- The CMS on Monday announced a slew of changes to the ACO REACH program that regulators said were designed to increase participation in the alternative payment model.
- Regulators lowered enrollment minimums for accountable care organizations in the program, which allows providers to link up and form groups to manage care and costs for fee-for-service Medicare enrollees.
- The CMS also increased the amount of money that needs to be reserved by participating ACOs in a bid to mitigate risk; and revised the risk adjustment methodology in the program to align with risk adjustment in Medicare Advantage.
ACO REACH, which began its first model year in January, is a redesign of CMS’ controversial direct contracting model that’s meant to tie traditional payments in Medicare to value and improve care coordination. Regulators shelved the direct contracting program last year, after some progressives slammed the model as a thinly veiled effort to privatize the Medicare fee-for-service program.
The model, in which physicians can accept either full or partial capitation as payment, offers higher levels of risk and reward compared to other ACO models, while providing additional flexibilities.
Along with the new name, ACO REACH has a stronger focus on health equity and provider governance than its direct contracting predecessor.
The CMS on Monday unveiled new changes that were applauded by stakeholders, including the National Association of ACOs, which said that regulators addressed many concerns raised by its members.
“We believe these changes will satisfy many concerns and stabilize future participation,” NAACOs CEO Clif Gaus said in a statement.
The CMS reduced enrollee minimums from 5,000 to 4,000 for new ACOs starting next year.
For high-need ACOs that manage care for complex patients, regulators reduced the minimum from 1,200 to 1,000 for 2025, and from 1,400 to 1,250 for 2026.
The agency also expanded enrollment criteria for high-need ACOs, and enacted an enrollment buffer allowing ACOs that fall beneath the enrollment threshold by up to 10% to remain in the program for one additional year
Regulators on Monday also added new variables into how they identify underserved beneficiaries for the health equity benchmark adjustment. The CMS will provide an extra $30 per-person per-month to ACOs with the highest-need beneficiaries.