What is ACO REACH?

Last reviewed May 12, 2026

Definition

ACO REACH — Realizing Equity, Access, and Community Health — is CMS’s most advanced full-risk Accountable Care Organization model, administered by the CMS Innovation Center. It succeeded the Global and Professional Direct Contracting (GPDC) Model in performance year 2023, retaining the underlying capitated payment structure while adding explicit health-equity requirements. Participating ACOs receive risk-adjusted per-member-per-month capitated payments and bear professional or global financial risk for aligned traditional Medicare beneficiaries.

Model history

ACO REACH sits in a lineage of CMS Innovation Center models exploring full-risk arrangements for traditional Medicare beneficiaries:

Next Generation ACO Model (2016–2021) — early test of two-sided risk with capitated payment options.
Global and Professional Direct Contracting Model (2021–2022) — formalized professional and global risk options with prospective alignment.
ACO REACH (2023–present) — redesign that retained GPDC’s payment mechanics while adding a Health Equity Plan requirement, refining beneficiary protections, and tightening governance and applicant screening criteria.

The model is scheduled to run through performance year 2026, with subsequent CMS Innovation Center decisions to determine whether it transitions to a permanent program, sunsets, or evolves into a successor model.

Risk options

ACO REACH offers two financial risk arrangements:

Professional option — The ACO accepts 50% shared savings and 50% shared losses against a performance-year benchmark. Payment mechanics include a Primary Care Capitation payment for participating primary-care practices.

Global option — The ACO accepts 100% shared savings and 100% shared losses — full risk for total cost of Part A and Part B care of aligned beneficiaries. Payment mechanics include Total Care Capitation, under which the ACO receives a capitated PMPM amount and pays participating providers directly under negotiated arrangements, or Primary Care Capitation paired with continued claims-based payment for other services.

The Global option is the most financially intensive arrangement available to traditional Medicare ACOs and has the closest structural resemblance to Medicare Advantage capitation.

Beneficiary alignment

ACO REACH uses two alignment mechanisms:

Claims-based alignment — Beneficiaries are aligned to the ACO based on their pattern of primary-care utilization, prospectively at the start of the performance year with limited retrospective reconciliation.
Voluntary alignment — Beneficiaries can affirmatively choose to align with an ACO, which strengthens the ACO–beneficiary relationship and stabilizes the aligned population.

Aligned beneficiaries retain full traditional Medicare benefits and freedom of choice. Alignment is not enrollment in a managed-care plan.

Health Equity Plan and benchmarks

The defining feature of the REACH redesign relative to GPDC is the Health Equity Plan requirement. Each participating ACO must submit a Health Equity Plan describing how it will identify and address disparities within its aligned population. The model also incorporates a health-equity benchmark adjustment that increases the benchmark for ACOs serving higher proportions of socially or clinically vulnerable beneficiaries, intended to make the model viable for ACOs serving historically underserved populations.

Connection to APCM

ACO REACH participants commonly adopt APCM. The model’s payment mechanics include capitated payments for primary-care services in many configurations, but participating primary-care practices retain the ability to bill Medicare under their TIN for Physician Fee Schedule services not included in the capitation arrangement — and APCM is a Physician Fee Schedule code. Adopting APCM allows REACH-participating primary-care practices to build out the care-management capability the REACH financial model rewards through shared savings on total cost of care, capture an additional Medicare revenue stream tied to that capability within the same TIN, and add behavioral health management capability through the CY2026 APCM-aligned BH add-on codes (G0568-G0570).

The compatibility depends on the specific capitation arrangement the practice has with its REACH ACO. Some Total Care Capitation arrangements may fold APCM-equivalent activities into the capitated payment, while others preserve APCM as a separately billable Physician Fee Schedule revenue stream. Practices should review their ACO participation agreement and confirm with the ACO before adopting APCM.

Practical positioning

For a primary-care practice in a REACH ACO, APCM adoption is best treated as a strategic capability decision, not just a billing decision. The care-management infrastructure APCM requires — risk stratification, panel-level monitoring, care planning, transitions management — is the same infrastructure REACH rewards through shared savings on total cost of care. In partnership-based BHI implementations, the behavioral health partner is paid a fixed Fair Market Value Management Services Agreement fee, not a share of REACH savings or capitation, consistent with the same-TIN constraint and federal fraud-and-abuse alignment.

Primary sources

Centers for Medicare & Medicaid Services Innovation Center. ACO REACH Model: Request for Applications and Model Overview (2022, with subsequent updates).
Centers for Medicare & Medicaid Services Innovation Center. Direct Contracting Model: Global and Professional Options — Model Overview (succeeded by REACH).
National Association of ACOs (NAACOS) ACO REACH briefings.
CMS Innovation Center performance-year reports for ACO REACH.

For the larger upside-only and on-ramp-risk ACO program, see What is the MSSP?. For the underlying payment structure, see What is PMPM?. For the broader payment shift, see What is value-based care?. For APCM and its behavioral health extension, see What is APCM? and What is BHI?. For strategic context, see The APCM Opportunity.