How Does CMS’ Newest ACO REACH Model Work?

How Does ACO REACH Work?

Medicare Advantage (MA) plans are required to submit data to the Medicare program about each beneficiary enrolled in the plan. This data includes information about the beneficiary's health history and current medical conditions. Plans use risk coding to determine how much they will pay for a given beneficiary. The scoring system for ACO REACH is based on a variety of factors, including the type of diagnosis and the severity of the condition. It proves to be one of the most accurate ways of gauging payments for MA plans that are used to bill a particular patient. It has also helped improve the quality of care that patients receive.

The Implications of Risk Scoring for Providers

The switch to value-based care arrangements can indicate certain adjustments to incentive alignment. With risk scoring being used as a means to decide payments for MA plans, MSSP ACOs, and direct contracting entities (DCEs) each year, it naturally entails that the higher the risk scores beneficiaries get, the more money providers receive. This is especially true if the risk scores are higher and the patient’s care costs are less than the risk score predicts. 

Since higher risk ratings result in larger benchmarks, MSSP ACOs can use this extra cash to boost their savings. Because costs have been lower than expected, MA plans and DCEs may get higher capitation payments that may potentially be unused.

Leveling the Field to Provide Accessible Healthcare

Risk scoring or risk coding is a method that uses algorithms to rate or code patients' risk. Providers implement it to identify beneficiaries who are high utilizers of healthcare services. This can help providers determine which patients may benefit from care coordination or other interventions. ACOs can use this information to help target the health population and improve their care, which can ultimately lead to cost savings and reduced healthcare expenditures. For beneficiaries, ACO REACH offers the opportunity to receive better care coordination and more timely preventive care. 

Guarantee Your Future with ACO REACH through All-Inclusive Solutions

ACO REACH is the newest CMS healthcare model that can address gaps in care for specific populations. This will help to ensure that all patients receive the necessary care they need, regardless of their location or socioeconomic status.

Since 1987, MedVision has been a leader in developing value-based integrated healthcare solutions. Our ACO REACH product is nationally recognized for its ability to improve care coordination and population health. With more than 25 years of experience, we deliver value to patients, providers, and payers alike with comprehensive healthcare solutions that:

• Evaluate providers following of clinical guidelines through scorecards 
• Define provider payments based on the agreed contract
• Manage and monitor different health population 
• Pull up reports for high risk and cost members, admissions, readmissions, and more.

Extend your organization’s reach with us. 

Reference:

Donlan, Andrew. “What the ACO REACH Model Means for Direct Contracting’s Future - Home Health Care News.” Home Health Care News. homehealthcarenews.com, February 28, 2022. https://homehealthcarenews.com/2022/02/what-the-aco-reach-model-means-for-direct-contractings-future/.