Is ACO REACH Really Reaching the Right Patients?

A brand‑new analysis in JAMA Health Forum (April 25, 2025) suggests the Center for Medicare & Medicaid Innovation’s ACO REACH model is not enrolling enough organizations that predominantly serve high‑risk, socio‑economically disadvantaged patients. In other words, the very program designed to shrink America’s health‑equity gap may be missing its mark.

Below we break down what the researchers found, why it matters for physician groups and accountable care organizations (ACOs), and—most importantly—what concrete steps you can take right now to position your organization for the next wave of value‑based care opportunities.

Key Findings at a Glance

*Data sources: CMS 2022 Medicare Beneficiary Summary File; †ADI 0 = least deprived, 100 = most deprived – lower = more affluent areas.

Bottom line: Early ACO REACH enrollees skew toward less deprived geographies and smaller proportions of dual‑eligible or minority beneficiaries than the national Medicare baseline.

Why This Matters for Independent Practices

1. Payment Innovation Is Moving—With or Without You. CMS has telegraphed that future Shared Savings and specialty models will borrow heavily from the ACO REACH rulebook. Understanding participation blind spots now means you can fill those gaps—and compete for bonus pools—later.

2. Equity Metrics Are the New Scorecard. Beginning in PY2026, ACO REACH ties a growing share of benchmark adjustments and quality withholds to performance on social‑risk measures. Practices that already manage hard‑to‑reach populations are poised to benefit—if they can articulate their value.

3. Referral & Partnership Dynamics Are Shifting. Health systems that did sign up are shopping for downstream physician partners who can prove a track record with disadvantaged patients. That puts data‑driven, community‑engaged groups in a prime contracting position.

Benchmark Your Panel in 30 Minutes (or Less)

To see how your practice stacks up, pull a 12‑month claims snapshot (or an extract from your population‑health tool) and calculate:

1. Dual‑Eligible Rate. Count beneficiaries with both Medicare & Medicaid coverage; divide by total Medicare patients.

2. ADI Score. Use patients’ nine‑digit ZIPs to pull the 2022 Neighborhood Atlas score, then average across your panel.

3. Racial & Ethnic Mix. CMS now provides self‑reported race & ethnicity in the Master Beneficiary Summary File. Export and tally the non‑White share.

Tip: If your numbers beat (i.e., are higher risk than) the ACO REACH Year‑1 averages above, you have an evidence‑backed story to tell prospective partners—and to CMS.

Five Steps to Join (or Build) an ACO REACH Network

1. Document Care‑Coordination Infrastructure. List bilingual care managers, community health workers, SDOH screening tools, and closed‑loop referral workflows.

2. Map Community Partnerships. Food banks, housing coalitions, ride‑share programs—catalog everyone you already work with.

3. Quantify Avoidable Utilization. Show reductions in ED visits or 30‑day readmissions over the last 18 months.

4. Prepare a Downside‑Risk Budget. Outline capital reserves or reinsurance strategies so partners know you can weather shared‑loss corridors.

5. Draft a Health‑Equity Improvement Plan. CMS wants specifics—goals, milestones, responsible leaders, and metrics.

Equity‑Readiness Scorecard

Must‑Have for ACO REACH Success

• ☐ Comprehensive social‑risk coding ≥ 70% of active patients (Z‑codes, dual status, ADI tagging)
• ☐ Community‑health workforce deployed – ≥ 1 community‑health worker per 500 dual‑eligible beneficiaries
• ☐ Live SDOH data stream integrated into EHR & population‑health analytics tools
• ☐ Access‑support budget in place (transport vouchers, broadband/telehealth kits)
• ☐ Quarterly quality dashboards segmented by race, ethnicity, language & ADI quartile
• ☐ Active Patient & Family Advisory Council with representation from top‑risk ZIP codes

Check four or more boxes and you’re well on your way to equity‑ready status—and a stronger negotiating position with ACO REACH partners.

Final Takeaway

ACO REACH is still in beta—and its growing pains mean opportunity for forward‑thinking physician groups. By benchmarking your own equity metrics, shoring up care‑coordination assets, and building a ready‑for‑risk narrative, you can:

• Win preferred‑partner status with current REACH enrollees,
• Attract CMS’ advance‑investment dollars in future cohorts, and
• Most importantly, deliver better outcomes for patients too often left behind.

Need help turning raw Medicare claims into actionable equity dashboards? HealthLink Secure ingests Blue Button data and surfaces high‑risk, high‑impact gaps—without storing PHI on your servers. Get a demo →

Have thoughts on the JAMA findings? Drop a comment below or connect with us on LinkedIn to keep the conversation going.