Background on ACO REACH
In January 2023, the ACO REACH model officially launched with 132 ACOs covering 131,772 health care providers and organizations providing care to an estimated 2.1 million beneficiaries.1 CMS has set a goal to have 100% of Traditional Medicare beneficiaries in an accountable care relationship by 2030, and has made it clear that the REACH model is one of its main innovation initiatives to help achieve this goal.2
For PCPs, ACO REACH presents an opportunity to embrace a more proactive care model for their Traditional Medicare patients, align incentives with keeping patients healthy, and increase revenue for effectively managing care. There are several features in ACO REACH that enable this care model, including:
- Stabilized Revenue: The model enables providers to transition from fee-for-service (FFS) to stable monthly payments.
- No Minimum Savings Rate: Groups start earning from the first dollar of shared savings.
- Less Administrative Work: None of the quality measures require active administrative work (e.g. chart submissions, widgets, MIPS) on the part of providers or their staff. Just high quality care.
- Voluntary Alignment: Unlike other models, ACO REACH allows for patients to become aligned with the model throughout the performance year.
The launch of ACO REACH in 2023 reflects a growing movement toward value-based care models that empower providers to better align payments with holistic patient care and increase revenue for coordinating care effectively. The CMS deadline to enroll in ACO REACH for 2024 is August 1st, and many providers are enrolling for the first time.
As a provider who has already decided to participate in ACO REACH in 2024, you may wonder what you can do to start preparing before the performance year officially begins on January 1, 2024. While it’s still only June, the next few months are important for ensuring that your practice is prepared to succeed. Below, we’ve shared a few details on the modifiable variables in ACO REACH that will impact the 2024 performance year and what you can do today to set yourself up for success!
Modifiable Variables in REACH
As we look ahead to PY2024 in ACO REACH, providers should keep the below variables and dates in mind:
- Patients aligned to your practice: The majority of patients are attributed to a provider in REACH through claims-based alignment. This means that the provider has delivered the plurality of primary care (PQEM) services to a patient during a given “lookback period.” For providers interested in participating in REACH starting in January 2024, the cutoff that CMS will use for claims-based alignment is June 30th (with the lookback period starting on July 1, 2021).
- Capitation amount paid to providers: Payment in REACH is based on a monthly capitation amount, risk-adjusted to the disease burden of your patients. Patients who are healthier tend to require less of your attention and fewer resources, often costing less to the system than a more complex patient. Your capitation amount for next year is based on the services you provide to patients between now and September 30th (i.e. Q1 to Q3 of 2023).
3 Tips for Success
- Schedule your patients’ Annual Wellness Visits (AWV): AWVs ensure that providers maintain regular contact with their patients and enable them to obtain baseline information on a patient’s overall health, including any new or ongoing diagnoses. By scheduling AWVs for patients, your practice will benefit from having a touchpoint with your patients, allowing you to more proactively take care of their health. It can also set you up for success for REACH in 2024. Any patients who complete their AWV before June 30th may be aligned to your practice for 2024, and your capitation payments are based on the diagnoses of your patients recorded between now and September 30th. So, there’s no time like the present to schedule and complete AWVs!
- Roll out any new initiatives you’re contemplating: If you’re considering a program with a new set of codes, we suggest you implement it between now and September 30th. As with AWVs, this will ensure that those services are reflected in your capitation amount for 2024. As an example, you may be working on a new remote patient monitoring (RPM) program to follow several patients with high blood pressure. You may also plan to use the RPM codes to reflect the delivery of those services. If, for example, your program were rolled out on October 15th, those services would not be included in CMS’ determination of your capitation amount for next year. We would suggest implementing these programs sooner rather than later, so there are no surprises next year (i.e. capitation payments not reflecting services provided after September 30th).
- Start setting up the infrastructure and processes to succeed in value-based care: Providers can consider the infrastructure and processes that will allow them to succeed in REACH right now. Data feeds that notify providers of admissions, discharges, and/or transfers (ADT) of patients with an acute episode are often available through local Health Information Exchanges (HIE) or regional payers. Some ACOs also offer these data feeds, with more sophisticated and actionable insights. Obtaining ADT information this year can help you become more acquainted with it, and allow you to set up the right processes to act promptly on the data.
Our Technology
Starting next year, ACOs will be required to submit demographic and social determinants of health (SDoH) data to CMS. Although REACH has aimed to reduce reporting requirements, providers may be interested in exploring the demographic and SDoH data they are capturing now. Beyond this data, it can be a good time to ensure you are capturing relevant patient information to succeed in REACH, including phone numbers and email addresses.
Lastly, many practices use surveys to gather information on patient satisfaction. One common tool is the Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey. If your practice uses CAHPS, now can be the time to review responses and put in place processes to act on any concerning feedback. Beyond CAHPS (the only quality measure not predicated on claims), it may be worth looking at your claims data to understand your performance on REACH’s other quality measures — namely all-cause readmissions, unplanned admission for patients with multiple chronic conditions, and timely follow-up after acute exacerbations of chronic conditions.
Pearl Health specializes in helping primary care providers and groups to make the transition toward risk-bearing value-based care models, starting with Medicare’s ACO REACH model. Our financial offering, technology, and services are all designed to make it easy to participate and succeed. Interested in learning more about ACO REACH with Pearl Health?
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- CMS, “CMS Announces Increase in 2023 in Organizations and Beneficiaries Benefiting from Coordinated Care in Accountable Care Relationship,” January 17, 2023.
- CMS, January 17, 2023.
