A small article in our local paper said that there would be a Zoom presentation about a new “Medicare Accountable Organization Realizing Equity” (ACO REACH) program that will begin in January. I missed the presentation but I’m interested.
I’m a Traditional Medicare beneficiary. Could this impact me (and other METARs)?
Medicare is so huge that any change could have Macroeconomic impact and/or impact companies that have stock in the market.
So I looked it up.
It’s written in “bureaucratese” so I found it difficult to understand.
Note: This is government so there is no copyright. I have copied large portions.
**Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model**
**by The Centers for Medicare and Medicaid Services, Feb 24, 2022, Innovation models Medicare Parts A & B**
**The ACO REACH model better aligns the model’s name with its purpose: to encourage health care providers to coordinate care to improve the care offered to people with Medicare – especially those from underserved communities....**
**In ACOs, physicians and other health care providers join together to take responsibility for the quality of care their patients receive and the total costs of that care. These responsibilities encourage providers to coordinate the services across clinicians and care settings.**
**The Affordable Care Act (ACA) created the Medicare Shared Savings Program, CMS’ largest ACO initiative, to provide beneficiaries in Traditional Medicare the opportunity to receive care that meets the full range of their needs. ACOs work to improve chronic disease management, ensure smoother transitions from hospitals to homes, and promote preventive care that keeps patients healthy. ...**
**What is the ACO Realizing Equity, Access, and Community Care (REACH) Model?**
**The ACO REACH Model is the redesigned version of the Global and Professional Direct Contracting Model (GPDC) Model and focuses on promoting health equity and addressing healthcare disparities for underserved communities, continuing the momentum of provider-led organizations participating in risk-based models, and protecting beneficiaries and the model with more participant vetting, monitoring and greater.**
**The ACO REACH Model provides tools and resources to empower doctors and other health care providers to better coordinate and improve the quality of care they provide for patients in Traditional Medicare. This approach affords patients greater individualized attention to their specific health care needs while preserving all services and flexibilities beneficiaries enjoy in Traditional Medicare. The goal of ACO REACH is to provide beneficiaries with access to enhanced benefits and to increase the availability of high quality, coordinated care, including for people in underserved populations. ...**
**How are beneficiaries affected by ACO REACH?**
**Beneficiaries with Traditional Medicare retain all of their rights, coverage, and benefits, including the freedom to see any Medicare provider. Like previous ACO models, the ACO REACH Model prohibits limited networks, prior authorization or any other means of restricting care. Even if a beneficiary is aligned to a REACH ACO, they always have the freedom to see any Medicare-enrolled provider.**
**CMS expects that beneficiaries whose primary care provider is part of a REACH ACO will see and feel improvements in the quality of health care they are getting because of the ACO REACH Model. For example, they may receive increased access to telehealth, home visits after leaving the hospital, cost sharing support to help with co-pays, or other enhanced services and incentives. Moreover, the new Health Equity provisions are expected to provide greater access for underserved communities, reaching beneficiaries who have not previously received coordinated care. ...** [end quote]
Anyone who has ever had a serious illness knows how uncoordinated medical care often is. I have helped other women newly diagnosed with cancer to find and set up appointments with their primary care, surgeon and oncologist. They were caught in a loop where the oncologist said to call the surgeon, the surgeon said to call the oncologist and the primary care was clueless. That doesn’t even count the problems of people who are released from the hospital without adequate care at home. The right hand doesn’t know what the left hand is doing. There’s no coordination among health care professionals.
Health care is particularly bad in underserved communities, such as minority and rural. I think that I would qualify as underserved since I live in a rural community but I’m not sure.
I would like to know whether this new program will cover telehealth visits (e.g. Teladoc) since Medicare’s rules are constantly changing.
I think that the ACO REACH program is aimed at larger medical practices which could become ACOs but I’m not sure. I imagine that Medicare (which has relatively low reimbursements to providers) will offer an incentive for them to put in the effort (and expense) of developing the ACO REACH model for themselves.
As a patient, I don’t know how I would find and tap into the benefits offered by ACO REACH. I don’t even know if I would qualify for extra services, or how to find out what those might be. I can guarantee that if I can’t figure this out the targeted beneficiaries (underserved, undereducated, minority and/or poor people who might live in city ghettos, isolated rural communities or Native American reservations) won’t be able to figure it out.
My understanding (which could be wrong) is that the benefit to the patient is better coordination among all the separated health care providers. I don’t know if this would cover a centralized health care coordinator which would be helpful for many patients but doesn’t exist now (to the best of my knowledge) except in specific hospitals and not between providers for the same patient which aren’t in that hospital. In my experience, primary care providers are useless for this since they don’t have the specialized knowledge and they are overwhelmed with 15-minute targeted meetings with patients.
I find that I’m quite confused about ACO REACH. I hope that other METARs will look into this and help clarify.