What ACO REACH is
ACO REACH is a voluntary total-cost-of-care model run by the CMS Innovation Center under its demonstration authority. It was redesigned from the Global and Professional Direct Contracting model, and its first performance year began January 1, 2023. The redesign added health-equity provisions, mandatory beneficiary advocates on ACO governing boards, and provider-controlled governance. REACH ACOs take accountability for Traditional Medicare beneficiaries and are paid through capitation.
Professional vs Global
REACH offers two risk options:
- Professional is the lower-risk option, with 50% shared savings and losses and a Primary Care Capitation Payment for primary-care services.
- Global is full risk, with 100% shared savings and losses, and offers either Primary Care Capitation or a Total Care Capitation Payment that covers all services, including specialty care.
In performance year 2025, 90 of 103 ACOs chose the Global option. The model also defines three participant types: Standard ACOs experienced with Original Medicare, New Entrant ACOs new to serving it, and High Needs Population ACOs serving complex, often dually eligible patients.
The health-equity design
The Health Equity Benchmark Adjustment redistributes benchmark dollars toward ACOs serving underserved beneficiaries, using a composite equity score built from the Area Deprivation Index and dual-eligibility status. The adjustment ranges from plus $30 per beneficiary per month for the most underserved populations down to minus $10 for the least. Each ACO must also submit a Health Equity Plan and collect demographic and social-needs data, which ties equity directly to benchmark dollars rather than to reporting alone.
What changed for 2026, and what comes next
The final performance year, 2026, tightened the model to improve sustainability: the risk model moved to 100% V28 HCC weighting, the Global risk corridor narrowed from 25% to 10% of benchmark, the quality withhold rose from 2% to 5%, and CMS added a cap on risk-score growth. ACO REACH ends December 31, 2026, and is succeeded by the LEAD Model, a voluntary ten-year model beginning January 1, 2027, that promises no benchmark rebasing for its full duration.
How Pelica supports full-risk ACOs
Full risk raises the operational bar: accurate HCC capture under V28, disciplined benchmark management, and documentation of the social-needs and equity data that move the benchmark. Pelica gives REACH ACOs one live record and an AI workforce that captures risk accurately and closes gaps, with RADV-defensible chain-of-custody on every diagnosis. Across deployments, customers have surfaced more than 25,000 HCC opportunities with documentation attached.
Related terms
See capitation for the payment mechanic, MSSP for the permanent shared-savings program, V28 for the risk model used in 2026, and RADV for the audit standard full-risk capture must meet.