Crain’s: New ACO REACH model could help local providers advance health equity, experts say

Original version published by Crain’s on August 29, 2022

HSG’s Juliette Price spoke with Crain’s New York about how the new ACO REACH model developed by the federal government works well with the upcoming redesign of New York's Medicaid program.

Crain’s wrote:

“The federal government’s new REACH model for accountable care organizations could be a good complement to the upcoming redesign of New York state’s Medicaid program, experts say, but potential participants are running out of time to decide whether to take the risk.

“The U.S. Centers for Medicare and Medicaid Services’ Innovation Center provisionally approved 110 organizations across the U.S. to participate in REACH—an acronym for Realizing Access, Equity and Community Health—starting Jan. 1. The model was released in February and outlines a new Medicare payment and reimbursement structure for accountable care organizations, which are voluntary groups of doctors, hospitals and other health care providers who together coordinate care for Medicare recipients.

“Organizations that participate in the model will receive a per-member, per-month payment from the federal government to provide primary care services to Medicare patients. If their spending comes in below a target budget, or benchmark, based on the characteristics of the patient population and geographic location, then they get to keep at least part of the difference. Organizations that agree to pay the federal government the difference if they go over budget will, on the flip side, get to keep a much greater share of savings if they achieve any.

“Participating organizations are required to submit a health equity plan and collect demographic data on their beneficiaries. Across the U.S., the accountable care organizations that serve the neediest 10% of Medicare beneficiaries will get an extra $30 per beneficiary, per month to implement the program.

“Accountable care organizations have until the end of the year to make a final decision, but Juliette Price, chief solutions officer with Albany consulting firm HSG, said that most will decide by Sept. 9. That is the deadline for organizations in a similar value-based initiative called the Medicare shared-savings program to decide if they will stick to that instead of the REACH model.

“Most stakeholders will want to be in one or the other rather than falling back to the Medicare fee-for-service model, Price said. But she added, “It’s hard to choose a new program.””

They continued:

“Asked about the New York accountable care organizations that were provisionally approved, a CMS spokesperson said the federal agency will disclose the list of participants and their states in early January. A list that the agency released this month does not include information about the organizations or the states where they will operate.

“Somos Community Care, a physician group, is among those organizations that got the green light to participate in the model next year. Dr. Ramon Tallaj, the organization’s co-founder and chairman, said REACH will enable its doctors to do more to help their patients, most of whom live in low-income communities.

“This program allows for wider involvement for doctors in their patients’ health care to make sure the patients receive the value-based services they need,” he said.

“Not every organization that won provisional approval will end up participating. Price said the federal government made stakeholders apply to participate before it released in-depth accompanying information on methodology.

“One of her clients, she said, has already opted not to participate in one of the states it planned to serve through REACH.”