What CMS 2024 ACO REACH Model Changes Mean for Your Practice

By Marco Castillo, Executive Vice President of Operations

The Centers for Medicare & Medicaid Services (CMS) isn’t afraid to adjust. That’s why it transitioned from Direct Contracting Entity to the ACO REACH model in 2023. And why it rolled out new changes to the ACO REACH model for 2024.

Before I get into the details, let’s take a step back and think about why CMS made these changes. It's not change simply for change’s sake. Instead, these changes represent CMS’s goal to protect Medicare beneficiaries and support the providers who care for them. These purposeful changes create more accountability for participants and providers, they represent collective learnings over the model’s first year and help establish future goals. The 2024 changes ensure that the ACO REACH model cares for Medicare beneficiaries and providers alike.

Now that you have the big picture, let’s talk about the specifics of what ACO REACH participants and providers need to know for 2024 and beyond. CMS made three major changes for the 2024 year:

1. Increasing predictability for ACO REACH participants.
2. Protecting against inappropriate risk scoring.
3. Greater focus on health equity.

What increased predictability means for ACO REACH in 2024

Increased predictability recognizes the reality new entrants face when entering the ACO REACH model. It takes time and a whole lot of effort to build up patient panels. CMS reduced the minimum number of beneficiaries served from 5,000 to 4,000 and added buffers so that the baseline panel size is more manageable and there are buffers in place to mitigate panel-size fluctuation from quarter to quarter. CMS has worked to modify its financial-guarantee requirements, allowing for, in some instances, ACO REACH participants to retain a guarantee for the current Performance Year instead of guarantees for all open Performance Years. These changes lead to a more realistic, inclusive approach that invites more model participation, especially from new ACO REACH entities and providers.

What protecting against inappropriate risk scoring means for ACO REACH in 2024

CMS aims to prevent fraud and waste in the system because that not only protects the taxpayers who fund Medicare but also Medicare beneficiaries themselves. When there’s less fraud and waste, beneficiaries have access to the care they need and are more likely to enjoy the outcomes they deserve. That’s why CMS focused on protecting against inappropriate risk scoring in 2024. They will move providers into a new risk-scoring methodology over time. You can think of it like the difference between a dimmer switch vs. a light switch. Rather than turning on a more stringent method overnight, CMS helps providers ease providers into this new method over time. ACO REACH quality measures that promote affordable, quality care will only continue to become more important over time.

What a greater focus on health equity means for ACO REACH in 2024

Health equity continues to be a hot-button topic for CMS. Rightfully so with 10.9% of Americans aged 65 and older experiencing poverty and people of color experiencing higher rates of poor health and chronic conditions. Disparities can also happen between urban and rural settings, where access to care may be harder to come by. Inequity can occur within high-cost urban areas, especially for those with barriers like financial strain, food insecurity or transportation difficulties. Areas that are considered food deserts, where access to food is scarce, and swamps, where access to high-processed, low-nutrition foods are plentiful, make getting and staying healthy a challenge for these underserved populations.

CMS 2024 ACO REACH model changes take a more sophisticated look at health equity with a revised composite measure that includes two new variables: Low Income Subsidy/Extra Help status and state-based area of deprivation indexes. Along with the national area of deprivation index, each of these three measures accounts for a third of the health-equity score. Providers and ACO REACH participants need to keep pace with CMS. It’s essential to have solid health-equity strategies in place now so you can execute and refine them over the course of the year.

ACO REACH beyond 2024

CMS wants all Medicare Part A and B beneficiaries to be in an accountable care relationship by 2030. With only six years left to meet this goal, more providers need to transition from the fee-for-service model to a value-based care model more quickly. Providers can no longer take an assembly-line or triage approach to healthcare. Instead, they must focus on providing more proactive, preventive care that addresses social determinants of health. By doing so, providers can drive individual patient outcomes, elevate the health status of their patient panels and improve population health.

We’ve seen increased awareness of the ACO REACH model for both providers and patients. More people are realizing the potential for change by supporting providers and patients with the right data, technology, services and compassion.

In 2025, ACO REACH participants should expect an even greater emphasis on health equity. Participants will need to have even more concrete plans for addressing inequities with increased focus on in-take forms and measurement.

While ACO REACH is currently slated to end on December 31, 2026, I believe CMS will keep the model alive and well because it’s effective in reducing waste in Medicare spending and improving outcomes for beneficiaries. We stand side by side with CMS, providers and patients to find simple solutions for a complicated industry.

How we work with CMS to make real, positive change

We also have a direct line of communication with CMS. We help shape the conversation around ACO REACH model changes and improvements with standing calls and interactions on many fronts whether it’s IT, operations, patient education or PCP feedback. Our open lines of communication extend not just to the program itself but also to reporting, data and success stories. We have CMS’s ear; CMS is a partner who listens to and understands us, our providers and our patients.

How ilumed shows up for ACO REACH providers and beneficiaries

At ilumed, we’re proud to be part of the revolution to heal healthcare, and we’ll keep doing it. We’re dedicated to providing excellent data and support to providers and patients alike as we’ve always done—now it’s just more intense.

We create systems for Medicare beneficiaries to stay on track with their treatment plans and help providers bend the curve for improved health outcomes on the patient level and for populations. While we may have more stringent requirements than CMS for our participating providers—we require 72-hour post-discharge follows vs. the standard 14 days—we ultimately reduce providers’ burdens in the long run. We help them meet the needs of their patients and their staff by managing both costs and outcomes. We support providers, primary care providers (PCPs) especially, in their time of need.

Want to learn more about ilumed and how we help providers like you? Check out our resource library.

Ready to transform the way you deliver affordable, quality care to Medicare beneficiaries for the better? Get in touch.