The Innovation arm of the Center for Medicare and Medicaid Services (CMS) announced Accountable Care Organization Realizing Equity, Access, and Community Health Model, or ACO REACH, a new program that will replace the Global and Professional Direct Contracting Program effective January 1, 2023. While much of the new ACO REACH program resembles the prior Direct Contracting model, there are several substantive changes in the financial and operational aspects of the program. Among the new financial program parameters, one key change is the health equity adjustment which will be applied to the performance benchmark. In this whitepaper, we will discuss the methodology of the health equity adjustment, as well as Wakely’s analysis of the potential geographic-specific financial impact of this adjustment based on the Medicare 100% Research Identifiable File (RIF) data.
Health Equity Adjustment under ACO REACH Program