ACOs are groups of doctors, hospitals and other providers who deliver care to people on Medicare. ACOs can share savings, otherwise known as performance payments, with the Medicare program.

ACO Reach is the Center for Medicare and Medicaid Innovation way to reach underserved beneficiaries.

The ACO REACH Model is the redesigned version of the Global and Professional Direct Contracting Model (GPDC) Model and focuses on promoting health equity and addressing healthcare disparities for underserved communities, continuing the momentum of provider-led organizations participating in risk-based models, and protecting beneficiaries and the model with more participant vetting, monitoring and greater.

Beneficiaries with Traditional Medicare retain all of their rights, coverage, and benefits, including the freedom to see any Medicare provider. CMS expects that beneficiaries whose primary care provider is part of a REACH ACO will see and feel improvements in the quality of health care they are getting because of the ACO REACH Model.

There are two ways that ACOs can be covered:

  • Specific insurance for members who exceed a specific dollar amount
  • Aggregate coverage for ACOs that exceed their benchmark. This coverage currently is offered by 2 carriers

To learn more about ACO Stop-Loss Coverage at McPhee & Associates—contact us via email skattoo@mcpheeassociates.com or call (818) 541-7900.

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