×
  • Services
    • E-Commerce Website Development
    • E-Learning Platform Development
    • Website Development
    • Custom ERP Development
    • Web Designing
    • Job Portal Software Development
    • CMS Development Services
  • Casestudy
  • Industry
    • Education & E-Learning
    • Textile Solutions
    • Retail Industry
    • Fitness & Training
    • Recruitment
    • Healthcare
  • Products
    • Job Board Software
    • Learning Management System
  • Blog
  • Contact Us
  • Career
  • Skip to main content
  • Skip to primary sidebar
☰

Knovator Technologies

Web and App Solutions

  • Healthcare
  • Services
    • First Sub Menu
      • Custom healthcare software development
        Custom Healthcare DevelopmentSpecialize in crafting healthcare software for all types of devices and systems
      • MVP Product Development
        MVP Product Development Minimum viable product to test and validate business assumptions
    • Second
      • Dedicated Technical team
        Dedicated Technical team Hire experienced remote development teams of software engineers and developers for growth
  • Solutions
    • First Sub Menu
      • Telemedicine App Development
        Telemedicine App Development Revolutionize the virtual care experience that prioritizes patients’ needs
      • Telehealth App Development
        Telehealth App Development We help bring your telehealth app idea from concept to success
      • mHealth App Development
        mHealth App Development Apps that are scalable, handle growth and adapt to changing needs
      • Remote Patient Monitoring Solution
        Remote Patient Monitoring Solution RPM platform intuitive design, delivering an unparalleled user experience
    • Second
      • Patient Engagement Solution
        Patient Engagement Solution Innovative, agile, and personalized solutions that are tailored to your unique needs
      • EMR/EHR Solution Development
        EMR/EHR Solution Development Customized EMR/EHR that brings a higher ROI for your healthcare organization
      • Prior Authorization Solution
        Prior Authorization Solution Prior authorization solutions increase efficiency by streamlining the process
  • Blog
  • Contact Us
Understanding the Shift from GPDC to ACO REACH Model
Healthcare, Stay Updated On The On-Goings Of Global Technology

Home » Blog » Understanding the Shift from GPDC to ACO REACH Model

Understanding the Shift from GPDC to ACO REACH Model

September 18th, 2023 6 mins
Share
ACO-REACH-Model

To fulfill the commitment of the Biden-Harris Administration to improve the quality of care that people receive, including the underserved communities, the Centers for Medicare & Medicaid Services (CMS) is testing new models of health care service delivery and payment across the USA.

The Global and Professional Direct Contracting (GPDC) Model has been redesigned to the ACO Realizing Equity, Access, and Community Health (REACH) Model to promote the stakeholder feedback, participant experience, and Administration priorities. It includes CMS’s commitment to advancing health equity for the citizens of the USA.

As the GPDC Model is changed to AOC REACH Model, CMS is also canceling the Geographic Direct Contracting Model (Geo Model), which was announced in December 2020 but paused in March 2021 in response to stakeholder concerns.

Here is all the related information and highlights of the ACO REACH Model.

1. Why is CMS making the change from GPDC to ACO REACH?

CMS redesigned and renamed the GPDC Model to the ACO REACH Model to reflect the changes and priorities of the Biden-Harris Administration that happened due to the feedback received from stakeholders and participants and to show its commitment towards health equity.

2. What is the model timeline?

The ACO REACH Model starts on January 1, 2023, and will have a span of four Performance Years, ending on December 31, 2026. Interested provider-led organizations need to apply Request for Applications (RFA) to begin participation in PY2023 with an optional Implementation Period (IP) from August 1, 2022, to December 31, 2022.

3. What are the model goals?

The goals of the REACH Model are:

  • To promote health equity and address historical healthcare disparities for underserved communities.
  • To continue the momentum of provider-led organizations participating in risk-based models.
  • To protect beneficiaries and the Model with more participant vetting, monitoring, and greater transparency

4. How will ACO REACH focus on Health Equity?

custom healthcare development
As it is shown by research that underserved communities experience worse health outcomes than the general population, the ACO REACH Model has introduced five new policies to promote health equity:

  1. Health Equity Benchmark Adjustment
  2. Health Equity Plan Requirement
  3. Health Equity Questions in Application and Scoring for Health Equity Experience
  4. Health Equity Data Collection Requirement
  5. Nurse Practitioner Services Benefit Enhancement

5. What will be the effect of the ACO REACH Model on the GPDC Model participants?

Current GPDC participants need to maintain a strong compliance record in 2022. That means participating providers or designated representatives hold at least 75 % control of each ACO’s governing body. Apart from that, this model requires two beneficiary advocates, at least one Medicare beneficiary, and at least one consumer advocate, and both of them should hold voting rights.

6. What are the risk adjustments?

The ACO REACH Model has improved upon the GPDC Model’s approach to risk adjustment, two changes to the “Risk Score Growth Cap” further mitigate potential inappropriate risk score gains:

  • Start with adopting a static reference year population for the remainder of the model performance period as per the ACO REACH Model. This means the capped risk scores of a single model participant will not grow greater than 3 % every two years in the later years of the Model.
  • Cap the REACH ACO’s risk score growth relative to the DCE’s demographic risk score growth, so the +/- 3% cap is appropriately adjusted based on demographic changes in the underlying population over time. The CIF (Coding Intensity Factor) essentially creates a ‘zero-sum’ environment and is the mechanism that provides 100% protection to Medicare against inflated payments.

7. What are the roles of additional monitoring and compliances?

Additional monitoring and compliance efforts and analytics as used in the REACH ACO Model will:

  • Audit annually REACH ACO contracts with providers to learn more about their downstream arrangements and identify any concerns.
  • Investigate any beneficiary and provider complaints and grievances on a rolling basis in coordination with 1-800-Medicare, the Innovation Center liaison on models in the Medicare Beneficiary Ombudsman team, CMS regional offices, and others as appropriate.
  • Annually track if beneficiaries are being shifted in or out of MA.
  • Examine ACO’s risk score growth to identify inappropriate coding practices.
  • Monitor for noncompliance with prohibitions against anti-competitive behavior and misuse of beneficiary data.
  • Increased use of data analytics to monitor services over time and compared to a reference population to assess changes in beneficiaries’ access to care, including stinting on care.
  • Review marketing materials regularly to ensure the information on the Model is accurate and beneficiaries understand their rights and freedom of choice.
  • Verify annually that REACH ACO websites are updated and provide the required information.

8. What will be the quality withheld?

Compared to the GPDC Model, where the quality withhold applied to the benchmarks of both Professional DCEs and Global DCEs was 5% is now reduced to 2% in the ACO REACH Model.

9. What are the benefits and protections for Medicare beneficiaries?

Benefits for medical beneficiaries (applies to all Performance Years of the Model) include:

  • There is a higher quality of care and more excellent clinical support and care coordination for beneficiaries.
  • “Benefit Enhancements” and “Beneficiary Engagement Incentives” offered under the Model (e.g., telehealth, post-discharge home visits and waiver of the homebound requirement, Part B cost-sharing support, concurrent care for beneficiaries that elect hospice care).

Beneficiary protections (applies to all Performance Years of the Model):

  • All aligned beneficiaries retain full Original Medicare benefits and see any Medicare physician.
  • Beneficiaries are automatically notified on an annual basis of their alignment to a DCE/ACO. Additionally, their benefits are not changed.
  • Beneficiaries retain the rights for all FFS Medicare channels for raising concerns or reporting complaints.

Related : Benefits of Buy Hospital Automated Prior Authorization Solution

The role of a healthcare software development company in the digital transformation of your healthcare business

A healthcare software development company like Knovator Technologies can help with the digital transformation of your healthcare business. This includes developing telemedicine, telehealth, or mhealth apps. Additionally, EHR implementation services, prior authorization and patient engagement solutions through our healthcare IT managed services help you boost your ROI, customer engagement and improve your customer experiences. Healthcare companies worldwide leverage our custom healthcare development, healthcare MVP development and hire dedicated developers for complex telemedicine software, websites and apps.

facebook-icon twitter-icon pintrest-icon instagram-icon
Pankit Gami
Pankit Gami
CEO & Founder of Knovator Technologies
facebook-icon twitter-icon linkedin-icon
Pankit Gami, a tech-savvy entrepreneur and CEO of Knovator Technologies, brings over 7 years of experience in software development and project management to the table. With a flair for web and mobile development, e-commerce and online portals, including Job portals, Healthcare portals, internet banking, hotel management systems, CRM, and other specialised solutions, he leads his team to excel in providing top-notch services. Passionate about travel and mentorship, he balances work with exploring new places and guiding aspiring tech professionals.
TABLE OF CONTENTS
  • Why is CMS making the change from GPDC to ACO REACH?
  • What is the model timeline?
  • What are the model goals?
  • How will ACO REACH focus on Health Equity?
  • What will be the effect of the ACO REACH Model on the GPDC Model participants?
  • What are the risk adjustments?
  • What are the roles of additional monitoring and compliances?
  • What will be the quality withheld?
  • What are the benefits and protections for Medicare beneficiaries?
Request a FREE Quote
Never miss a story
thumsup  Thank you for Signing Up
Please correct the marked field(s) below.
1,true,6,Lead Email,21,false,1,First Name,21,false,1,Last Name,2
close

Want More Sales From LinkedIn?

Download This Cheatsheet

Download

It's FREE!

Get Actionable Tips That Can Help You Close More Deals.

Related Articles

OPD Transformation in Health Care

OPD Transformation in Health Care

OPD – The Outpatient Department serves as a gateway to the patient’s journey through your hospital...

Healthcare
18 Sep 2023
HITECH Act: Health Information Technology For Economic & Clinical Health

HITECH Act: Health Information Technology For Economic & Clinical Health

If you’ve ever wondered, “What is the HITECH Act?” you’re not alone. The HITECH Act of 2009, or ...

Healthcare, Insights
17 Jul 2023
GDPR: Understanding Its Impact and Ensuring Compliance

GDPR: Understanding Its Impact and Ensuring Compliance

Welcome! Today we’re diving deep into a game-changing law – the General Data Protection Regulation (GDPR). It...

Healthcare, Insights
14 Jul 2023
X
Request a Free Quote
Expert Tech Guidance
Industry Research
Free Project Estimation
Dedicated Support
  • Max. file size: 2 GB.
  • This field is for validation purposes and should be left unchanged.

Request a FREE Quote
Whats App
Together we can do great things.

Get free technical consultation

Speak to our experts to get the customised app, a timeline for the project and the costing.

Get your app faster

Instant prototype, faster application development and delivery.

Aftercare

We will maintain your project to keep it running smoothly.
Get in touch with us
  • This field is for validation purposes and should be left unchanged.

knovator logo
561 bridge ave, Windsor Ontario, N9B 2M3, Canada
7990 485 021
[email protected]
[email protected]
DMCA.com Protection Status
About Us
  • Blog
  • Career
  • Contact Us
  • Privacy Policy
  • Terms And Conditions
  • Cancellation And Refund
Our Services
  • Custom Healthcare Development
  • Dedicated Technical Team
  • Healthcare MVP Development
Solutions
  • Telemedicine App Development
  • Telehealth App Development
  • mHealth App Development
  • Remote Patient Monitoring Solution
  • Patient Engagement Solution
  • EMR/EHR Solution Development
  • Prior Authorization Solution
Resources
  • OPD Transformation in Health Care
  • HITECH Act: Health Information Technology For Economic & Clinical Health
  • GDPR: Understanding Its Impact and Ensuring Compliance
  • HIPAA: Complete Guide On Impact, Consequences, & Compliances

Copyright © 2023 · All Rights Reserved by Knovator Technologies