In a broad op-ed article published online on June 9 by the American Journal of Managed Care (AJMC), David Pittman and Clif Gaus, Sc.D. of NAACOS, the Washington, D.C.-based National Association of ACOs, which represents most accountable care organizations in U.S. healthcare, took the opportunity to praise the ACO REACH Model, the most recently developed alternative payment model (APM) created under the auspices of the Medicare program, and to explain why that new model signals hope for the future of value-based payment under Medicare.
In “ACO REACH Brings Next Era of Medicare Models,” Pittman and Gaus write that “The future of accountable care in Medicare was at a crossroads late this past winter. According to multiple news reports, the Biden administration was strongly considering canceling the Global and Professional Direct Contracting (GPDC) Model. It was a Trump-era value-based care model that built upon the successful Next Generation Accountable Care Organization (ACO) Model by adding more options for capitated payments. The White House and HHS Secretary Xavier Becerra were strongly persuaded by some progressives in Congress that GPDC needed to be permanently ended to protect patients and Medicare’s future. Fortunately,” they write, “cooler heads prevailed, and CMS evolved GPDC to a more traditional ACO model, adding numerous beneficiary protections and creating the first Medicare payment model with serious, tangible health equity requirements. The ACO Realizing Equity, Access, and Community Health (REACH) Model will officially launch next year after a summer-long application process,” say Gaus, who
The importance of sustaining Medicare’s financial future cannot be ignored, the NAACOS leaders insist, writing that, “With Medicare’s solvency in serious jeopardy, we need more emphasis than ever on growing accountable care models that improve patient care while reducing costs. Terminating GPDC would create fewer options. Instead, ACO REACH provides the next great opportunity in moving a health care payment system toward paying for value and rewarding preventive care and keeping patients healthy. It increases the voice of providers and further ensures patients’ rights while sending a strong signal that advancing toward value-based care is the direction we need to take. We hope that REACH provides a great opportunity for value-based care’s future but also dispels doubts about our need to shift to more value-based care models.” They also argue that the new model improves on GPDC, as “ACO REACH is the first model launched by CMS that puts a strong emphasis on health equity.”
Indeed, the authors note, patients receive more benefits under ACO REACH, and under other ACO models, than they do in traditional Medicare. Among the benefits: broad use of telehealth, and the waiving of a three-day inpatient hospital stay before admission to a skilled nursing facility.
“The bottom line is this: Policy makers need to do more to strengthen traditional Medicare. Traditional Medicare needs more and better ways to control spending or it risks losing out totally to MA”—Medicare Advantage—they contend. “That’s the point of all CMS Innovation Center models, including GPDC and ACO REACH.”
