In an effort to drive health system transformation and achieve equitable outcomes through high-quality, affordable, person-centered care for all patients in Traditional Medicare, the Centers for Medicare & Medicaid Services (CMS) introduced the ACO REACH model, the successor to the Global and Professional Direct Contracting Model (GPDC), in early 2022.

Beneficiaries with Traditional Medicare retain all of their rights, coverage, and benefits, including the freedom to see any Medicare provider. Like previous ACO models, the ACO REACH Model prohibits limited networks, prior authorization or any other means of restricting care. CMS expects that beneficiaries with providers participating in ACO REACH will benefit from improvements in quality of care, enhanced services, like telehealth, home visits after leaving the hospital, cost sharing support, and greater access for underserved communities, reaching beneficiaries who have not previously received coordinated care.

No, not all ACOs are participating in the ACO REACH model. The good news is that even if your ACO doesn’t participate in ACO REACH, as a Preferred Provider you can participate with more than one ACO REACH entity.

We recognize the critical role you play in delivering care. By choosing to join the Preferred Provider network, there is an opportunity to produce measurable improvements in patient outcomes and enhance the quality of care for patients.The new era of transformation offers meaningful improvements to physicians, patients, and practices. By joining the Preferred Provider network, you will have an opportunity to:

• Expand value-based models to a larger population
• Address and focus on health concerns that matter to patients and physicians.
• Participate in an advanced CMS model that will serve to guide current and future models in health equity.
• Increase the potential volume of patient referral.

In the ACO REACH program, we are working together to help:

• better coordinate patient care
• offer services that can improve a patient’s care, including greater access to enhanced benefits such as telehealth visits, home care after leaving the hospital, and copay assistance
• get care when a patient needs it
• help ensure patients get quality care
• reduce the total cost of care

To qualify as a potential ACO REACH entity aligned beneficiary, Medicare beneficiaries must meet all of the following criteria:

• Enrolled in Medicare Parts A & B
• Not enrolled in Medicare Advantage plan or with another payer such that Medicare is the beneficiary’s secondary payer
• Resident of the United States
• Resident of a county that is included in the ACO REACH service area.

Beneficiaries that meet the above criteria are assessed by CMS using ACO REACH’s attribution methodology.

Attribution may also be referred to as assignment or alignment and is the methodology used by CMS to identify the beneficiaries associated with an ACO REACH entity.

Medicare beneficiaries are aligned to each ACO REACH entity based on:

Claims Attribution - CMS attribution model that identifies patients with a plurality of claims submitted by Participant providers

Voluntary Alignment - The patient voluntarily chooses to become an aligned patient

For more information,visit CMS website https://www.cms.gov/files/document/medicare-shared-savings-program-shared-savings-and-losses-and-assignment-methodology-specifications.pdf-1

If you receive a letter inviting your practice to become a preferred provider, use the reference number provided in the letter to contact Honest.

(844) 279-9342

aco-reach-network@honestmedicalgroup.com

The team is available from 9:00 a.m. to 6:00 p.m. ET, Monday through Friday and closed on company observed holidays.

The fee reduction specified in the PP contract will solely be applicable to ACO REACH beneficiaries associated with the contracting ACO entity of the PP.

The ACO entity will furnish the provider roster and fee reduction information to CMS through the 4i reporting system, which will then share the data with the local MAC (Medicare Administrative Contractor )(MAC).

Subsequently, the MAC will apply the discount to all Fee-for-Service (FFS) claims submitted by the practice, utilizing the provider roster and fee reduction data provided by the ACO entity, and the ACO entity’s list of attributed Medicare beneficiaries.

Honest is a market leading value-based care and physician enablement company that forms partnerships with prominent, local physician organizations, so doctors can better focus on the unique needs of their patients. Our care model, technology and analytics supports whole-person-care which is essential for creating more value for patients and physicians in the ACO REACH model.

If you have questions regarding the preferred Preferred provider Provider contracting process, your existing preferred Preferred provider Provider agreement, how to update your roster, or other general ACO REACH questions, please contact Honest at aco-reach-network@honestmedicalgroup.com.

For questions regarding application of the fee reduction or other claims related questions, please contact your MAC at:

• New York

• Michigan

For more information on ACO REACH, please visit the CMS Innovation website.