ACO REACH And Advancing Equity Through Value-Based Payment, Part 2

Value-based payment (VBP) models can be a useful tool for reducing health inequities and advancing equity goals. 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.

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 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.

ACO REACH is a substantial pilot program. It is aimed at improving equity but also at assessing which payment reform design elements can best do so while also achieving the “Triple Aim”—better care experience, better population outcomes, and lower health care costs. ACO REACH and the other equity-focused VBP models consequently provide an unprecedented opportunity for augmenting the meager evidence we have on how to improve equity.

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