The Centers for Medicare & Medicaid Services (CMS) on Tuesday announced an expansion to certain accountable care initiatives in 2023, doubling down on efforts to have all patients with traditional Medicare in an accountable care relationship by 2030.
More than 700,000 health care providers, including nursing homes, will participate in at least one of three expanded initiatives. Accountable Care Organizations, or ACOs, are made up of groups of doctors, hospitals and other health care providers to collaborate and provide coordinated care to Medicare patients. ACOs are able to leverage certain flexibilities, including waiving the three-day stay rule related to SNF coverage.
Among this year’s expanded initiatives is the ACO Realizing Equity, Access, and Community Health (REACH) Model, which aims to improve the quality of care for people with traditional Medicare through better care coordination.
The REACH model was designed to replace the Global and Professional Direct Contracting Model as a provider-led organization, with doctors and health care providers having at least 75% control of the ACO’s governing body. The old model allowed only 25% of provider control.
While SNFs have gravitated toward institutional special needs plans (I-SNPs) when it comes to value-based care plans in the past, the REACH model has offered a new path for operators to dive into risk-based care plans.
The REACH Model will test benchmark adjustments, shifting payments to better align with underserved communities – including care in the home, CMS said in its statement.
REACH is entering 2023 with 132 ACOs with 131,772 providers and 2.1 million beneficiaries, CMS said. More than twice the number of federally qualified health centers, rural health centers and critical access hospitals will be participating in the model this year compared to 2022.
About 824 of such critical access point centers for underserved populations will offer the REACH program this year.
There’s more good news for nursing homes considering involvement in the REACH program – 105 of the existing 132 REACH ACOs offer the three-day stay waiver for nursing homes as part of benefit enhancements, according to a list of such plans compiled by CMS. That’s nearly 80% to offer such a crucial benefit for beneficiaries.
Currently, the blanket waiver related to the three-day stay is contingent on the public health emergency (PHE), which was just extended on Jan. 11 for another 90 days. CMS hasn’t announced a separate sunset for the waiver like it has for other pandemic-related waivers, including one tied to the utilization of temporary nurse aides (TNAs).
Suspension of the three-day stay requirement allows Medicare patients to be discharged to a skilled nursing facility without having to stay at a hospital as an inpatient for at least three days.
Without the waiver, patients transferred from a hospital to a SNF in fewer than three days would have incurred out-of-pocket costs. CMS initially waived the requirement to free up hospital beds at the onset of the pandemic.
Dr. Clif Gaus, president and CEO of NAACOs, said he’s encouraged by recent changes to ACOs, seeing the CMS move as a “turning point” in ACO growth, accelerating in 2024 thanks to CMS leadership.
“The interest in high-risk models like ACO REACH should be a signal that CMS needs to include more high-risk options in the Shared Savings Program with many of the features of REACH,” added Gaus.
“Increasing the number and reach of ACOs in underserved communities will help close racial and ethnic disparities that have been identified among people with traditional Medicare in accountable care relationships,” CMS said in its statement. More than 55% of REACH ACOs have self-reported as provider organizations.
Other initiatives seeing expansion this year include the Kidney Care Choices (KCC) Model.
“Through the CMS accountable care initiatives and working with our partners, we have made significant progress in addressing our greatest health care challenges,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “Health care providers coming together as Accountable Care Organizations provide high quality and equitable care to people with Medicare while improving the sustainability of the Medicare program.”
