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 the quality and efficiency of care, across diverse communities, through a value-based design.

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.

  • Comprehensive Provider Support: Reduce burdens with resources that let you focus on patient care.
  • Shared Surplus Opportunity: Providers earn quality-based payments tied to better outcomes.
  • Data-Driven Insights: Use analytics to optimize care delivery and identify at-risk patients.
  • Operational Flexibility: Participate at your own pace without disrupting existing workflows.
  • Enhanced Patient Care: Deliver comprehensive, patient-centered care with targeted support.
  • Improved Health Equity: Address disparities to provide better care for underserved populations.
For Providers

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.

  • ACO Reach Allows for Shared Surplus Opportunity

    ACO REACH provides a pathway for providers to stabilize revenue through value-based care incentives. By focusing on timely, quality care, providers are rewarded for achieving better outcomes, reducing costs, and improving patient satisfaction-all while allowing for a shared surplus opportunity.

  • Empowered Care Delivery with Comprehensive Support

    With ACO REACH, providers gain access to resources, tools, and data-driven insights that enable them to practice medicine the way they’ve always envisioned. From enhanced care coordination to actionable population health analytics, providers can focus on addressing root causes and delivering patient-centered care without being bogged down by administrative burdens.

  • Flexibility and Equity in Care Models

    ACO REACH empowers providers to customize their participation in value-based care, offering adaptable solutions that align with their practice structure and readiness. By prioritizing health equity, the program ensures traditionally underserved populations receive better care, helping providers make a meaningful difference in their communities.

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 MSSP ACO REACH
Maximum provider choice
No referrals/
pre-authorizations
Prospective Capitation Payments to Primary Care Physicians
Engage a Portion of Group Practice in VBC
Simplified Quality Metrics

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

    Using insights from Medicare claims data, patients with chronic diseases, like Congestive Heart Failure, are reviewed to ensure they are on the right compliment of medications. ilumed Medical Directors work with primary care physicians, and supporting clinical pharmacists to optimize guideline directed medical therapy. These medication adjustments reduce emergency department visits and unnecessary hospitalizations.

  • 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.

  • Reduction in readmissions

    Approximately 20% of all Medicare beneficiaries experience hospital readmission within 30 days.³

    Reduction in readmissions

    ilumed partners with a patient's primary care physician to ensure a follow-up visit post hospital discharge takes place within seven days. These critical visits reduce the likelihood of a hospital readmission by approximately 50%.

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.

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. “Fast Facts: Health and Economic Costs of Chronic Conditions” Centers for Disease Control and Prevention, published July 12, 2024 https://www.cdc.gov/chronic-disease/data-research/facts-stats/?CDC_AAref_Val=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.