The CMS ACO Reach Model is a payment and service delivery model designed to improve health equity and quality of care for Medicare beneficiaries. ACOs participating in this model receive additional payments and support to address health disparities and social determinants of health.
Community Engagement: ACOs engage with local communities to understand their unique needs and develop targeted interventions. This engagement may include partnerships with community organizations and leaders to address social determinants of health.
Care Coordination: They improve care coordination among healthcare providers to ensure beneficiaries receive timely and appropriate care. This includes ensuring that patients receive necessary follow-up care and referrals to specialists.

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