Accountable Care Organizations And Disparities

Hartzman, Alex; Rhodes, Kimberly

doi:10.1377/hlthaff.2017.0236

Cited by 5 publications

(6 citation statements)

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“…14 -21 Although not the primary intent of health reform efforts, one of the anticipated benefits of such legislation has been the reduction in healthcare-related disparities among historically disadvantaged populations. 14,15 Although some data exist regarding the efficacy of ACOs in reducing healthcare expenditures and improving quality, the impact of these organizations on access to surgical services for racial and ethnic minorities has not been explored. Some theorize that streamlined care pathways will work to the benefit of both minority and nonminority patients, reducing variation, and improving overall quality.…”

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confidence: 99%

“…Some theorize that streamlined care pathways will work to the benefit of both minority and nonminority patients, reducing variation, and improving overall quality. 14,15 Others postulate that historically marginalized populations, including minority patients, are likely to receive even fewer services as ACOs look to reduce expenditures and improve their financial standing. 16,17 Although there is no empiric evidence for either of these opposing suppositions, the latter might be more plausible given known realities within the American healthcare system, including historical examples of discrimination and more recent substantiation of hospital and healthcare segregation.…”

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confidence: 99%

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Disparities in Rates of Surgical Intervention Among Racial and Ethnic Minorities in Medicare Accountable Care Organizations

et al. 2019

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confidence: 99%

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confidence: 99%

Disparities in Rates of Surgical Intervention Among Racial and Ethnic Minorities in Medicare Accountable Care Organizations

et al. 2019

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“…Work has demonstrated that compared with nonparticipating groups, physician groups participating in the MSSP took care of a similar proportion of patients who are racial minorities, dually enrolled in Medicare and Medicaid, or living in a high-poverty zip code 17 and that ACOs with a high proportion of minority patients are committed to the mission of MSSP. 18 Accountable care organizations may worsen disparities even if physician groups care for similar proportions of socially vulnerable patients when they join the ACO if, once joining, physician groups reduce the share of vulnerable patients in their panels after joining an ACO, a practice known as cream-skimming. Evidence has demonstrated that the highest-risk patients in terms of medical complexity and expected spending are more likely to leave ACOs, and that ACOs with more medically complex patients were more likely to drop their ACO contracting.…”

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confidence: 99%

Proportion of Racial Minority Patients and Patients With Low Socioeconomic Status Cared for by Physician Groups After Joining Accountable Care Organizations

et al. 2020

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IMPORTANCE The incentive structure of accountable care organizations (ACOs) may lead to participating physician groups selecting fewer vulnerable patients. OBJECTIVE To test for changes in the percentage of racial minority patients and patients with low socioeconomic status cared for by physician groups after joining the ACO. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort consisted of a 15% random sample of Medicare fee-for-service beneficiaries attributed to physician groups from 2010 to 2016. Medicare Shared Savings Program (MSSP) participation was determined using ACO files. Analyses were conducted between January 1, 2019, and February 25, 2020. EXPOSURES Using linear probability models, we conducted difference-indifferences analyses based on the year a physician group joined an ACO to estimate changes in vulnerable patients within ACO-participating groups compared with nonparticipating groups. MAIN OUTCOMES AND MEASURES Whether the patient was black, was dually enrolled in Medicare and Medicaid, and poverty and unemployment rates of the patient's zip code. RESULTS In a cohort of 76 717 physician groups caring for 7 307 130 patients, 16.1% of groups caring for 27.8% of patients participated in an MSSP ACO. Using 2010 characteristics, patients attributed to ACOs from 2012 to 2016, compared with those who were not, were less likely to be black (8.0% [n = 81 698] vs 9.3% [n = 270 924]) or dually enrolled in Medicare and Medicaid (12.8% [n = 130 957] vs 18.2% [n = 528 685]), and lived in zip codes with lower poverty rates (13.8% vs 15.5%); unemployment rates were similar (8.0% vs 8.5%). In the difference-indifferences analysis, there was no statistically significant change associated with ACO participation in the proportions of vulnerable patients attributed to ACO-participating groups compared with nonparticipating groups. After joining an ACO, ACO-participating groups had 0.0 percentage points change (95% CI, −0.1 to 0.1 percentage points; P = .59) for black patients, −0.1 percentage points (95% CI, −0.2 to 0.1 percentage points; P = .32) for patients dually enrolled in Medicare and Medicaid, 0.2 percentage points (95% CI, −3.5 to 4.0 percentage points; P = .91) in poverty rates, and −0.4 percentage points (95% CI, −2.0 to 1.2 percentage points; P = .62) in unemployment rates. CONCLUSIONS AND RELEVANCE In this cohort study, there were no changes in the proportions of vulnerable patients cared for by ACO-participating physician groups after joining an ACO compared with changes among nonparticipating groups.

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“…Recent studies have drawn attention to the association between success and organizational characteristics such as structure and practice patterns, [7][8][9][10] while others have linked savings to beneficiary-level demographics. [11][12][13] Lewis et al 14 also showed that ACOs tend to form in relatively resource-rich areas, potentially widening existing disparities. This finding has been replicated at the physician level and across other CMS payment models like Comprehensive Primary Care Plus.…”

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confidence: 99%

“…If, for example, ACOs serving lower resource communities systematically underperform, practices in these areas will neither participate in ACOs nor share in their benefits, thereby widening health disparities. 11,13,14 Our study seeks to address this question by exploring to what extent contextual service area characteristics are associated with ACO savings.…”

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Accountable Care Organizations Serving Deprived Communities Are Less Likely to Share in Savings

et al. 2019

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Primary care physicians are increasingly participating in accountable care organizations (ACOs). While prior studies have identified ACO and patient characteristics associated with savings, none have examined characteristics of the communities served by ACOs. Our objective was to assess the relationship between an ACO's service area characteristics and its savings rate. Methods: In this cross-sectional study, we used the Centers for Medicare and Medicaid Services 2014 Medicare Shared Savings Program ACO Provider and Beneficiary, and Public Use Files to identify ACO and beneficiary characteristics. We used the American Community Survey to measure community deprivation at the ACO service area-level by using the social deprivation index. The outcome of interest was the ACO savings rate. We conducted bivariate analyses and regressions, adjusting for ACO organization and beneficiary characteristics. Results: Our sample consisted of 320 ACOs participating in the Shared Savings Plan. The savings rate for ACOs serving the most deprived communities was 1.19% compared with 1.14% for those serving the least deprived. Adjusting for ACO and beneficiary characteristics, however, ACOs serving the most deprived had a savings rate that was 2.3 percentage points lower than those serving the least deprived. Conclusions: ACOs serving deprived communities generate less savings. These findings are important to primary care practices, payers, and policy makers anticipating continued ACO expansion, if population health is to be achieved equitably. (J Am Board Fam Med 2019;32:913-922.

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Accountable Care Organizations And Disparities

Cited by 5 publications

References 0 publications

Disparities in Rates of Surgical Intervention Among Racial and Ethnic Minorities in Medicare Accountable Care Organizations

Disparities in Rates of Surgical Intervention Among Racial and Ethnic Minorities in Medicare Accountable Care Organizations

Proportion of Racial Minority Patients and Patients With Low Socioeconomic Status Cared for by Physician Groups After Joining Accountable Care Organizations

Accountable Care Organizations Serving Deprived Communities Are Less Likely to Share in Savings

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