Page 1 - Retiree News Summer 2022

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cseany.org
Mary E. Sullivan, President
Medicare’s new ACO REACH pilot payment model arrives
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NEWS SUMMER 2022
Since 2012, Medicare has been testing new ways to pay groups of health care
providers that voluntarily join together to form an accountable care organization (ACO).
The idea is that when providers are collectively responsible for meeting cost and quality targets, they are more likely to collaborate to reduce unnecessary tests, duplicative services and medical errors. ACOs receive a portion of any savings they generate and, in some cases, in addition to sharing in any savings, ACO providers must absorb some of the costs if their spending exceeds a certain amount.
When the Trump Administration implemented a new form of payment models called Direct Contracting, CSEA and AFSCME heavily opposed the plan.
Our union viewed the Direct Contracting model as a backdoor attempt to extend the reach of private managed care interests into the traditional Medicare program.
The Biden Administration has revamped the Direct Contracting model, calling it the ACO REACH.
The ACO REACH model is a reasonable way to test a new value-based payment model while
providing important safeguards to protect Medicare beneficiaries.
While Medicare’s fee-for- service payment model has important advantages, it also has shortcomings that affect beneficiaries. For example, fee- for-service delivery can create health care provider incentives for overuse and inappropriately aggressive treatment, while often lacking incentives to engage in care coordination activities that help vulnerable seniors navigate care and have a better overall experience.
end of 2026.
It is important to note that ACO
REACH has important safeguards that protect beneficiary interests.
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right to see any participating Medicare provider.
ACO REACH introduces supplemental, enhanced benefits that are not allowable in traditional Medicare.
Beneficiaries may receive increased access to telehealth, easier access
to home visits post-acute care, or assistance with cost sharing.
CSEA/AFSCME generally
supports Medicare’s work to
find new payment models that
lead to seniors getting better
care while maintaining important
aspects of traditional Medicare.
It is important, however, that
Medicare’s pilot programs be well designed with adequate beneficiary protections. •
Testing “value-based” models that go beyond fee-for-service
can help deal with some of these problems. While ACO REACH may not be the solution, it does remain just a pilot program that Medicare can sunset if it does not improve things for beneficiaries. ACO REACH will be tested through the
CSEA and AFSCME will remain vigilant in protecting Medicare for EVERYONE!
— Adam Acquario
•
Beneficiaries can opt out
of participating in an ACO REACH entity (though
they may have to change primary care providers to do that, which CSEA/AFSCME opposes). Beneficiaries can also opt out of having CMS share their data with an ACO.
Beneficiaries retain all the rights, coverage and benefits associated with traditional Medicare — including the
If you have questions or concerns, contact Medicare by calling 1-800-MEDICARE (1-800-633- 4227), TTY users should call 1-877-486-2048.