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医疗保险中心 & Medicaid bet8娱乐 (CMS) recently announced that it is converting the Global and Professional Direct 承包 (GPDC) model to a new model called Accountable Care Organization Realizing Equity, 访问, and Community Health (ACO REACH). The new model revises several challenging financial mechanisms of the GPDC (e.g.,减少质量预提和CMS折扣,对标 underserved populations) while adding new health equity requirements that many healthcare organizations may already be addressing under the umbrella of 健康的社会决定因素 (SDOH).
简而言之,CMS的更新使 ACO REACH model even more inviting to provider organizations that were previously considering GPDC as an advanced alternative payment model (A-APM) or that 错过了申请的机会.
下面我们概述了原因 providers may want to participate in ACO REACH, key updates (from GPDC to ACO REACH),以及申请流程的后续步骤. 考虑到侵略性的时间 frame—a nonbinding application is due Friday, April 22, 2022—we’ve also shared some of our insights from past experience assessing organizational readiness and successfully submitting applications for Medicare Shared Savings ACOs and GPDCs.
ACO REACH的关键更新
什么是GPDC?
Many of the core characteristics of the GPDC model persist with ACO REACH.
- 与医疗集团战略结盟的机会
- MIPS奖金作为A-APM[1]
- Benefit enhancements to facilitate patient engagement with their providers
- 协调和改善护理的机会(e).g., through enhanced benefits and rule waivers, patient-centered care models)
- 有能力的护理选择(例如.g., 初级保健人均, total care capitation) to support innovative care models and investments in population health infrastructure
什么是新的在ACO REACH?
The updates reflect feedback from current participants and health equity requirements that many organizations are already addressing (or beginning to address) as part of SDOH项目. Participation years are PY2021–PY2026 (2026 is new for current DCEs that elect to continue with ACO REACH).
- 与现有的蚁群模型一致, providers must make up 75% of the board (changed from 25% in the previous GPDC). 另外, a patient advocate and a Medicare beneficiary must now be separate individuals, 每个人都必须是有投票权的成员.
- 质量预扣从5%减少到2%.
- 全球型号的折扣从最高5%降至3%.5%.
- 限制风险评分的增长, one year’s population will be used for the entirety of the model; apply a +/-3% cap to HCC risk scores, 相对于人口增长.
- 四个额外的评分标准被添加到应用程序中:
- 提供高质量病人护理的专业知识
- 为bet8娱乐不足人群提供bet8娱乐的记录
- Program integrity risks posed by ACO REACH ownership interest/parent companies
- 关注健康公平和/或经验
- 新的保健公平要求如下:
- Health equity plan: participants must develop plans to mitigate health disparities.
- Health equity benchmark adjustment: financial incentive to care for underserved populations using the 面积剥夺指数 (以及潜在的其他因素).
- Health equity data collection requirement: participants will be expected to collect demographic and social risk factors that may impact the ability for care to be rendered to attributed beneficiaries.
- Nurse practitioner (NP) services benefit enhancement: NPs can assume certain additional responsibilities or furnish certain services not previously allowed by Medicare.
- 临终关怀证书, 糖尿病鞋, 心脏康复中心, and home infusion therapy plan of care; referral for medical nutrition therapy
ACO REACH适合我们吗?
在基于价值的护理模式下取得成功的ACOs(例如.g., MSSP’s ENHANCED Track, Next Generation ACO, Medicare Advantage) should consider ACO REACH. 另外, organizations that have been working on capabilities to manage advanced payment models may find that the time is right to enter into an A-APM via ACO REACH in 2023.
Organizations contemplating participation should consider these questions:
- What are the Medicare and Medicare Advantage trends in our service area?
- 我们有足够的供应商网络吗? 或者,我们应该与谁合作来加强我们的网络?
- 是我们的企业吗?, 以及我们的主要合作伙伴, culturally ready to transform care delivery to align with redesigned payment arrangements?
- 该计划的财务和战略意义是什么?
Existing GPDC entities will also have to consider whether the transition to the ACO REACH model is consistent with their objectives and the realities of their network. While GPDC participants do not need to reapply with the new ACO REACH application, they will need to agree to meet the ACO REACH requirements before January 1, 2023年(与CMS签订修订和重述的参与协议).
你现在需要做什么
创新中心的项目通常采用“及时”的方法, 关键细节可能存在不确定性. 例如, 财务方法的细节将于今年夏天公布, 非绑定应用程序完成后.
- 如果您正在考虑ACO REACH模型,请在2022年4月22日申请. The application is nonbinding, so providers that apply are not required to participate.
- While the legal entities and contractual relationships do not need to be finalized prior to the application, 在短时间内确定你的潜在合作伙伴, 并开始编写对应用程序的叙述性响应.
- Determine how to engage with key representatives during and after the application to prepare the application and implementation. 这可能意味着尽快召集一个指导委员会.
- Implement a strong team to manage your application and implementation and to ensure that your REACH ACO will meet the requirements in the rapidly evolving guidance. We believe strong project management is a critical success factor in bringing ACO models from design to implementation.
We are encouraged to see continued commitment to value-based payment models at the Center for Medicare & 医疗补助创新(CMMI), along with programmatic changes from GPDC to ACO REACH that improve key areas for provider-led networks.
acro REACH模型是否适合您的组织?
Don’t hesitate to reach out to our team with questions about the new model or to discuss your situation. 心电图可以帮助建立框架并提供指导. We assist healthcare leaders in assessing their current situation—in the context of all CMMI models—and arrive at a decision with confidence.
bet8娱乐脚注
- 1.
ACO REACH’s Global and Professional risk-sharing options currently both meet the criteria under 42 C.F.R. § 414.截至2022年3月4日,1415个将成为A-APMs).
出版于2022年3月9日