The PY2024 Model for ACO REACH allowed the Centers for Medicare & Medicaid Services (CMS) to announce improvements to the model. These changes aim to increase predictability to model participants, protect against risk score growth, maintain consistency across CMS programs and models, and further advance health equity.
Reduced Beneficiary Alignment Minimum for New Entrants
The beneficiary alignment minimum for New Entrant ACOs changed from 5,000 to 4,000 for PY2025. For High Need Population ACOs, the beneficiary alignment minimum reduced from 1,200 to 1,000 for PY2025. Through the changes, REACH ACOs can only be below the minimum for one performance year. A 10% minimum buffer can only be applied once per ACO. This ensures that ACOs consistently meet performance expectations under the ACO REACH model.
Retrospective Trend Adjustment (RTA)
A retrospective trend adjustment (RTA) is applied to modify benchmarks that over or under state the prospective trend factor greater than 1%. For the PY2024 Model for ACO REACH, CMS is applying three symmetric risk corridors to RTA:
- (+/-) 0-4%
- (+/-) 4-8%
- Greater than (+/-) 8%
This applies to REACH ACOs accepting 100%, 50%, and 0% responsibility for each corridor respectively.
Protection Against Inappropriate Risk Growth
Another change in the PY2024 ACO REACH Model came through a revision to risk adjustment methodology. Under the revised risk adjustment model, risk scores will be blended using 67% of risk scores from the 2020 risk adjustment model and 33% of risk scores under the 2024 model. Higher Needs Population ACOs will use the CMMI-HCC concurrent risk adjustment model.
Changes in ACO Participation
Changes made to improve the ACO REACH Model each year have already proved to be more successful. For 2024, according to CMS, the ACO REACH Model has 122 ACOs with 173,004 healthcare providers and organizations providing care to millions of Medicare patients.
CMS often adjusts its programs and models based on collected feedback from participants. These changes reflect evolving healthcare needs, legislative changes, and the results of ongoing evaluations. They also address issues to improve the program’s effectiveness, bringing CMS closer to its intended goals.
The Goal of the ACO REACH Model
The ACO REACH Model aims to improve access to value-based care in underserved and rural communities. It also focuses on improving care for people with chronic conditions. Improvements in the quality of care that patients with recurring conditions receive leads to reduced healthcare spending and saved resources.
CMS’ goal is to have all Medicare beneficiaries enroll in an ACO program by the year 2030. Changes to the ACO REACH Model are made to improve the model for both New Entrants and enrolled ACOs.
ACOs promote care collaboration amongst healthcare providers, hospitals, insurers, and other healthcare organizations. This care collaboration uses data to help understand the needs of Medicare and Medicaid beneficiaries. Through the ACO REACH Model, ACOs use additional data, such as Social Determinants of Health (SDoH), to understand how patients’ environments and outside influences impact the health and needs of the population. SDoH encompasses factors like socioeconomic factors, education, housing, and environmental influences that can all impact a person’s health outcome.