Health Equity and Predictabilty Updates to ACO REACH Model 2024

CMS recently announced targeted updates to the ACO REACH Model for PY 2024 on August 15. CMS is attempting to increase predictability for participants and shield against unexpected increases in risk scores. Despite provider backlash and controversy surrounding elements of the model (including its predecessor Direct Contracting Model), the changes suggest that CMS views the Model as a valuable alternative for certain providers.  

Among other changes, the Health Equity Benchmark Adjustment helps to identify underserved beneficiaries living in high-cost areas. Looking down the road, the alignment minimum for New Entrant ACOs will be decreased from 5,000 to 4,000 for PY 2025 and PY 2026. The alignment minimum for High Needs Population ACOs is also decreasing. Given CMS's interest in consistency among programs and models, we may see similar changes in the Medicare Shared Savings Program.