ACO REACH
ACO REACH Model
The ACO REACH Model provides novel tools and resources for health care providers to work together in an Accountable Care Organization (ACO) to improve the quality of care for people with Original Medicare. Redesigned from the Global and Professional Direct Contracting (GPDC) Model, it encourages providers to break down silos and deliver high-quality, coordinated care.
Innovation
Redesigned from the GPDC Model, ACO REACH introduces a new Substance Access Beneficiary Engagement Incentive and implements an adjusted financial methodology to improve model sustainability.
The Problem
The health care system can be challenging to navigate, particularly for patients with chronic conditions and those who receive care from multiple providers who do not communicate with each other. These patients often receive unnecessary, repeat diagnostic tests or conflicting treatments for their different health conditions, and their primary care physician, if they have one, may not have a full picture of the treatment received by other providers.
The Solution
The ACO REACH Model encourages health care providers — including primary and specialty care doctors, hospitals, and others — to come together to form an Accountable Care Organization, or ACO. ACOs break down silos and deliver high-quality, coordinated care to their patients, improve health outcomes, and manage costs.
Expected Outcomes
People with Medicare in a REACH ACO get help navigating the health system and managing their conditions. They may have greater access to enhanced benefits, such as telehealth visits, home care after leaving the hospital, and help with co-pays.
Strategy
ACOs are critical partners in empowering people to manage their conditions to keep them healthier longer.
Model Goals
- Improve the quality of care for people with Original Medicare
- Break down silos and deliver high-quality, coordinated care
- Improve health outcomes
- Manage costs
Patient Eligibility
People with Original Medicare, particularly those with chronic conditions.
- Must be enrolled in Original Medicare
Provider Eligibility
Health care providers who come together to form an Accountable Care Organization (ACO).
- Must be part of a REACH ACO
- Includes primary and specialty care physicians, hospitals, and others
Care Categories
Chronic Disease Management
CMS Benchmarks & Thresholds
financial
operational
quality
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