The Promise And Peril Of Accountable Care For Vulnerable Populations: A Framework For Overcoming Obstacles

Lewis, Valerie A.; Larson, Bridget K.; McClurg, A.B.; Boswell, Rebecca G.

doi:10.1377/hlthaff.2012.0490

Cited by 86 publications

(86 citation statements)

References 14 publications

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“…These findings are consistent with concerns that Medicare ACO programs may not effectively address health disparities. 3,4 Because ACO programs are likely to be dominated by currently eligible rather than newly integrated provider groups, 31 the sociodemographic differences between patients served by larger and smaller groups suggest that any clinical benefits achieved by ACOs may accrue disproportionately to white patients in more affluent areas. Previous research [11][12][13][14][15][16] and ACO program requirements 2,32 suggest that provider integration encouraged by ACO programs might be associated with enhanced abilities to monitor and improve quality of care, but we found that larger provider groups achieved smaller racial disparities in only two of six quality measures we analyzed.…”

Section: Discussionmentioning

confidence: 99%

Quality of Care and Racial Disparities in Medicare Among Potential ACOs

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Quality of Care and Racial Disparities in Medicare Among Potential ACOs

et al. 2014

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“…7,8 The most vulnerable populations experience social disadvantages and clinical vulnerabilities that can result in a disproportionate risk of not receiving the care that they need. 9 In California, safety-net clinics provide health care services to individuals and their families regardless of a patient's ability to pay. 10 Safety-net services are intended to ensure that individuals who are medically underserved and uninsured and living below poverty level receive adequate health care.…”

Section: Introductionmentioning

confidence: 99%

Patient Preferences for Discussing Childhood Trauma in Primary Care

Goldstein

Athale

Sciolla

et al. 2017

TPJ

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Context: Exposure to traumatic events is common in primary care patients, yet health care professionals may be hesitant to assess and address the impact of childhood trauma in their patients.Objective: To assess patient preferences for discussing traumatic experiences and posttraumatic stress disorder (PTSD) with clinicians in underserved, predominantly Latino primary care patients.Design: Cross-sectional study. Main Outcome Measure:We evaluated patients with a questionnaire assessing comfort to discuss trauma exposure and symptoms using the Adverse Childhood Experiences (ACE) Study questionnaire and the Primary Care-PTSD screen. The questionnaire also assessed patients' confidence in their clinicians' ability to help with trauma-related issues. Surveys were collected at an integrated medical and behavioral health care clinic.Results: Of 178 adult patients asked, 152 (83%) agreed to participate. Among participants, 37% screened positive for PTSD, 42% reported 4 or more ACEs, and 26% had elevated scores on both measures. Primary Care-PTSD and ACE scores were strongly positively correlated (r = 0.57, p < 0.001). Most patients agreed they were comfortable being asked about trauma directly or through screening questionnaires and did not oppose the inclusion of trauma-related information in their medical record. In addition, most patients perceived their clinician as comfortable asking questions about childhood trauma and able to address trauma-related problems.Conclusion: Screening is acceptable to most primary care patients regardless of trauma exposure or positive PTSD screening. Findings may aid primary care clinicians to consider screening regularly for ACEs and PTSD to better serve the health care needs of trauma-exposed patients.

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“…The Commonwealth Fund has supported a variety of activities, including a policy analysis of the challenges for vulnerable populations under the accountable care model, 11 a survey of hospitals' ACO activities, 12 an ongoing evaluation of the Alternative Quality Contract in Massachusetts, 3,4 and work by Dartmouth and the University of California, Berkeley, 13 to identify the challenges to implementing a comprehensive approach to evaluation and find ways to address them.…”

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confidence: 99%

A Framework For Evaluating The Formation, Implementation, And Performance Of Accountable Care Organizations

et al. 2012

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The implementation of accountable care organizations (ACOs), a new health care payment and delivery model designed to improve care and lower costs, is proceeding rapidly. We build on our experience tracking early ACOs to identify the major factors-such as contract characteristics; structure, capabilities, and activities; and local contextthat would be likely to influence ACO formation, implementation, and performance. We then propose how an ACO evaluation program could be structured to guide policy makers and payers in improving the design of ACO contracts, while providing insights for providers on approaches to care transformation that are most likely to be successful in different contexts. We also propose key activities to support evaluation of ACOs in the near term, including tracking their formation, developing a set of performance measures across all ACOs and payers, aggregating those performance data, conducting qualitative and quantitative research, and coordinating different evaluation activities.T he implementation of accountable care organizations (ACOs), a new payment and delivery model designed to improve health care and lower costs, is proceeding rapidly in both the public and private sectors. As of August 2012 we had identified 227 provider organizations that have established ACO contracts with Medicare, Medicaid, private payers, or some combination thereof.The ACO concept originated in response to a growing recognition that fee-for-service payment was a major contributor to the rapidly rising costs and poorly coordinated care that characterize the US health care system. 1 Under this new payment model, provider groups willing to be accountable for the overall costs and quality of care for their patients are eligible for a share of the savings achieved by improving care.Proponents believe that ACOs will encourage providers across the full range of practice settings-from individual office-based practices to integrated delivery systems-to improve quality and slow spending growth. Under this model, payers establish quality benchmarks and riskadjusted spending targets for the patients cared for by the physicians in the ACO. If the organization meets the quality benchmarks, it is then eligible for a share of the savings achieved below the set spending target. In some models, the organization is also at risk for a portion of any spending that exceeds the target. Early evidence on ACO performance is promising. [2][3][4] Challenges to the success of the model remain, however. Little is known about what capabilities and activities are most important to the longterm success of these new organizations. Also, the optimal design of accountable care contracts between providers and payers is uncertain.In addition, many stakeholders are concerned about the complex interactions among public and private reform initiatives based on ACOs. For example, some economists wonder whether implementation of ACOs in the Medicare popu- lation will lead to provider consolidation and thus higher prices for private payers...

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The Promise And Peril Of Accountable Care For Vulnerable Populations: A Framework For Overcoming Obstacles

Cited by 86 publications

References 14 publications

Quality of Care and Racial Disparities in Medicare Among Potential ACOs

Quality of Care and Racial Disparities in Medicare Among Potential ACOs

Patient Preferences for Discussing Childhood Trauma in Primary Care

A Framework For Evaluating The Formation, Implementation, And Performance Of Accountable Care Organizations

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