Aco Reach Falls Short In Serving Vulnerable Populations Compared To Medicare Overall

The Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) program is designed to provide value-based care access, including home-based care, to underserved communities. New research shows that in its inaugural year, the program fell short of its aims.

REACH beneficiaries have lower levels of social risk compared to the overall Medicare population, according to a study published in JAMA Health Forum, showing that the program failed to enroll organizations serving the vulnerable populations it was designed to help.

“The lack of broader participation from vulnerable populations could limit the potential impacts of other equity elements of the ACO REACH program in its overarching goal of reducing health inequities,” the study’s authors wrote. “Policy and programmatic modifications are imperative to address enrollment challenges and ensure that ACO REACH effectively serves those most in need.”

Researchers analyzed a pool of about 35.8 million fee-for-service Medicare beneficiaries, about 1.96 million REACH beneficiaries and about 11.3 million Medicare Shared Savings Program (MSSP) beneficiaries from January 2022 to January 2023 to determine beneficiary characteristics of each program.

According to the study, REACH beneficiaries were more often older, more often white and less often Black or Hispanic compared to Medicare beneficiaries overall. Just over 80% of REACH beneficiaries were white, compared to about 77% of overall beneficiaries. Black patients made up 5.9% of REACH beneficiaries compared to 8.2% of the overall Medicare population, and Hispanic patients accounted for 5.8% of REACH participants compared to 6.7% of all Medicare beneficiaries.

REACH beneficiaries were also less likely to have Medicare entitlement because of a disability. 15.2% of REACH beneficiaries had Medicare entitlement because of a disability compared to 17.6% among overall beneficiaries.

The study also found that REACH beneficiaries were less likely to be rural, with 3.9% of REACH beneficiaries living in a rural area compared to 8.4% of the overall Medicare population.

“Despite ACO REACH’s explicit focus on equity, REACH beneficiaries were at lower risk on every dimension of social risk examined compared with the broader pool of Medicare beneficiaries, including Black race or Hispanic ethnicity, disability, dual enrollment, rurality and SVI,” the study’s authors wrote.

The study’s researchers recommend policy and programmatic interventions to address REACH’s enrollment challenges and ensure the program serves those most in need.

Home health care providers and Medicare-for-all advocates have pushed back against the ACO REACH model, with one advocate previously describing it as “Medicare Advantage on steroids.” 

Some home-based care companies have reported success with the model. In November 2024, home-based care provider HarmonyCares reported a net savings rate of 23% in the “High Needs Track” of ACO REACH.

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