CMS plans significant ACO REACH model adjustments in 2024 to enhance payment predictability and equity benchmarks, as detailed in a reference guide. The ACO Realizing Equity, Access, and Community Health initiative, targeting Medicare cost reduction and care enhancement, spans from January 1 to the end of 2026. Highlights include reduced beneficiary alignment thresholds, an expanded high-needs definition, improved risk adjustment standards, revised health equity benchmark payments, and NACO’s endorsement of these changes for stability and improved participation.
The Centers for Medicare & Medicaid Services (CMS) are set to implement a series of adjustments to the ACO REACH model in 2024, aimed at enhancing predictability in participant payments and refining equity benchmarks. These alterations were detailed in a reference guide released on August 14th.
The ACO Realizing Equity, Access, and Community Health model, developed by CMS, is a collaborative savings initiative intended to enhance care quality and curtail costs within traditional Medicare. The model’s operational period commenced on January 1st and will run until the conclusion of 2026.
Outlined below are five essential aspects of the forthcoming modifications to the model for 2024:
1. Beneficiary Alignment Thresholds: Beginning with the payment year 2025, CMS will lower the minimum number of beneficiaries aligned with each ACO. The reduction will be from 5,000 to 4,000 for newly joining ACOs and from 1,200 to 1,000 for high-needs ACOs. Additionally, commencing in the payment year 2024, a safety buffer of 10 percent will be extended to ACOs should their beneficiary counts temporarily drop below the stipulated minimum.
2. Expanded High-Needs Definition: The CMS will broaden the criteria for high-needs ACOs to encompass organizations catering to beneficiaries who have utilized either 90 days of Medicare-covered home health services or 45 days of skilled nursing coverage during the previous 12 months.
3. Enhanced Risk Adjustment Standards: In 2024, the CMS will introduce a blended risk adjustment approach for ACO REACH participants. Beneficiary risk scores will be determined by assigning a 67 percent weight to the 2020 standards and 33 percent to the novel risk adjustment model being gradually introduced for Medicare Advantage.
4. Revised Health Equity Benchmark Payments: CMS will revise the framework for health equity benchmark payments to better reflect the needs of underserved beneficiaries residing in regions characterized by elevated living costs.
5. Endorsement from NACO President: Clif Gaus, Sc.D., President of the National Association of ACOs (NACO), expressed his satisfaction with the changes brought about by CMS. He cited various positive adjustments that address concerns raised by NACO members, encompassing safeguards against midyear benchmark changes, the expansion of Health Equity Benchmark Adjustment, and updates to risk adjustment policies. Dr. Gaus believes that these alterations will alleviate concerns and provide stability for future participation.
Overall, the upcoming revisions to the ACO REACH model by CMS for 2024 are geared towards enhancing payment predictability, refining benchmarks, and accommodating the needs of beneficiaries to promote improved care and cost reduction within the traditional Medicare framework.
