CMS leaders outline plan for “strategic alignment” for ACO efforts

ACO REACH Model, starting in 2023, aims to improve health equity.

The federal Centers for Medicare and Medicaid Services (CMS) will use “strategic alignment” to improve its accountable care organization (ACO) efforts.

Leaders at CMS outlined recent history and future plans for the center’s goal of having Medicare beneficiaries “cared for by providers who are accountable for costs and quality of care by 2030.” The article “Expanding Accountable Care’s Reach Among Medicare Beneficiaries” appeared in the New England Journal of Medicine.

The CMS Shared Savings Program will serve as “a chassis for growth and care transformation” by testing new ACO models and features with that program.

The CMS Shared Savings Program, now 10 years old, has 483 ACOs serving more than 11 million Medicare beneficiaries and more than 525,000 clinicians. It has generated consistent cost savings for Medicare, including about $6 billion over the last five years.

The ACOs outperform some physician groups using the Merit-Based Incentive Payment System, but participation has plateaued, the CMS officials said.

In addition, CMS will support new and smaller ACOs to boost participation.

Expanding ACOs into underserved communities also will enhance health equity by directing resources to patients, which cannot be done under the traditional Medicare fee-for-service payment system, the CMS officials said.

The ACO REACH Model, short for Realizing Equity Access and Community Health, announced earlier this year, will run January 2023 through the end of 2026. It will test features that enhance health equity, the CMS officials said.

“By better aligning CMS’ ACO initiatives and policies, Medicare can create pathways for payers and providers to advance accountable care,” the article said. “This approach could bring improved quality and patient experience, as well as the ability to be part of a care relationship that meets medical and social needs, to more beneficiaries. For providers, alignment of initiatives and policies could increase participation rates and accelerate care transformation.”

The authors were Douglas Jacobs, MD, MPH, CMS chief transformation officer; Prva Rawal, PhD, chief strategy officer for the Center for Medicare and Medicaid Innovation (CMI); Liz Fowler, JD, PhD, deputy administrator and director of CMI; and Meena Seshamani, MD, PhD, deputy administrator and director of the Center for Medicare.

The article was published April 27, the day before the National Association of ACOs (NAACOS) began its spring conference, where Fowler and Seshamani were scheduled to speak.

The meeting agenda had a presentation on the CMS’ ACO REACH model, which “includes numerous improvements that NAACOS has repeatedly advocated for.”

The organization praised the ACO REACH model in a March letter to the CMS Innovation Center. ACO REACH “is an excellent example of how models can be carefully designed to embed efforts to improve equity, and we look forward to working with both the Innovation Center and ACO REACH participants to ensure success of the model,” the NAACOS letter said.