The ACO REACH Model: Health IT for Success

January 1, 2023 began the first performance year of the ACO REACH Model designed to promote health equity initiatives among accountable care organizations (ACOs). This new program aims to improve quality of care and health outcomes for underserved patients while reducing the health disparities they face.

To comply, ACOs participating in the program, and other risk-bearing entities working to improve quality measures, will likely need the help of technology to: 1) support high-quality data collection and exchange, 2) identify and address health disparities, and 3) improve care coordination and patient outcomes.

What is the ACO REACH Model?

ACO REACH, shorthand for the Accountable Care Organization Realizing Equity, Access, and Community Health, is the latest risk-based care program established by the Centers for Medicare and Medicaid Innovation (CMMI) to replace the Global Professional Direct Contracting (GPDC) Model. ACO REACH will measure participants’ adherence to health equity goals through three principal targets:

• Identifying underserved patient populations and health disparities they face
• Collecting and sharing standardized data reported by beneficiaries on demographic and social determinants of health (SDOH) information
• Demonstrating a reduction in health disparities through a measurable health equity strategy

Under this new model the two voluntary financial risk options remain the same as those of the GPDC Model, but ACO REACH aims to improve the risk approach by creating beneficiary-level risk adjustments for REACH ACOs that treat a higher percentage of underserved populations with complex healthcare needs. CMMI created a comparison chart to show the differences between GDPC and ACO REACH.

Data Quality and Interoperability Requirements for ACO REACH

Data quality and interoperability will be key to comply ends on the collection and exchange of accurate, complete, and standardized data as the foundation. Without it, identifying and following beneficiaries with high-priority or unmet healthcare needs can be burdensome. Siloed information and lack of interoperability create barriers to care coordination and collaboration, leading to unnecessary costs and negative outcomes, such as readmissions.

Ensuring the quality and actionability of this data depends on ACOs having the capabilities in place that will allow them to access and exchange data from across the continuum of care, ideally aggregated from multiple sources to get the most complete and accurate data. Data silos, incomplete or inaccurate data, or data received in unusable or indigestible formats will hinder these efforts, so ACOs should ensure they have the right health IT partner and solutions in place to prevent these obstacles.

Health IT Solutions for ACO Reach Quality Measures and Compliance

All ACOs and risk-bearing entities managing specific populations require data identifying, describing, and locating their patients to support better outcomes and improve quality measures. Reach ACOs in this first performance period will need to rely on technology and automation to help them identify those target populations and meaningfully exchange standardized data to show measurable results for program compliance.

ACOs need health IT solutions that support streamlined exchange and access to accurate, complete, and timely information about patient demographics, clinical records, and unmet social needs linked to SDOH data. With access to this high-quality data, ACOs can then effectively identify and monitor patients who meet criteria that could put them at higher risk for unfavorable outcomes like readmissions or frequent emergency department utilization. Having technology that supports automated criteria-based alerts in provider workflows for these populations being monitored can allow for targeted interventions that have a greater impact.

New technology options offered by trusted technology partners can help by providing actionable, real-time insights about patients as they move throughout the care continuum, leading to improved outcomes and quality measures. Without real-time awareness of patient admissions and discharges, it is difficult for providers and care coordinators to support safe transitions of care, help reduce readmissions, and provide timely post-discharge follow-up/services—all common metrics targeted by quality measures for risk-bearing entities.

By implementing strong technology solutions, ACOs can target risk-mitigation strategies for the patients who need it most and improve care coordination by breaking down data silos and preventing gaps in care. As the first performance year starts, REACH ACOs will benefit from ensuring their strategy for success is supported by the appropriate partner and solutions to get the job done right.