On October 20, 2023, the Centers for Medicare & Medicaid Services released participant-level financial and quality results for the Global and Professional Direct Contracting (GPDC) Model for Performance Year 2022 (PY2022). Ninety-nine Direct Contracting Entities (DCEs) participated in the model in PY2022, the second year of the model. The GPDC Model was a voluntary, Accountable Care Organization (ACO) model designed to put patients at the center of their care by providing incentives for care coordination and team-based care, and by rewarding better patient outcomes and higher quality. The GPDC Model was redesigned and renamed the ACO Realizing Equity, Access and Community Health (ACO REACH) Model, which launched on January 1, 2023. The full quality and financial results for PY2022 are available on the GPDC webpage.
The financial and quality results are calculated differently than in the model’s formal evaluation. For this report, results are presented in comparison to financial benchmarks set for model participants. This approach to setting financial benchmarks creates transparent and understandable incentives for participating DCEs to improve quality of care and reduce spending. In contrast, the evaluation considers the model’s spending and quality impact relative to a control group. This evaluates performance compared to what would have occurred absent the model. The first annual evaluation for the GPDC Model, for PY2021, is available on the model webpage.
PY2022 Quality Results Highlights
- The average total quality score in PY2022 was 99.4% across the 91 Standard and New Entrant DCEs, and the average quality score was 99.0% across the 8 High Needs Population DCEs. Just 11 total ACOs (11%) had quality scores that were below 100%.
- In PY2022, 80% of DCE quality scores were assessed on a Pay-For-Reporting basis, with DCEs given credit for the provision of data as is common in the first years of a model.
- PY2022 quality results indicate a slight improvement compared to PY2021, though the 9-month length of the first model year limits the comparability of year-over-year changes.
For the ACO REACH Model, beginning in PY2023, quality measurement is assessed on a 100% Pay-For-Performance basis rather than a Pay-for-Reporting basis. This means ACOs will earn their quality withhold (i.e. 2% of benchmark) purely based on their performance across all quality measures, the majority of which are patient outcomes-based. More specifically, in PY2023, ACOs are evaluated on their ability to reduce unplanned hospital admissions for patients with multiple chronic conditions and all-cause hospital readmissions, improve patient experience as captured by the Consumer Assessment of Healthcare Providers and Systems (CAHPS), and increase rates of Timely Follow-Up Care (Standard and New Entrant ACOs) or Days at Home for Patients with Complex, Chronic Conditions (High Needs ACOs).
The shift from 20% to 100% Pay-For-Performance quality score assessment may result in more variation in quality scores among ACOs in PY2023 as we incentivize performance across the measures.
PY2022 Financial Results Highlights
The model’s net savings to CMS was $371.5 million (1.6% of model benchmark), and the net savings to DCEs was $484.1 million (2.1% of model benchmark). This is an absolute increase from the $70.4 million in net savings to CMS and the $46.5 million in net savings to DCEs in PY2021. Medicare beneficiaries aligned to DCEs participating in the GPDC Model retained all rights, coverage, and benefits that all beneficiaries with Traditional Medicare enjoy, including the freedom to see any Medicare clinicians.
- The total financial savings increased from PY2021 to PY2022 due to growth in model participation, a longer performance period in PY2022 (12 months vs. 9 months in PY2021), and performance improvements by model participants as they gained experience.
- 99 DCEs (from 53 DCEs in 2021) with 21 million beneficiary months (from 3 million in PY2021) participated in the program in PY 2022.
- Between PY2021 and PY2022, Per-Beneficiary, Per-Month gross savings increased by 7.8% to $41.26.
- PY2021 cohort DCE net savings for PY2022 was $303.4 million (3.3% net savings rate).
- PY2022 cohort DCE net savings for PY2022 was $180.8 million (1.3% net savings rate).
- 93% of PY2022 CMS net savings were driven by the 2% discount applied to benchmarks of DCEs in the Global (100%) risk option – i.e., the majority of CMS’ savings were earned by capturing the first 2% of all savings generated by DCEs in the Global risk option.
- High Needs Population (12.6% net savings rate) and New Entrant DCEs (5.0%) achieved higher performance compared to Standard DCEs (1.8%), the result of more tailored benchmarking policies as well as a smaller number of participants within the former two DCE types.
Given the financial and quality results are calculated differently from the evaluation results, the latter for PY2022 will contain different savings estimates, and typically reflect more conservative financial results. Evaluation results lag financial and quality results. For PY2022, the evaluation results are expected in mid-2024.
CMS is excited to continue learning about the care innovations employed by REACH ACOs to improve quality for their patients.