The reference and the DAC output are on theory low impedance. In principle one may get away with a simple 1 OP-amp difference amplifier between the output and ref. voltage. However loading the reference will add some nonlinear error. It is also not clear how well the output handles loading: this can also add errors. Loading could be reduced by 2 additional, but less critcal amplifiers to provide most of the current (kind of virtual class A). So one would get more parts, but fewer critical parts.