ACO Reach Model summary What is
ACO REACH?

ACO REACH stands for Accountable Care Organization Realizing Equity, Access and Community Health. Designed by Medicare for providers and patients in traditional Medicare, this innovative model aims to improve health equity in underserved communities through coordinated value-based care while reducing costs.

Why the ACO REACH model?

ACO REACH offers better patient outcomes, payments tied to quality care and an emphasis on health equity. When healthcare works like it should, more patients get healthier, and providers are fairly compensated for a job well done. The ACO REACH model does both. Here’s how.

  • High-quality, coordinated, patient-focused care
  • Sustainable financial model for providers
  • Enhanced patient benefits at no extra cost
  • Improved patient health outcomes and equity
  • Removed barriers to health and well-being
  • Lower cost, affordable care for patients
For ProvidersFor Patients

ACO REACH in practice

ACO REACH helps to eliminate waste and create savings in Medicare while bolstering patient empowerment in the exam room, at home, and everywhere in between. It’s taking value-based care to the next level for both providers and patients.

  • Coordinated Care

    ACO REACH helps providers work smarter to improve patient health as a team.

  • Holistic support

    ACO REACH helps patients take charge of their health with guided support.

  • Social determinants

    ACO REACH addresses root causes behind health disparities and access to health.

How ACO REACH compares to other
Medicare models

Discover how the ACO REACH model stacks up against traditional Medicare as well as Medicare Advantage for beneficiaries.

Model feature Traditional Medicare Medicare Advantage ACO REACH
Maximum provider choice
No referrals/
pre-authorizations		 Sometimes
Value-based care Sometimes
Patient scheduling support and outreach Sometimes
Social determinants of health support Sometimes

How ilumed puts ACO REACH in action

Click the cards below to see how ilumed works to improve patient outcomes and lower Medicare costs while addressing inequities in the healthcare system through the ACO REACH model.

  • Reduced emergency visits

    Unnecessary ER visits cost the system $32 billion a year.¹

    Reduced emergency visits

    ACO REACH patients aligned with ilumed providers see their primary care provider at least once a quarter, which helps spot issues early on, drive better provider/patient relationships and prevent unnecessary emergency room visits.

  • Chronic disease management

    Chronic conditions account for 90% of national health costs.²

    Chronic disease management

    ilumed gives providers better tools for treating underlying causes that can exacerbate chronic illness like financial strain, food insecurity and transportation barriers. ACO REACH teams help patients adhere to their treatment plans with personalized support.

  • Food insecurity

    More than 5.5 million seniors experience food insecurity.³

    Food insecurity

    ilumed's social workers help connect patients to local programs like food banks, and food pantry delivery services. With their regular nutrition provided for, patients can focus less time and energy covering the basics and more time improving their health.

FAQs about ilumed's ACO REACH model

Medicare and ACO REACH can be complex. Use the answers to these frequently asked questions as your starting point.

Patient FAQs

There are 2 types of letters:

  1. Annual Notice
  2. Voluntary Enrollment with a form

If you see “Required Annual Notice” below your address, there’s nothing you need to do. This is a courtesy letter to tell you your doctor is part of a Medicare program called ACO REACH and working with ilumed to improve the quality of care for patients like you at no cost to you. Nothing changes with your traditional Medicare benefits, and you may receive additional benefits from ilumed like help scheduling appointments and rides to and from the doctor. Call us at 800-481-8745 to learn about what we offer.

If you see a confirmation form and a return envelope, this is the Voluntary Enrollment letter. This is a courtesy letter to tell you your doctor is part of a Medicare program called ACO REACH and contracted with ilumed to improve the quality of care for patients like you at no cost to you. Your doctor thinks you might benefit from ilumed’s services. Nothing changes with your traditional Medicare benefits, and you may receive additional benefits from ilumed like help scheduling appointments and rides to and from the doctor. Call us at 800-481-8745 to learn about what we offer.

Learn more about the ACO REACH model here.

Verfiy ilumed is an ACO REACH participant here.

ACO REACH stands for Accountable Care Organization Realizing Equity, Access and Community Health.

ACO REACH is designed by Medicare to improve patient care at no cost to you while potentially offering you added benefits you wouldn’t otherwise get in traditional Medicare.

ACO REACH does not affect your current benefits. In fact, you get additional benefits with ilumed like having someone help you schedule doctor visits or get transportation to and from the doctor’s office.

No. You get additional ACO REACH services and benefits as a patient associated with a ACO REACH-contracted provider. There’s no catch. This is a program designed by Medicare to improve your health while lowering your costs.

With ACO REACH, you may potentially have even more benefits such as $0 coinsurance, free transportation to and from the doctor and pharmacy, chronic condition support, post discharge help after being hospitalized and home visits.

ACO REACH may reduce or eliminate your copays for certain services.

Value-based care is a term that describes care focused on providing high-quality, patient-centered care. Healthcare providers are paid for the quality of care they provide rather than the quantity of care.

Provider FAQs

ACO REACH stands for Accountable Care Organization Realizing Equity, Access and Community Health.

It’s an innovative care model created by Medicare meant to improve health equity and outcomes for beneficiaries in traditional Medicare while lowering costs.

ACOs are groups of physicians and healthcare providers who come together to provide value-based care to Medicare patients. In an ACO that’s part of the Medicare Shared Savings Program (MSSP), practitioners are grouped together under a single tax ID, which means all providers must participate.

The ACO is paid directly through Medicare’s fee-for-service claims process. Providers in ACO MSSP may choose both downside risk and upside reward.

ACO REACH entities can get more creative with both payments and services. In the ACO REACH model, providers only experience upside reward because the ACO REACH entity takes on the downside risk. Providers may individually choose to participate in an ACO REACH.

With the exception of Durable Medical Equipment (DME), all types of Medicare licensed
providers can participate in the ACO REACH model.

Primary care providers are called “Participant Providers” in the model and may include doctors of medicine (MDs), doctors of osteopathic medicine (DOs), nurse practioners (NPs) and physician assistants (PAs).

Specialists, including hospitals, skilled nursing facilities and home health agencies can also participate as “Preferred Providers” in the model.

Traditional Medicare patients retain 100% of their benefits, including access to acre from any provider who accepts Medicare.

Patients are aligned to an ACO REACH entity’s contracted primary care practioner (e.g., MD, DO, NP, PA) by the Centers for Medicare & Medicaid Services (CMS) through a review of historical primary care claims. Patients can also voluntarily align themselves to the contracted primary care provider.

The ACO REACH model offers providers the greatest opportunity to deliver care at the highest quality and the most efficient cost. If a provider puts in the work to achieve success in the model, they can far exceed financial expectations in other models through quality payments and shared surplus savings based on their performance.

Providers can only participate in ACO REACH by contracting with an ACO REACH entity approved by the Centers for Medicare & Medicaid Services.

  1. “The Cost of Unwarranted ER Visits: $32 Billion a Year,” Morning Briefing, KFF Health News, published Thursday July 25, 2019, https://kffhealthnews.org/morning-breakout/the-cost-of-unwarranted-er-visits-32-billion-a-year/.

  2. “Health and Economic Costs of Chronic Diseases,” Centers for Disease Control and Prevention, published March 23, 2023, https://www.cdc.gov/chronicdisease/about/costs/index.htm.

  3. “Facts About Senior Hunger,” Feeding America, 2021 https://www.feedingamerica.org/hunger-in-america/senior-hunger-facts#:~:text=In%202021%2C%205.5%20million%20seniors%20aged%2060%2B%20faced%20hunger.,depression%2C%20asthma%2C%20and%20diabetes.