CMS Moves Toward Greater Health and Health Care Sustainability with New ACO REACH Model

Accumulating criticism of CMS’ legacy “Direct Contracting” programs has finally resulted in concrete action to fix them by announcing the ACO REACH – Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model (ibit.ly/DAX2). Called “Indirect Contracting”, the legacy (Direct Contracting) programs promoted anything other than sustainable health care practices by furthering a previous administration goal of “privatizing medicare”. ibit.ly/d5kp The Direct Contracting programs are an example of “bluewashing” that happens often in health and health care where companies, organizations, and firms oversell the sustainability benefits of a new health program, approach, intervention, or technology. Sustainable practices in health and health care can avoid bluewashing by focusing on the public and private economic, services, and infrastructure impacts of their work. Any entity with responsibility for health and health care should think deeply about how to avoid bluewashing, for our future’s sake. More on #bluewashing later. There is a case for why ACO REACH has sustainability potential.

Economic sustainability is addressed with ACO REACH by building on the momentum evident in CMS’ existing ACO programs. ACOs in 2020 “decreased costs by over $4 billion and saved CMS almost $2 billion.” ibit.ly/4EnP The programs are not perfect. They do provide a stable foundation to build on given they limit the types of exclusivity and gaming present elsewhere. ACO REACH will provide for “stronger protections against inappropriate coding and risk score growth”. The “coding game” is a corrosive artifact of poor economic sustainability in today’s health and healthcare practices and needs reform. Innovation is absolutely possible! ibit.ly/JrKW

Services sustainability features exist with ACO REACH by instituting requirements that preserve the rights of Traditional Medicare beneficiaries, promote equity in the delivery of high-quality services, and ensures a focus of delivering accessible care in underserved communities. The word “equity” is mentioned 13x in CMS’ vision for the the next 10 years ibit.ly/VYW6, and 33x in the Innovation Center Strategy Refresh (https://tinyurl.com/2p8p86ya); it must be important! Addressing inequality is critical to improving our nation’s health and economic prosperity. Analyses point to the fact “that disparities amount to approximately $93 billion in excess medical care costs and $42 billion in lost productivity per year as well as additional economic losses due to premature deaths.” ibit.ly/91kU

Infrastructure sustainability is also addressed with ACO REACH by recognizing the limits of private markets in reliably providing essential resources such as public health, hospitals, and scarce services. This includes better stewardship of hospitals as a resource by avoiding over-utilization, improved transitions in and out of hospitals, and more provider-led efforts. CMS is committed to a new level of data transparency, specifically related to quality data for All Condition Readmissions and Unplanned Admissions for Patients with Multiple Chronic Conditions, two metrics that are an important assessment of a participant’s impact on infrastructure. “Hospital at Home” programs have been shown to achieve “savings of 30% and more per admission”, proving that improved stewardship of critical health infrastructure (like hospitals) is possible. ibit.ly/moU2

Highlights of ACO REACH

  • Addresses #bluewashing in the CMS Direct Contracting programs
  • For Traditional Medicare:
    • Ensures beneficiaries retain all rights
    • Promotes greater equity in the delivery of high-quality services
    • Extends reach into underserved communities
  • Redesigns the Global and Professional Direct Contracting (GPDC) program
  • Cancels the Geographic Direct Contracting Model (“Geo Model”) effective immediately (paused 3/2021)

ACO REACH has 5 new policies to promote health equity in PY2023 –http://ibit.ly/DAX2:
1. Health Equity Plan Requirement
2. Health Equity Benchmark Adjustment
3. Health Equity Data Collection Requirement
4. Nurse Practitioner Services Benefit Enhancement
5. Health Equity Questions in Application and Scoring for Health Equity Experience

Integrating Advanced Practice Providers into value based care strategies: One organization’s journey to achieve success through interprofessional collaboration – https://tinyurl.com/38jbek8x

Promoting Nursing Leadership in the Transition to Value-Based Care – https://tinyurl.com/2p8hph24

#directcontracting #indirectcontracting #aco #acoreach #sustainability #sustainable #bluewashing #health #healthcare

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