Customizing Hospice, Palliative Care Payment Contracts in ACO REACH

October 13, 2022

Hospices and Accountable Care Organizations can customize payment contracts within the Realizing Equity, Access, and Community Health (ACO REACH) program.

Starting January 1, 2023, CMS is replacing the Global and Professional Direct Contracting (GPDC) model with ACO REACH. The new program reflects its redesigned strategy for payment system demonstrations, with advancing health equity as a key tenet.

The flexibility can apply not only to hospice itself, but also to the upstream services that many of those providers offer, such as palliative care, PACE, and home health, among others.

“Our participation agreement [with CMS] says that the financial arrangements are between us and that provider, but within that we’re always ensuring that what we’re doing is fair market value,” Andrea Osborne senior vice president of delegated programs for VillageMD said. “We follow all the Medicare rules, but the arrangement itself may look different. It could be a bundled payment. It may be inclusive of things that aren’t always the responsibility of that provider but that really we believe provide overall better care for the patients when they’re coordinated under one payment model.”

However, providers should bear in mind that even in ACO REACH some limitations apply, according to Melody Danko-Holsomback, vice president of education for the National Association of ACOs.

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