The Centers for Medicare & Medicaid Services (CMS) recently announced an update to the Responsible Care Organization (ACO) “REACH” model. This provides private home health providers with the opportunity to participate in traditional risk sharing agreements with Medicare.
According to Fred Bentley, managing director of ATI Advisory's Care Continuum Strategy and Solutions Practice, the new updates are essentially “adjusted” based on learning obtained during the first two years of the program. It also raises questions about the future of the program, which is expected to end on December 31, 2026.
“Will the Trump 2.0 team expand their reach or will they fold into the Medicare Shared Savings Program? Bentley told Home Healthcare News. “This whole program is in a pivotal phase here.”
New changes to the program have essentially allowed CMS to win more dollars through the program, Bentley said. Changes include updates that limit the growth of risk scores. The higher the risk score, the higher the ACO will receive a higher spending benchmark, potentially leading to savings and bonuses.
“The idea is that through these (accountable care organizations) (ACO) models, when ACO works, we capture some of the savings that ACO generates, and the federal government captures a certain share of it,” Bentley said. “(The changes) are essentially designed to enable CMS to capture as many benefits as possible of this and to assess ACOs fairly and accurately.”
The change is likely to have a minor impact on home health providers, but it raises other questions.
Looking at the CMS changes to the ACO reach model, you may wonder if they are updating their eyes to place ACO reach to endure future years, Bentley said.
“It's certainly not a big change,” Bentley said. “We're running the CMS or (Centre for Medicare and Medicaid Innovation) (CMMI), or more specifically, we're running this program, so we're constantly tweaking the model, even in the later stages.”
Home care providers have successfully participated in ACO Reach. For example, home-based primary care provider HarmonyCares reported a net savings rate of 23% on ACO Reach's “high needs track” in 2023.
Still, ACO Reach is a “mixed bag” for home health providers.
“On the other hand, that's a challenge because if you're monitoring ACOS, which is closely monitoring how you're doing as a home health provider, they're making decisions about whether you're on or outside of their network,” Bentley said. “But if you're in a small pool of home health providers, who are (AN)ACO's preferred providers, you could get more business.”
