ACO REACH And Advancing Equity Through Value-Based Payment, Part 1

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Journal Article

ACO REACH And Advancing Equity Through Value-Based Payment, Part 1

Given the wide expansion of value-based payment (VBP) models in the United States, VBP can be a useful tool for reducing health inequities and advancing equity goals. VBP models provide more flexibility to address social drivers of health (SDoH); they provide services and care coordination that are not typically covered but may be particularly important for people experiencing worse outcomes due to socioeconomic status, race, ethnicity, or other factors. 

However, some evidence suggests that the uptake of VBP models has lagged in marginalized populations, and that in some circumstances, VBP could exacerbate disparities. Consequently, many VBP models are now adopting a more intentional focus on equity, such as the Oregon Health Authority’s Coordinated Care Organizations 2.0 model and Supporting Health for All through Reinvestment Initiative. But addressing equity through VBP remains a nascent field with diverse approaches in use—with limited evidence on which approaches work or help avoid undesirable outcomes.

In this context, the Center for Medicare and Medicaid Innovation (the Innovation Center) recently announced that its Global and Professional Direct Contracting pilot will be redesigned into a new model called the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH). Reflecting the Innovation Center’s strategic focus on health equity as a top priority—and on achieving the broader equity goals of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS)—ACO REACH incorporates many new health equity-focused elements affecting upfront payments, data collection, provider selection, community governance, and delivery and benefit design. These health equity-focused VBP design elements are on top of ACO REACH’s main advanced alternative payment structure of monthly population-based payments for either primary care services or for all covered services with strong links to quality of care.

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Duke-Margolis Authors

William K. Bleser - Margolis headhot

William K. Bleser, PhD, MSPH

Research Director, Health Care Transformation for Social Needs and Health Equity
Senior Team Member
Anti-Racism and Equity Committee Member

Andrea Thoumi headshot

Andrea Thoumi, MPP, MSc

Area Lead, Community Health and Equity
Faculty Director of Health Equity Educational Programming
Senior Team Member
Anti-Racism and Equity Committee Member
Core Faculty Member
Adjunct Assistant Professor
2020 Intern Mentor

Deborah Kaye

Deborah Kaye, MD

Assistant Professor of Surgery
Margolis Core Faculty

Mark McClellan

Mark McClellan, MD, PhD

Director of the Duke-Margolis Institute for Health Policy
Robert J. Margolis, MD, Professor of Business, Medicine and Policy
Margolis Executive Core Faculty

Robert Saunders

Robert Saunders, PhD

Senior Research Director, Health Care Transformation
Adjunct Associate Professor
Executive Team Member
Margolis Core Faculty