Can ACO Reach Program Be Adapted For Independent Practices?

The ACO Reach Program, launched in January 2023, aims to revolutionize Medicare care by emphasizing health equity and coordinated care delivery. But can independent practices, the backbone of primary care in many communities, benefit from this program?

The ACO Reach Landscape

ACO Reach stands for Accountable Care Organization Realizing Equity, Access, and Community Health. It's a new model by the Centers for Medicare & Medicaid Services (CMS) that encourages healthcare providers to collaborate in ACOs (Accountable Care Organizations). These work together to deliver better quality care for Medicare beneficiaries while controlling costs.

Here's what makes ACO Reach unique!

 

• Focus on underserved communities: A core aspect of Reach is addressing health disparities. Participating ACOs must develop a plan to identify and serve Medicare beneficiaries in underserved areas.
• New payment approach: The program offers innovative payment structures that reward ACOs for positive patient outcomes and care coordination, particularly for underserved populations.
• Flexibility in ACO structures: Reach allows for various ACO models, including standard ACOs, high-needs population organizations catering to specific patient demographics, and new entrant ACOs for organizations venturing into the program.

Can Independent Practices Participate?

The good news is that independent practices can potentially benefit from the ACO Reach Program. While the program traditionally targets larger healthcare systems, there are ways for independent practices to get involved:

 

• Join an existing ACO: Several established organizations are actively seeking independent practices to join their network. This allows independent practices to employ the ACO's infrastructure and resources while contributing to their unique patient base and care approach.
• Form a smaller ACO: Independent practices can consider forming their own ACO, particularly if they are located in a geographically concentrated area. However, this path requires significant collaboration and may necessitate partnering with other healthcare providers like hospitals or specialists.
• Advocate for future iterations: The ACO Reach program is constantly evolving. Independent practices can advocate for future models that cater specifically to their needs and challenges.

Challenges & Considerations

 

• Administrative burden: ACO participation involves additional data reporting and performance measurement requirements.
• Financial investment: Depending on the chosen participation model, there may be upfront costs associated.
• Technological infrastructure: Effective participation might necessitate investments in health IT systems to ensure data exchange and care coordination with other ACO members.

Weighing the Pros & Cons

Independent practices should carefully evaluate the potential benefits and drawbacks of ACO Reach participation. Here are some key questions to consider:

 

• Does my practice align with the program's emphasis on population health and underserved communities?
• Am I willing to invest the time and resources required for ACO participation?
• Are there existing ACOs in my area that I can partner with? 

Want to know more? Reach out to Persivia and get your answers right away!