ACO REACH Misses Targett In Serving High-Risk Groups

In its first year, Medicare’s Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model fell short of enrolling providers that serve patients with high social risks, according to a new study published in JAMA Health Forum.

Researchers of the study said that without further participation from these types of organizations, the program is unlikely to meet its goal of reducing health disparities.

Many folks in the U.S.—especially those who are Black, Hispanic, American Indian, low-income or living in rural or vulnerable communities—face barriers to accessing high-quality healthcare.

These groups tend to experience higher rates of chronic illness, hospital visits and early death.

To reduce these disparities, CMS launched the ACO REACH program in January 2023 to bring the benefits of accountable care to communities that have been left out of previous programs, such as the Medicare Shared Savings Program (MSSP).

While ACOs have been part of Medicare since 2012, REACH is the first to focus on equity and includes new incentives and requirements that can attract providers who serve patients with high social risk.

For example, it adjusts financial criteria to reflect the added cost of caring for disadvantaged populations and requires participating organizations to create equity plans and collect data on patients’ social needs, the study shared.

Although it could take years to understand the program’s impact on health outcomes, it’s crucial to evaluate whether it’s increasing access to care.

If REACH expands access for socially at-risk patients, it could provide valuable insights for future efforts to reduce health inequities, researchers shared.

However, if it fails, it's important to catch it early so policymakers can adjust the program to achieve its goals, they added.

Researchers of the study examined whether REACH has helped expand access for vulnerable groups compared to MSSP and Medicare overall.

In the cross-sectional study, researchers used Medicare data to identify which ACOs participated in the ACO REACH and MSSP models.

They compared beneficiaries of each model based on how Medicare assigns patients. For example, REACH uses prior-year usage and voluntary sign-ups, while MSSP uses year-end data.

They then looked at patient information, such as age, sex, race, income status and location, linking this to Medicare enrollment and social vulnerability.

To analyze clinicians and organizations in each ACO, the team identified provider ID numbers and matched them to publicly available information on provider type, specialty and location.

If REACH expands access for socially at-risk patients, it could provide valuable insights for future efforts to reduce health inequities, researchers shared.

They grouped providers into physicians, nurses or social workers and organizations such as hospitals and clinics.

It was found that out of the 35,801,118 beneficiaries in the Medicare fee-for-service program in 2023, 52.8% were female.

About .5% were American Indian or Alaska Native, 3.5% were Asian or Pacific Islander, 8.2% were Black, 6.7% were Hispanic, 77.2% were White and 3.9% identified as another race or unknown.

Out of these groups, 1,958,881 beneficiaries fell into the ACO REACH model and 11,340,987 were in MSSP. ACO REACH had 132 participating ACOs, while MSSP had 456.

Compared to the overall Medicare population, REACH beneficiaries were older, with a higher percentage aged 85 and older (14.2% vs. 10.3%).

They were also more likely to be White (80.2% vs. 77.2%) and less likely to be Black (5.9% vs. 8.2%) or Hispanic (5.8% vs. 6.7%).

In addition, REACH beneficiaries were less likely to have Medicare due to disability, to be dually enrolled in Medicaid or to live in rural or highly vulnerable areas.

Findings from the Next Generation ACO (NGACO) model shared additional information that supports REACH’s annual results.

While NGACO didn’t save Medicare money overall—since the savings were mostly balanced out by payments made to ACOs—it did reduce total Medicare spending by $1.7 billion over six years, a report found.

The biggest savings came from ACOs that were physician-led, took on full financial risk and used population-based payment methods.

These results suggest that stronger financial incentives and broader payment reforms could help ACO REACH meet its goals.

Strengths & Limitations of the JAMA study

Researchers included a complete comparison of ACO REACH and MSSP beneficiaries.

Although REACH focused on equity, the study found its beneficiaries were at lower social risk than the broader Medicare population, limiting its ability to serve high-risk groups. This highlights the need for targeted strategies to increase participation from underserved populations.

In addition, the study found strong clinician involvement, with a focus on team-based care and equity planning.

However, limitations include the short duration of the study and the lack of patient outcome data.

Researchers suggest that differences in organizational data and race coding methods could also affect the results.

In addition, it’s proposed that future research should explore how ACO REACH can engage higher-risk populations and further evaluate the effectiveness of its policy changes.

More targeted outreach and program adaptations may be important as well to ensure that vulnerable populations benefit fully from the ACO REACH model.