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ACO REACH: Fact vs. Fiction
In an effort to lower the rate of Medicare spending and improve the quality of care, the Center for Medicare and Medicare Innovation launched a new alternative payment model built of the success of various value-based payment models. Under the ACO (Realizing Equity, Access, and Community Health) REACH Model, participating ACOs take responsibility for the quality and total cost of care of a defined set of patients. If ACOs lower spending below a defined benchmark and hit quality targets, they earn the right to share savings generated. The model is part of a portfolio of value-based care efforts to place Medicare on a more sustainable financial path and improve patient care.
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Fiction
ACO REACH will privatize Medicare
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Fact
Patients remain in traditional Medicare and retain all of their rights and benefits of traditional Medicare, including the freedom of choice to go to any Medicare provider. In fact, they may receive more benefits at no cost through patient incentives.
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Fiction
ACO REACH secretly moves patients into care plans they can’t opt out of
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Fact
ACOs must send letters to patients notifying them that their doctor is part of an ACO. Patients can opt out of data sharing at any time, and their care remains the same under traditional Medicare.
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Fiction
ACO REACH will lead to “middlemen” denying patients care
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Fact
There are no networks or prior authorization under ACO REACH. Instead, ACOs work to coordinate otherwise siloed care to emphasize efficient, preventive care, and eliminate waste and unnecessary care.
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Fiction
ACOs receive capitated payments which can then be pocketed as profit
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Fact
While some ACOs receive fully capitated Medicare payments, only primary care payments are capitated for most ACOs. All other care patients receive is paid by Medicare under their fee-for-service payment structure.
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Fiction
REACH ACOs are Wall Street-backed with more loyalty to investors than patients REAC
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Fact
Most REACH ACOs are hospitals and physician practices, many with a history participating in value-based care program and long track record of upholding solid, quality patient care.
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Fiction
ACO REACH will eventually cover 30 million Medicare beneficiaries
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Fact
ACO REACH is a temporary model set to expire in 2026. DCEs will likely serve between 2 million to 3 million patients.
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