CMS announces remaining provisional awardees in stealth mode.
If you weren't looking closely, you might have missed CMS' announcement of the 110 participants that have been provisionally accepted into the ACO REACH program for 2023.
The agency released the names via an updated letter in a list of other ACO REACH documents—noting, with no plans to name, the 18 applicants that have withdrawn since late June. CMS will also not announce the 142 organizations that applied but were not selected.
Perhaps the low acceptance rate—47%—shouldn't have been a surprise. As Juliette Price, chief solutions officer at HSG, noted in July: "CMS had a cleverly-phrased portion of the ACO REACH request for applications that gave them the right to limit the total number of ACOs accepted into the program based on the volume of applications received. This tiny but significant sentence has been talked about in many conference hallways since it was released."
How the numbers may change
The 99 groups currently participating in the Global and Professional Direct Contracting model—GPDC, or Direct Contracting—may transition to ACO REACH with no added selection process, raising the total participants from the conservatively sized freshman class from 110 to 209.
While this would turn ACO REACH into a sizeable CMMI model, the numbers will only go down. CMS has signaled that the freshman class will be the only class, announcing in an August 15 companion FAQ: "At this time, CMS is not planning any other application opportunities for the ACO REACH Model."
The chosen ones
What do we know about the 110 organizations that were chosen and why, including the "provisional" designation? The latter simply means that more organizations have the option to withdraw before ACO REACH model year one begins January 1, 2023.
The only organization clearly linked to a current GPDC participant is agilon health, which plans to participate in ACO REACH in the Tennessee and Toledo, Ohio, markets. As a GPDC participant, agilon health links to four provider management organizations with multiple participating physician groups. In its FAQ, CMS states that it "will include supplementary
information on the participating ACOs in these announcements as available, including ACO type, risk sharing option, state(s) where the ACO operates, and ACO website."
What's in a name? Not much
Until then, the only safe speculation is that multiple health plans lurk beneath less-than-illuminating legal entity names like ACO REACH (in California, Washington, DC, Florida, Nevada, and Texas) and less-than-inspiring names such as "Dedicated US Holdings, LLC." The ability of health plan-linked organization to become direct contracting entities within original Medicare was part of the GPDC model controversy, at least among some circles.
HealthLeaders will continue to investigate the organizations behind the curtain as provisional participants wade through the methodology papers that detail the "financial, quality, and alignment policies under the redesigned ACO REACH Model." Per CMS, these will be published late summer 2022 on the ACO REACH Model website.
Laura Beerman is a contributing writer for HealthLeaders.
On August 15 with little fanfare, CMS posted the list of organizations selected for ACO REACH for plan year 2023.
The agency's first selection announcement in late June included 128 provisional awardees, now down to 110 due to applicant withdrawals.
HSG writes that the acceptance rate was already surprisingly low at 47%, less than other CMMI models.