CMS recently unveiled a replacement for the Direct Contracting Model, renamed now as the ACO REACH Model. Many of the original Direct Contracting Model tenets will remain the same, with a few significant changes announced.
The stated goals of the overhaul are to advance Equity and expand Access, while continuing with the original aspirations to improve quality and reduce cost.
The Direct Contracting Model received criticism as a move toward privatizing Medicare that would result in “The end of Medicare as we know it.” (This same criticism was leveled against Medicare Advantage.) And while the new ACO REACH model does not answer those concerns directly, it does dial in the focus on societal needs in what could be some very meaningful ways.
The purpose of the Direct Contracting Model was to:
The new ACO Reach Model sets out to achieve those same aims, while adding:
There are two voluntary risk-sharing options under the ACO REACH Model. In each option, participating providers accept Medicare claims reductions and agree to receive at least some compensation from their ACO.
Two policies protect against risk coding growth:
Two changes to the ‘Risk Score Growth Cap’ further mitigate potential inappropriate risk score gains:
DCE Over-Coding Enforcement
In the prior DCE model a coding intensity factor was applied to limit the growth or the loss of the risk score (RAF). The risk score growth was capped at +/- 3%. This was done to prevent “over coding” according to CMS. In reality many institutions may not have been accurately coding & got better with coding education. Patients would also get sicker & these new diagnoses would add to the risk score.
ACO REACH Limits Risk Score Gains
In the ACO Reach model CMS is attempting to further limit the risk score gains. In the prior model the risk growth took into consideration the RAF increase for HCC codes. But in this new model the growth in RAF relative to HCC growth will further be tied to demographic growth within the entity.
More Changes and Clarifications Coming This Summer
More changes and details are forthcoming this summer, but at present, it looks like the DCE Model has mostly survived, with increased reporting needs around health equity in underserved communities. The exact details of these reporting needs will be released this summer. Follow DoctusTech to keep up to date on the latest news.