The Centers for Medicare & Medicaid Services (CMS) recently announced updates to the Accountable Care Organization (ACO) “REACH” Model, which provides private home-focused health care providers with an opportunity to participate in risk-sharing agreements with traditional Medicare.

The new updates are essentially “tweaks” based on learnings acquired through the first two years of the program’s operation, according to Fred Bentley, managing director in ATI Advisory’s care continuum strategy and solutions practice. They also raise questions about the future of the program, which is currently slated to end on Dec. 31, 2026.

“There’s a big question around, will the Trump 2.0 team extend ACO REACH, or are they going to fold it into the Medicare Shared Savings Program … or some other thing?” Bentley told Home Health Care News. “This whole program is entering a pivotal phase here.”

The new changes to the program essentially allow CMS to capture more dollars through the program, Bentley said. Among the changes are updates that limit risk score growth. Higher risk scores enable ACOs to receive higher spending benchmarks, potentially leading to greater savings and bonuses.

“The idea is that through these [accountable care organization] (ACO) models, if the ACOs do well, then the ACOs capture some of the savings that they generate, and then the federal government also captures a certain share of it,” Bentley said. “[The changes are] essentially designed to ensure that CMS is going to capture as much of the upside of this as possible and to be able to assess the ACOs fairly and accurately.”

The changes are likely to have a marginal impact on home health providers, but they do raise other questions.

One could look at CMS’ changes to the ACO REACH model and wonder if they are updating it with an eye toward positioning ACO REACH to endure for future years, Bentley said.

“Admittedly, these aren’t huge changes,” Bentley said. “CMS or [The Center for Medicare and Medicaid Innovation] (CMMI), more specifically, which runs this program, they’re constantly tweaking models, even in the late stages.”

Home-based care providers have found success in participating in ACO REACH. For example, home-based primary care provider HarmonyCares reported a net savings rate of 23% in the “High Needs Track” of ACO REACH in 2023. 

Still, ACO REACH is a “mixed bag” for home health providers.

“On the one hand, it is a challenge, because if you’re working with REACH ACOs who are closely monitoring how you as a home health provider are doing, and they are making decisions around whether you’re going to be in their network or out of the network, that’s a challenge,” Bentley said. “But there is the potential to get more business if you’re in a smaller pool of home health providers who are the preferred provider for [an] ACO.”