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Starting in January 2023, health care payment policy will take an important step toward health equity. Last month, the Centers for Medicare and Medicaid Services (CMS) announced a new accountable care model that replaces the prior Directing Contracting models and incorporates changes to help organizations address equity and access through accountable care organization (ACO) participation.
The forthcoming ACO Realizing Equity, Access, and Community Health (REACH) model makes several foundational advances required for promoting equity through payment model design. These advances include intentional planning on how participants will improve health equity, collection of data on individual-level social determinants, and use of financial incentives directly tied to equity. The REACH model builds on CMS’s equity-based payment incentive in the End-Stage Renal Disease Treatment Choices Model announced last year, the first time a model has directly financially rewarded equity gap closure. While individual organizations in existing ACO programs may be working on advancing equity in their own settings, ACO REACH is also first model built on a CMS Innovation Center strategic refresh oriented explicitly around this goal.
More broadly, ACO REACH underscores a call to action for health care stakeholders to take several steps as part of a broader framework for addressing equity by going beyond traditional approaches to value-based payment. In this article, we outline how the REACH model takes several foundational steps needed to prioritize equity in health care payment. We also describe the work that we believe still needs to be done. (See exhibit 1 at end of article.)