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Advanced Primary Care Management: The Strategic Program for ACO REACH Leaders Ready to Win on Risk

Authored by Jon-Michial Carter, Founder & Chief Growth Officer

For clinical leaders operating within ACO REACH, and for those beginning to map a path toward ACO LEAD, the pressure to demonstrate value-based outcomes has never been more acute. You are already bearing risk. The question is no longer whether to act proactively, but which tools will generate the greatest return on that risk. Advanced Primary Care Management (APCM) is that tool  and the window to build enrollment defensibility is open right now.

The ACO REACH Reality

ACO REACH was designed with a fundamental premise: assume downside risk in exchange for shared savings. If your attributed beneficiaries accumulate avoidable costs such as unmanaged chronic conditions, preventable ED visits, and care gap-driven hospitalizations, those costs come back to your organization. This is the operating reality of every ACO REACH participant today.

Yet too many ACOs focus on managing utilization reactively rather than engineering the upstream conditions that prevent costly downstream events in the first place. This is the gap that APCM is purpose-built to close.

APCM is not a workflow add-on. It is a structured, CPT-billed care management program that deploys your clinical team's time systematically against your highest-impact open care gaps before they become hospitalizations, before they miss a HEDIS threshold, before they erode your quality scores and your shared savings calculations. 

Waiving Copays in ACO REACH: The Enrollment Accelerant 

One of the most underutilized strategic levers available to ACO REACH (and its soon-to-be replacement, ACO LEAD) participants is the ability to waive Medicare cost-sharing, specifically beneficiary coinsurance responsibility, for APCM services. This authority is not broadly advertised, but it is explicitly permitted within the ACO REACH model framework.

Why does this matter? Because patient cost-sharing is consistently one of the primary barriers to enrollment in care management programs. When a patient perceives a monthly bill associated with the program, they often disengage. By waiving that coinsurance, you remove the friction at the exact moment of enrollment decision.

Cost-sharing creates hesitation, even among high-risk patients who would benefit most from the program. When coinsurance is waived:

•   Enrollment conversations convert at measurably higher rates
•   Patient retention improves because there is no monthly bill to question
•   You reach the patients with the greatest complexity; those most likely to drive costs and most sensitive to out-of-pocket exposure
•   Your denominator of enrolled lives grows faster, amplifying downstream quality and financial impact

CMS permits this waiver specifically within value-based care models because the policy intent aligns with the model's design: get more patients into coordinated care, reduce total cost of care, and improve quality. 

The implications for your ACO's trajectory are significant. A higher enrollment rate means a larger portion of your attributed beneficiary population is receiving structured, proactive care management, directly impacting the quality metrics and total cost benchmarks that determine your shared savings performance.

What Enrollment Translates to in Revenue and Impact

The following comparison illustrates projected APCM enrollment and estimated monthly revenue at 25% versus 50% enrollment rates across a range of panel sizes. These figures are intended to anchor strategic planning conversations with finance and executive leadership. 

	+25% More Enrollments (waived co-insurance)		+50% More Enrollments (waived co-insurance)
Eligible Patient Panel	Enrolled Patients 18% level 1 70% level 2 12% level 3	Est. Monthly Revenue	Enrolled Patients 18% level 1 70% level 2 12% level 3	Est. Monthly Revenue
2,500 Patients	1,285	$233,377	1,542	$280,053
5,000 Patients	2,569	$466,755	3,083	$560,106
10,000 Patients	5,136	$933,510	6,165	$1,120,212

* Results vary by provider. Average ChartSpan enrollment rates consider a typical coinsurance responsibility. The above rates are assuming a waived coinsurance, thus averaging rates above ChartSpan’s average.

APCM is the Engine for Quality Measures That Drive ACO REACH Performance

ACO REACH evaluates participant performance across a defined set of quality measures. Performance on these measures directly influences your eligibility for enhanced shared savings. At ChartSpan, our APCM program is uniquely structured to move these metrics systematically with regular outreach to your enrolled patients.

ChartSpan APCM clinical time delivers the highest leverage for ACO Reach participants through these measures: 

• Controlling High Blood Pressure 
• Hemoglobin A1c Poor Control 
• Diabetes Eye Exam 
• Depression Screening
• Cognitive Assessment 
• Social Determinants of Health

When a care manager reviews a patient's record and identifies an overdue A1c reading or a depression screen not completed in the prior year, that intervention drives a quality gap closure that feeds directly into your ACO REACH scoring. 

At ChartSpan, the clinical team is not operating without a compass. Our program has the technology to gather medical records from multiple providers, pharmacies, national and state databases to create a 360-degree view of patient health. This allows our care managers to uncover missing and undocumented data, then provide actionable steps like providing screenings or scheduling appointments that help you close care gaps and drive E&M encounters. 

Utilization That Actually Matters: Building the Right Clinical Habits Now

For ACO leaders who think carefully about their attributed populations, the goal is not less care: it is appropriate care, delivered at the right time, in the right setting. APCM, done well, generates abundant utilization of exactly the services that prevent the costly, low-value encounters you are financially penalized for.

Consider what a high-performing APCM program looks like:

• Regular, structured outreach that is well-documented for quality measures
• Care plan development and goal-setting with patients at scale, creating accountability and continuity outside of the visit
• Social determinants screening and community resource support

This is the utilization pattern that ACO REACH rewards: high-touch, longitudinal, relationship-based care that keeps beneficiaries engaged with their care team and away from the ED. 

The ACO LEAD Bridge: Why Starting Now Creates Compounding Advantage

ACO REACH is being sunsetted by the end of 2026, replaced by ACO LEAD, a new model designed to deepen the value-based care commitment by expanding the scope of risk, tightening quality accountability, and embedding a stronger emphasis on health equity and total population management. The transition reflects CMS's broader strategic intent to move more Medicare beneficiaries into accountable care relationships, raise the bar for what “accountable” means, and reward organizations that have built the infrastructure to manage populations longitudinally.

Organizations that have not yet begun building the care management infrastructure that ACO LEAD will require are already behind. Those who have invested in APCM enrollment, care gap closure workflows, and quality measure performance under ACO REACH are building exactly the capabilities that will define competitive positioning in the new model.

The clinical and operational infrastructure required to succeed in ACO LEAD is not fundamentally different from what APCM builds in ACO REACH. It is the same muscles, applied at greater scale and sophistication. Organizations that invest in APCM enrollment and infrastructure today will enter any future risk arrangement with:

• An already-enrolled beneficiary population accustomed to care management outreach and engagement
• Documented care gap closure rates that demonstrate quality improvement 
• Clinical team workflows optimized for systematic population health management
• A growing body of attribution logic and quality measure performance data that informs where to direct resources in a new model

The organizations that will thrive in ACO LEAD are not the ones that scramble to build care management programs the year they transition. They are the ones that used ACO REACH as the proving ground by enrolling, closing gaps systematically, and generating the outcomes data that justifies continued risk-bearing. 

Summary

You are already in a risk arrangement. The only question is whether you are actively managing that risk or hoping it resolves itself. APCM is not a speculative investment in future capability, it is a billable, quality-generating, risk-mitigating program you can stand up against your existing attributed population right now.

The strategic case rests on four pillars:

• Waived coinsurance in ACO REACH creates defensibly higher enrollment rates
• Higher enrollment means a larger share of your attributed population receiving structured care gap closure
• APCM generates billable revenue while simultaneously reducing the total cost of care events you are financially penalized for under downside risk

You already understand the complexity of your attributed populations and know which patients are most likely to generate avoidable costs and miss quality thresholds. APCM gives you a systematic, billable, scalable mechanism to act on that knowledge with the intentionality that value-based care was always designed to reward.