and to execute effective health equity plans.
First and foremost, what are the requirements of ACO REACH participants, where health equity is concerned?
According to CMMI, all ACO REACH entities must submit an official Health Equity Plan (HEP) by March 31, 2023. This deadline gives an ACO REACH entity 90 days in which to identify community disparities and health equity drivers among its aligned Medicare beneficiaries.
With your March deadline in mind, we recommend following Belong Health’s three-step planning process towards the development of a robust health equity plan.
1. Define ‘Health Equity’
Every community has different needs, dynamics, and demographics. As such, CMMI allows Accountable Care Organizations to identify and address key health equity priorities in their respective communities and, in turn, to define what health equity means for their respective populations. To help arrive at those definitions, here are a few questions you might consider:
- Are you seeing inequitable access to care?
- Is there a high variation in quality performance within your population?
- Are those disparities defined by race, gender, age, or disability status?
As an ACO REACH participant, awareness of community needs and equity gaps is paramount, and answering these three questions will prove key to the development of your unique health equity plan. By the end of this quick process, a fuller understanding of your own community will have naturally revealed itself to you.
2. Plan with a multi-stakeholder governance model
A multidisciplinary task force being critical to the planning of health equity intervention, it’s fortunate CMMI has already created a framework through which such a task force can be launched.
CMMI requires the Board of Directors of an ACO REACH entity to seat 75% provider participation with at least one consumer advocate and one Medicare beneficiary. Such a framework offers tremendous opportunity for built-in engagement between the provider and beneficiary communities — and aims to empower each Board to better understand inequities in care, prioritize key issues to address those inequities, and develop interventions that will meet the needs of beneficiaries.
At Belong Health, we enthusiastically recommend the formation of a health equity subcommittee to:
- Provide input on key inequities in the community
- Assist with gaining buy-in on interventions from participating ACO providers
- Evaluate outcomes to ensure interventions meet the aims of the ACO REACH entity
With this model, ACO REACH participants benefit from an up-close look at the healthcare challenges faced in each community. Additionally, board members are empowered to address those challenges and to hold leadership accountable in planning and executing on a health equity plan.
