Who is eligible to participate in the ACO REACH model?
Healthcare organizations that applied with the CMS Innovation Center and were accepted are participating in the model. Equality Health Direct is proud to be among the few entities throughout the United States that were chosen to participate in this innovative model.
Primary care providers can participate by choosing to contract with Equality Health Direct. Primary care professionals are important participants in the model because they coordinate ongoing care and preventative services for Medicare beneficiaries.
Specialists and ancillary services may also participate in the model by contracting with Equality Health Direct.
If you are a primary care provider, specialist or ancillary services provider who wishes to learn more about joining Equality Health Direct, please email us at equalityaco@equalityhealth.com or call 1-888-696-1122.
Medicare beneficiaries under the care of primary care providers who are contracted with Equality Health Direct are aligned to the ACO. Medicare beneficiaries have their same coverage, benefits, and choices plus they will benefit from their provider’s collaboration with other providers in the model.
What are the benefits to primary care providers who are participating in Equality Health Direct?
There are many benefits to the provider:
How are my patients attributed in Equality Health Direct?
CMS attributes Medicare beneficiaries based on historical claims. Not all established Medicare beneficiaries in your practice may be in the program because CMS uses historical claims. For example, newly aged in beneficiaries may not be included in the program until future years.
Beneficiaries may also align to their provider through a voluntary alignment process that would also include them in this program. Voluntary alignment is a process designed by CMS to support patients in communicating their desire to be aligned with a primary care provider for their care. Medicare beneficiaries are aligned in two ways:
- A Medicare beneficiary actively selects a “Primary Clinician” on MyMedicare.gov or completes a paper form developed by CMS (the “Confirmation of Main Doctor Form”). This form is available online at Medicare.gov.
- A Medicare beneficiary will be attributed to the ACO through claims-based alignment. Beneficiaries are aligned based on where the beneficiary has historically received their primary care services, based on billing activities.
How does ACO REACH differ from Medicare Advantage (MA)?
Unlike patients who enroll in a Medicare Advantage plan, Medicare beneficiaries aligned in the payment model options under the ACO REACH model remain in traditional Medicare (aka fee-for-service (FFS)). Their healthcare coverage will not change, and they retain the freedom to seek care from their Medicare FFS provider or supplier of choice whereas MA plans often require patients to use a specific network of providers.
However, ACOs like Equality Health Direct are similar to MA plans in that they are risk-bearing entities coordinating the care of a specific panel of patients. It is important to note that Equality Health Direct does not pass the risk from this model on to participating providers.
