Value-Based Care Newsletter

Reach ACO Key Differences to Traditional ACO

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Eligibility for those with insufficient number of aligned beneficiaries (5,000)

Two risk sharing and capitation options with participation options for participants and preferred providers

Claims-based quality performance

Health Equity Requirements

Health Equity Plan Requirement REACH ACOs will be required to develop and implement a Health Equity Plan starting in 2023 to identify underserved patients within their beneficiary population and implement initiatives to measurably reduce health disparities. Use Disparities impact statement as a guide.

Health Equity Benchmark Adjustment

A beneficiary-level adjustment will be applied to increase the benchmark for those REACH ACOs serving higher proportions of underserved beneficiaries in order to mitigate the disincentive for ACOs to serve underserved patients by accounting for historically suppressed spending levels for these populations.

• BY1, 2 & 3 will be 2017, 2018 & 2019 for all REACH ACOs including existing DCEs
• Benchmark includes a mix of historical claims experience and a regional rate book
• Trending, geographic adjustments, risk adjustments, discounts and incentives

New- Health Equity Benchmark Adjustment

• Area Deprivation Index
• Dual Medicaid Status
• Top 10% receives a $30 PMPM positive adjustment
• Bottom 50% receive a $6 PMPM negative adjustment

Atlas map

Health Equity Data Collection Requirement

Demographic and SDOH Data Reporting?and Bonus

• REACH ACOs will be required to collect and report certain beneficiary-reported demographic data and social determinants of health data on their aligned beneficiaries for purposes of Model monitoring and evaluation.
• In PY2023, completing the requirement to collect and report beneficiary-reported demographic information will result in a bonus to the ACO’s quality score, but there will be no downward adjustment for the failure to report this information.
• In PY2024 and beyond, CMS may impose a requirement on ACOs to collect and report demographic and social determinants of health data on their aligned beneficiaries that results in a downward adjustment to the ACO’s quality score if not completed.

Nurse Practitioner Services Benefit Enhancement

Nurse Practitioners will be able to assume certain responsibilities or furnish certain services without physician supervision that they typically could not under current Medicare law, to the extent permitted under applicable state law Health Equity Questions in Application and Scoring for Health Equity Experience?

Split the TIN for participants (NPI participation)

Splitting the TIN will be permitted, which will allow Participant Providers with separate NPIs who bill through the same TIN to join separate models. In addition, a Participant Provider may participate in another model using another TIN that is not being used for the ACO REACH Model.?Does not apply to preferred providers.

Kris Gates, CEO, Health Endeavors