CMS gives ACO model a makeover: 7 things to know

In an effort to improve health equity, CMS has changed to the Global and Professional Direct Contracting model after receiving stakeholder feedback, it said Feb. 24.

Hundreds of healthcare organizations wrote to HHS Secretary Xavier Becerra Feb. 14, urging HHS to refine the model rather than scrap it.

Seven things to know about the new model:

1. CMS is requesting applicants to participate in the new model, which will be renamed to the Accountable Care Organization Realizing Equity, Access, and Community Health model, or ACO REACH. The new name is based on the model's purpose to encourage healthcare providers to improve care for people using Medicare.

2. With the redesign, the Geographic Direct Contracting model will be permanently canceled, a move announced in December 2020, and paused in March 2021. It is being canceled because of stakeholder concerns, CMS said.

3. The ACO REACH model has three main principles. The first is to improve health equity and bring the benefits of accountable care to underserved areas. CMS will do this through better support care delivery and will require model participants to create a health equity plan to be implemented in underserved communities.

4. The second principle is to promote provider leadership and governance, which will make sure doctors and healthcare providers play a vital role in accountable care, according to CMS. At least 75 percent of each ACO is to be controlled by participating providers and their designated representatives; the Global and Professional Direct Contracting model only required 25 percent. It also requires at least two beneficiary advocates on the governing board, with one being a Medicare beneficiary and one a consumer advocate.

5. The third principle is to protect beneficiaries and the model through more participant vetting, monitoring and transparency. More information on applicants' ownership, leadership and governing board will be required. There will be more up-ront screening of applicants, monitoring of participants and more transparency while the model is implemented. There will also be stricter protections against incorrect coding and risk score growth.

6. To improve transparency, CMS will share the following information at the participant level about the Global and Professional Direct Contracting model for the remainder of this year and will do the same with ACO REACH: type of entity, risk-sharing arrangement, payment option, benefit enhancements and beneficiary engagement incentives they have elected to use, organization website and core service area.

7. The Global and Professional Direct Contracting model will continue until Dec. 31, 2022, and ACO REACH will begin Jan. 1, 2023. Participants in the Global and Professional Direct Contracting model will have to meet requirements for ACO REACH by Jan. 1, 2023 to continue to participate.

Read more here.

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