ACO REACH Resources

Learn more about the Centers for Medicare & Medicaid Services' (CMS) ACO REACH Model

Pearl Resources

FREE GUIDE

Pearl's Guide to Medicare's ACO REACH Model

Cut through the clutter with a quick overview about the ACO REACH Model. Discover how Pearl Health is positioned to support your practice with a broader vision for building an ecosystem that enables value-based success.

Free guide & case study

Financial Impact of Medicare's ACO REACH Model

Medicare’s ACO REACH model provides an opportunity for PCPs to capture the full dollar value generated from effectively managing care for Medicare patients. PCPs can use these funds to reinvest in their staff, their practices, and their patients.

Michael Kopko on Physician Leadership and Direct Contracting (DCE) by CMS | Part One

Today our special guest is Michael Kopko, CEO or Pearl Health (www.PearlHealth.com). This is the first interview inside our new 3-Part Series with Michael.

Direct Contracting Entities: What Doctors Need to Know, Part 2

So if you're a Doctor who takes care of Medicare fee-for-service (FFS) patients, then this topic is going to impact your practice and your patients whether you're paying attention or not.

Direct Contracting Benchmark Tutorial

Patrick Mauro, Principal Data Scientist at Gordian Data and Advisor to Pearl Health provides an overview of CMMIs Direct Contracting benchmark and how understanding a practice's key drivers can ...

An Introduction to Pearl Health

Pearl Health Chief of Staff Gabriel Drapos walks through an overview of the benefits of the CMS Direct Contracting Model and the ways in which Pearl Health is enabling independent physicians to ...

An Overview of CMMI - Successes and Challenges

Pearl Health President Ankit Patel gives an overview of the origin, successes and challenges of the value-based care programs ...

A Roundtable Discussion of Physician Experience in Value-Based Care

Pearl Health's Liz Permenter and Justus Ruff talk about what they have learned from speaking with physicians across the country ...

A Roundtable Discussion on the Past and Future of Value-Based Care

Pearl Health leaders explore the ways in which previous efforts to transition physician ...

Center for Medicare and Medicaid Services (CMS)

Direct Contracting Model Options

The Center for Medicare and Medicaid Innovation (Innovation Center) is excited to announce that 53 Direct Contracting Entities (DCEs) are participating ...

Direct Contracting Fact Sheet

Direct Contracting (DC) is a set of voluntary payment model options aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare fee-for-service (FFS) ...

Detailed Program Requirements (CMS RFA)

The Direct Contracting Model creates a new opportunity for the Centers for Medicare & Medicaid Services (CMS) to test an array of financial risk-sharing ...

CMS/CMMI Direct Contracting Model Financial Methodology

New performance year benchmark methodologies focused on increasing benchmark stability, simplicity, and prospectivity ...

CMS/CMMI Direct Contracting Model Financial Methodology - Reconciliation

Financial model that supports broader participation by entities new to Medicare Fee for Service (FFS) and/or focused on delivering care for high needs populations ...

Other Resources

The 'on-ramp' to capitation: A moderately deep dive into Direct Contracting

Before I started research for this newsletter, all I knew was that value-based care models can be contentious, and that they almost always seem contentious for insider-baseball ...

CMS Innovation Center at 10 Years — Progress and Lessons Learned

The federal CMMI was created to assess new payment and service delivery models for improving health care nationwide. This review reports that during the agency’s first decade of operation ...

Lessons for Primary Care from the First Ten Years of Medicare Coordinated Care Demonstration Projects

Over the past decade, Medicare has tested care coordination programs in an effort to achieve the triple aim of improving the patient experience ...

Milliman’s DCE vs MSSP Comparison

The financial benchmark in the CMS Direct Contracting (DC) payment model will share key attributes with the Medicare Shared Savings Program (MSSP) financial benchmark. In this white paper, we compare and contrast ...

Evaluation Of Medicare Alternative Payment Models: What The Data Show

The COVID-19 pandemic has impacted every aspect of life in the US and challenged the capacity of the health care system like no other event in modern times ...

A Multi-Payer Analysis of Healthcare Spending in North Carolina

In 2018, the US spent $3.6 trillion on health care. That's a lot of money. But where this money goes and variation in spending is not well understood ...

No New DCEs, Playbook from Existing DCEs

The Coalition is an opportunity for participants to exchange information, share best practices, and collaborate on advocacy opportunities that will strengthen the experience in the Direct Contracting Model.

Accountable Care Organizations Are Increasingly Led by Physician Groups Rather Than Hospital Systems

Because hospitals and health systems sponsored the majority of new accountable ...

Physician-Led Accountable Care Organizations Outperform Hospital-Led Counterparts

New analysis from Avalere finds that physician-led accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) outperformed hospital-led ACOs by a significant margin.

Medicare Advantage in 2021: Enrollment Update and Key Trends

Over the last decade, the role of Medicare Advantage, the private plan alternative to traditional Medicare, has grown. In 2021, more than 26 million people are enrolled in a Medicare Advantage plan, accounting for 42 percent of the total Medicare population,

Temporal Patterns of High-Spend Subgroups Can Inform Service Strategy for Medicare Advantage Enrollees

Most healthcare costs are concentrated in a small proportion of individuals with complex social, medical, behavioral, and clinical needs that are poorly met by a fee-for-service healthcare system.

Managing the Most Expensive Patients

When corporate executives, health care leaders, and policy makers discuss the challenge of curbing U.S. health care costs, the conversation invariably turns to the sickest 5% of the population, who consume 50% of health care spending. For a long time the hope has been that improving the efficiency and quality ...

The Little-Known Agency That’s Trying To Boil The Ocean—A Look At CMMI’s Decade Of Trying To Change Medicare & Medicaid

TLDR: 1) Voluntary models don't work 2) Clear focus on primary care going forward 3) Where Medicare goes so goes the rest of healthcare.

Early 2021 Data Show No Rebound in Health Care Utilization

Here is utilization is certainly down but there is a question of how much of it is unnecessary and how much of it is “pent up”

Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare's Solvency and Affordability Challenges

Pearl Take: Medicare Advantage is costing taxpayers 3% more than Traditional Medicare.

Doubling down on direct contracting; Can discovery be engineered? Clubhouse FOMO, and more

One of the hallmarks of value-based care is a shift away from reactive, fee-for-service models and toward prospective payment models.

Sg2 Experts Explain CMS’ Direct Contracting Program

Part 1 | Overview

Part 1 gives an overview of the program and how it works, including the application process. Find out how Sg2 can help your organization with Direct Contracting ...

Part 2 | Alignment, Participants & Org Types

Part 2 gets into more details including participant providers, preferred providers, and organization types ...

Part 3 | Payment Mechanisms

Part 3 covers payment mechanisms. Find out how Sg2 can help your organization with Direct Contracting ...

Part 4 | Benchmarking Methodology

Part 4 covers benchmarking methodology. Find out how Sg2 can help your organization with Direct Contracting ...

Part 5 | Quality Waiver Requirements

Part 5 tackles quality waiver requirements ...

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