ACO REACH builds on lessons learned from earlier shared-savings, ACO models, encouraging health care providers to form ACOs to break down silos and deliver high-quality, coordinated care to their patients, improve health outcomes, and manage costs. The model makes important changes to the previous GPDC Model, including 1) policies that promote health care provider leadership and governance and participation of beneficiary advocates on the governing board and 2) greater participant vetting, monitoring, and transparency to protect patients and the model.
Aims
The model seeks to improve quality of care and health outcomes for people with Medicare through:
- Alignment of financial incentives.
- Emphasis on patient choice and care delivery.
- Strong monitoring to ensure that patients maintain access to care.
Innovation
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.
- Professional: A lower risk-sharing arrangement — 50% savings/losses — with one payment option for participants: Primary Care Capitation Payment, a risk-adjusted monthly payment for primary care services provided by the ACO’s participating providers.
- Global: A higher risk sharing arrangement — 100% savings/losses — with two payment options: Primary Care Capitation Payment (described above) or Total Care Capitation Payment, a risk-adjusted monthly payment for all covered services, including specialty care, provided by the ACO’s participating providers.
Design
The ACO REACH Model is focused on provider-based organizations and offers three types of participants:
- Standard ACOs: ACOs composed of organizations that generally have experience serving Original Medicare patients, including Medicare-only and also dually eligible beneficiaries, who are aligned to an ACO through voluntary alignment or claims-based alignment. These organizations may have previously participated in another CMS Innovation Center shared-savings model (e.g., Next Generation ACO Model and Pioneer ACO Model) and/or the Center for Medicare’s Shared Savings Program. Alternatively, new organizations, composed of existing Original Medicare providers and suppliers, may be created to form a Standard ACO. In either case, clinicians participating within these organizations would have substantial experience serving Original Medicare beneficiaries.
- New Entrant ACOs: ACOs composed of organizations that have not traditionally provided services to an Original Medicare population and who may rely primarily on voluntary alignment, at least in the first few performance years of model participation. Claims-based alignment will also be utilized.
- High Needs Population ACOs: ACOs that serve Original Medicare patients with complex needs, including dually eligible beneficiaries, who are aligned to an ACO through voluntary alignment or claims-based alignment. These participants are expected to use a model of care designed to serve individuals with complex needs, such as the one employed by the Programs of All-Inclusive Care for the Elderly (PACE), to coordinate care for their aligned beneficiaries.
Beneficiary Engagement Incentive (BEI)
As part of ACO REACH’s PY 2026 updates, a new Substance Access BEI will give model participants the option of consulting with their patients about the possible use of eligible hemp products. The implementation of this BEI and any related dispensing would be funded entirely at the participant’s expense; CMS would not cover the cost of such products. Further, CMS will have strict program integrity safeguards to ensure that these incentives do not result in program or patient abuse.
The Substance Access BEI is only available to participants in states where the eligible hemp products are considered legal.
The Substance Access BEI is also being made available to participants in Enhancing Oncology Model starting in performance period 6 and in the upcoming LEAD Model, which begins on January 1, 2027.
