Global and Professional Direct Contracting Model Transitioning to ACO Realizing Equity, Access, and Community Health (REACH) Model

Building on the Biden-Harris Administration’s priorities for a better health care system, today the Centers for Medicare & Medicaid Services (CMS) announced a redesigned Accountable Care Organization (ACO) model that better reflects the agency’s vision of creating a health system that achieves equitable outcomes through high quality, affordable, person-centered care. The ACO Realizing Equity, Access, and Community Health (REACH) Model, a redesign of the Global and Professional Direct Contracting (GPDC) Model, addresses stakeholder feedback, participant experience, and Administration priorities, including CMS’ commitment to advancing health equity.

In addition to transitioning the GPDC Model to the ACO REACH Model, CMS is canceling the Geographic Direct Contracting Model (also known as the “Geo Model”) effective immediately. The Geographic Direct Contracting Model, which was announced in December 2020, was paused in March 2021 in response to stakeholder concerns.

“The Biden-Harris Administration remains committed to promoting value-based care that improves the health care experience of people with Medicare, Medicaid and Marketplace coverage,” said CMS Administrator Chiquita Brooks-LaSure. “To fulfill that commitment, CMS, through the Innovation Center, is testing new models of health care service delivery and payment to improve the quality of care that people receive, including those in underserved communities. The Innovation Center is making improvements to existing models and launching new models to increase participation in our portfolio, and CMS will be a strong collaborator to health care providers that participate in those models.”

As CMS works to achieve the vision outlined for the next decade of the Innovation Center, CMS wants to work with partners who share its vision and values for improving patient care, guided by three key principles. First, any model that CMS tests within Traditional Medicare must ensure that beneficiaries retain all rights that are afforded to them, including freedom of choice of all Medicare-enrolled providers and suppliers. Second, CMS must have confidence that any model it tests works to promote greater equity in the delivery of high-quality services. Third, CMS expects models to extend their reach into underserved communities to improve access to services and quality outcomes. Models that do not meet these core principles will be redesigned or will not move forward.

Consistent with these principles, the ACO REACH Model, tested under the CMS Innovation Center’s authority, will adhere to the following priorities: a greater focus on health equity and closing disparities in care; an emphasis on provider-led organizations and strengthening beneficiary voices to guide the work of model participants; stronger beneficiary protections through ensuring robust compliance with model requirements; increased screening of model applicants, and increased monitoring of model participants; greater transparency and data sharing on care quality and financial performance of model participants; and stronger protections against inappropriate coding and risk score growth.

The ACO REACH Model builds on CMS’ ten years of experience with accountable care initiatives, such as the Medicare Shared Savings Program, the Pioneer ACO Model, and the Next Generation ACO Model. The ACO REACH Model provides novel tools and resources for health care providers to work together more closely to improve the quality of care for people with Traditional Medicare.  To help advance health equity, the ACO REACH Model will require all participating ACOs to have a robust plan describing how they will meet the needs of people with Traditional Medicare in underserved communities and make measurable changes to address health disparities. Additionally, under the ACO REACH Model, CMS will use an innovative payment approach to better support care delivery and coordination for people in underserved communities.

REACH ACOs will be responsible for helping all different types of health care providers — including primary and specialty care physicians — work together, so people get the care they need when they need it. In addition, people with Traditional Medicare who receive care through a REACH ACO may have greater access to enhanced benefits, such as telehealth visits, home care after leaving the hospital, and help with co-pays. They can expect the support of the REACH ACO to help them navigate an often complex health system.

“CMS is testing a redesigned model because accountable care organizations make it possible for people in Traditional Medicare to receive greater support managing their chronic diseases, facilitate smoother transitions from the hospital to their homes, and ensure beneficiaries receive preventive care that keeps them healthy,” said CMS Deputy Administrator and Director of the CMS Innovation Center Liz Fowler, PhD, JD. “Under the ACO REACH Model, health care providers can receive more predictable revenue and use those dollars more flexibly to meet their patients’ needs — and to be more resilient in the face of health challenges like the current public health pandemic. The bottom line is that ACOs can improve health care quality and make people healthier, which can also lead to lower total costs of care.”

The GPDC Model will continue until December 31, 2022 and then will transition to the ACO REACH Model. In the meantime, CMS will operate the GPDC Model with more robust and real-time monitoring of quality and costs for model participants. GPDC Model participants that do not meet model requirements, such as participants that restrict medically necessary care, will face corrective action and potential termination from the model.

The first performance year of the redesigned ACO REACH Model will start on January 1, 2023, and the model performance period will run through 2026. CMS is releasing a Request for Applications for provider-led organizations interested in joining the ACO REACH Model. Current participants in the GPDC Model must agree to meet all the ACO REACH Model requirements by January 1, 2023 in order to participate.

For a fact sheet on the ACO REACH Model, visit: https://www.cms.gov/newsroom/fact-sheets/accountable-care-organization-aco-realizing-equity-access-and-community-health-reach-model

A comparison table of ACO REACH and GPDC is available at:  https://innovation.cms.gov/media/document/gpdc-aco-reach-comparison

More information on the ACO REACH Model is available at: https://innovation.cms.gov/innovation-models/aco-reach

More information on the Global and Professional Direct Contracting Model—including information on model participants for the 2021 and 2022 performance years, and performance and quality data for the 2021 performance year—is available at: https://innovation.cms.gov/innovation-models/gpdc-model

The National Rural Health Association (NRHA) is proud to announce that it has received a one-time, unrestricted donation in the amount of $7 million from philanthropist and author MacKenzie Scott.

“These funds will be utilized in the priority areas of rural leadership development, health equity, state capacity building, and educational and policy programing,” says NRHA CEO Alan Morgan. “NRHA staff will work directly with the association’s elected member leaders to complete a rural health environmental scan and establish a process to ensure these funds are allocated to projects that will demonstrate a clear outcome and provide a direct benefit to the health of rural communities.”

At a time when the pandemic has particularly impacted rural communities and health care, this investment will help NRHA improve health care access and outcomes for all rural Americans.

NRHA has a strong grassroots network that helped secure more than $21 billion in emergency funding for rural health care providers, worked directly with federal agencies to boost rural COVID-19 vaccine confidence and uptake, and ensured vital legislative and regulatory changes to allow rural patients to receive health care via telehealth during the pandemic. NRHA has also worked directly with rural hospitals, rural health clinics, and federally qualified health centers across the country to ensure they have the resources to care for their communities. This generous donation will empower the association to provide even more long-term support beyond the public health emergency.

“This gift is a recognition of the history of outstanding work that NRHA has undertaken in addressing rural health issues and rural health disparities,” says NRHA President Beth O’Connor. “The funds will greatly expand our reach and ability to improve the health care system for 62 million Americans who call rural home.”

Backed by longstanding support from private and public partners, NRHA and its members have initiated and implemented critical rural programming that comprises three-fourths of the association’s overall revenue. These include developing and supporting the now 43 state rural health associations across the country since 1992, training and creating a network of more than 2,000 community health workers, developing rural medical education programming, and convening and establishing border health and oral health initiatives. Additionally, for 27 years NRHA has convened the Health Equity Council and Health Equity Conference – the only event of its kind in the nation – creating a forum for vital discussions related to underserved rural multiracial, multicultural, LGBTQ+, veteran, homeless, and other populations.

This unprecedented gift is the largest unrestricted donation in NRHA’s 45-year history and will be utilized to further the mission of the organization. Scott does not accept solicitations or proposals from organizations.

About NRHA
NRHA is a nonprofit organization working to improve the health and well-being of rural Americans and provide leadership on rural health issues through advocacy, communications, education, and research. NRHA’s membership consists of diverse individuals and organizations, all of whom share the common bond of an interest in rural health.

The Colgate-Palmolive Company has launched a public health initiative, “Know Your OQ™,”  to empower health professionals and consumers to understand and improve their oral health quotient (OQ). The initiative promotes compelling information about the global oral health crisis and provides oral health resources for primary care physicians, nurses, and educational leaders, as well as consumers, to improve oral hygiene, encourage healthier habits, and promote overall health. The interactive assessment is free.

Click here for more information and to take the assessment.

The Technical Assistance and Service Center (TASC) has partnered with the Northwest Regional Telehealth Resource Center (NRTRC) to produce an update to the Critical Access Hospital (CAH) Telehealth Guide. Recent federal guidance has been included in this edition. The updated guide provides information and guidance for assessing and implementing telehealth services for CAHs, including purchasing, staffing, maintenance, reimbursement, and reporting for outpatient services. For additional guidance on using this tool, please see the introductory webinar that was held with the original release of the guide in September 2021.

The guide includes best practices and resources developed by subject matter experts (SME), technical consultants, and telehealth resource centers (TRCs). The objective is to provide Flex Programs and CAHs with a comprehensive guide that will allow them a singular point of reference for CAH telehealth standards with direct content and links to appropriate public and federal resources.

Further questions and concerns can be directed to tasc@ruralcenter.org.

Count Question Resolution Program

The Census Bureau began accepting and researching case submissions for the 2020 Census Count Question Resolution Operation (CQR) in January. CQR gives tribal, state, and local officials the opportunity to request the Census Bureau review their official 2020 Census boundaries and/or housing counts by block for potential processing errors.

Any corrections made will not impact the apportionment counts, redistricting data, or any other 2020 Census data products. They would, however, be used in the Census Bureau’s Population Estimates and other future programs that use 2020 Census data. The Census Bureau has provided Participant Guides on their website to assist government units prepare their CQR submission.

Governments that would like to request a review of group quarters population counts would be able to through a separate proposed program, the 2020 Post-Census Group Quarters Review (2020 PCGQR). Under this proposal, the Census Bureau will accept 2020 PCGQR cases submitted by tribal, state, and local government units from Spring 2022 through Summer 2023.

American Community Survey (ACS)

1-Year Data:

Due to the impact of the COVID-19 pandemic, the Census Bureau changed the 2020 American Community Survey (ACS) release schedule. Instead of providing the standard 1-year data products, the Census Bureau released experimental estimates from the 1-year data. This includes a limited number of data tables for the nation, states, and the District of Columbia. The 2020 ACS 1-year experimental estimates are posted on the 2020 ACS 1-Year Experimental Data Tables page; they are not available on data.census.gov.

5-Year Data:

On March 17, the U.S. Census Bureau will release the standard, full suite of 2016–2020 American Community Survey (ACS) 5-year data products—down to the block group level. Following pandemic-related data collection disruptions, the Census Bureau revised its methodology to reduce nonresponse bias in data collected in 2020. After evaluating the effectiveness of this methodology, the Census Bureau determined the resulting data are fit for public release, government and business uses, and understanding the social and economic characteristics of the U.S. population and economy.

Disclosure Avoidance

The Census Bureau is working on the next phase of 2020 Census data product development. The Updated 2020 Census Data Product Planning Crosswalk is available. The Crosswalk compares the 2020 Census proposed 2020 Census Demographic Profile, Demographic and Housing Characteristics File (DHC), and Detailed Demographic and Housing Characteristics File (Detailed DHC) tables to the published 2010 Census tables. The Bureau plans two releases of demonstration data for the DHC and Detailed DHC products. With feedback from these releases, they plan to begin production of data products in Summer 2022.

During Calendar Year (CY) 2021, Pennsylvania (exclusive of Philadelphia) reported a 28% increase in Early Syphilis from CY 2020. The reported 1,418 cases in CY 2021 represents the highest number of Early Syphilis cases in more than 30 years. Additionally, during CY 2021, there was also a reported 36% increase in Early Syphilis cases in females of whom 90% were child-bearing age. Read more.

After several COVID-related delays, the Office of the National Coordinator (ONC) has set a December 31 deadline for the healthcare industry to support apps that store records electronically, such as Apple Health. This is part of the 21^st Century Cures Act, and it works both ways: Health IT developers will need standardized APIs and FHIR technology to support data exchange and interoperability, and providers will be expected to use APIs and FHIR technology. Patients won’t be required to use apps, but medical offices will at least have to support electronic exchanges using the FHIR standards. What remains to be seen is how this will be enforced.