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Redesigned CMS ACO Emphasizes Health Equity

CMS is managing a data-driven effort to improve beneficiaries’ quality of care.

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The Centers for Medicare and Medicaid Services (CMS) has redesigned one of its Accountable Care Organizations (ACO) to focus more on addressing health care disparities for underserved communities — and it’s currently soliciting cohort participants.

CMS ACOs are groups of doctors, hospitals and other health care providers who work together to provide coordinated, high-quality care to Medicare patients. The setup reduces duplication of services and also prevents medical errors.

The “Global and Professional Direct Contracting (GPDC)” ACO is now called the “Realizing Equity, Access, and Community Health (REACH)” model.

“CMS is renaming the model the ACO REACH Model to better align the name with the purpose of the model: to improve the quality of care for people with Medicare through better care coordination, reaching and connecting health care providers and beneficiaries, including those beneficiaries who are underserved, a priority of the Biden-Harris administration,” according to a notice on its website.

“The Biden-Harris administration remains committed to promoting value-based care that improves the health care experience of people with Medicare, Medicaid and marketplace coverage,” CMS Administrator Chiquita Brooks-LaSure said in a press release. “To fulfill that commitment, CMS, through the Innovation Center, is testing new models of health care service delivery and payment to improve the quality of care that people receive, including those in underserved communities.”

A key role for ACOs has been to bridge providers to take responsibility for the quality and total cost of patient care.

“CMS is testing a redesigned model because accountable care organizations make it possible for people in traditional Medicare to receive greater support managing their chronic diseases, facilitate smoother transitions from the hospital to their homes, and ensure beneficiaries receive preventive care that keeps them healthy,” said Elizabeth Fowler, CMS deputy administrator and innovation center director, in a press release. “Under the ACO REACH Model, health care providers can receive more predictable revenue and use those dollars more flexibly to meet their patients’ needs — and to be more resilient in the face of health challenges like the current public health pandemic. The bottom line is that ACOs can improve health care quality and make people healthier, which can also lead to lower total costs of care.”

The redesigned ACO REACH model relies more upon data analytics to monitor the use of services over time and assess beneficiaries’ access to care, especially for underserved populations. Fowler said CMS is collecting more health equity data on a standardized basis across the agency.

“When we look back at our past models, if we’re improving quality, are we improving quality for everybody? Or does it only affect some groups?” Fowler said at Academy Health’s Datapalooza event last week. “Collecting this data will be able to give us the ability to say whether we’re improving quality based on some of these factors.”

All REACH participants are required to collect and submit health equity data, and CMS plans to continue increasing this data reporting in the future.

“We’re looking to require REACH ACOs to collect and report demographic data and social determinants of health data,” Meghan Elrington-Clayton, CMS innovation center division of financial director risk and seamless care models, said at datapalooza. “In 2023, we’re actually providing a 10% bonus to the quality score for those ACOs for submitting demographic reporting. That reporting will be based on a United States Core Data for Interoperability version 2, USCDIV2, which includes race, ethnicity, language, gender identity and sexual orientation. Eventually, we were looking to move to require full reporting — both demographic and social needs data.”

In addition to the health equity data requirement, participants also have to develop a health equity plan to identify underserved communities and implement initiatives to measurably reduce health disparities for their beneficiaries.

“CMS continues to learn that while documenting disparities and planned mitigating actions is an important first step, it is critical to track adherence to these plans over time and update them as needed,” according to a CMS press release. “The Innovation Center will provide ACOs with a template based on the CMS Disparities Impact Statement created by the CMS Office of Minority Health to identify health disparities, define health equity goals, establish a health equity strategy, and a plan for implementing the health equity strategy and monitoring and evaluating progress to advance health equity for underserved communities.”

The new cohort for the ACO REACH model will begin Jan. 1, 2023.

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