Accountable care organizations (ACOs) are groups of clinicians and healthcare organizations that voluntarily collaborate and assume responsibility for the quality and costs of their attributed patients. ACOs were introduced by Medicare after passage of the Affordable Care Act with the goal of improving quality and slowing growth in healthcare spending. Although ACOs in the Medicare Shared Savings Program (MSSP) are not explicitly measured on their ability to change healthcare disparities, they may invest in programs that disproportionately benefit patients who face barriers to care, including those with low income.
In a study in JAMA Network Open, Dr. Amelia Bond, associate professor of population health sciences, Dr. Dhruv Khullar, associate professor of population health sciences, and colleagues from the Division of Health Policy and Economics examined whether MSSP ACOs have differentially impacted outcomes for low-income patients compared to higher-income patients. Researchers evaluated six MSSP ACO cohorts, inclusive of 585 ACOs, and found that ACO formation was not associated with significant changes in income-based disparities for quality measures such as preventable ED visits, ambulatory care-sensitive admissions, and hospital readmissions. However, there was wide variation across ACOs.
The findings suggest that while, on average, MSSP was not associated with a reduction in socioeconomic healthcare disparities in its first decade, a subset of ACOs may have been associated with improved quality for low-income patients while maintaining quality for their broader attributed population. ACOs associated with a reduction in disparities had similar shares of low-income patients compared to other ACOs, but a higher level of baseline disparities.
Researchers propose that if policymakers wish to improve care for low-income patients in accountable care arrangements, they may need to consider more targeted incentives. Options may include introducing models that directly incentivize care improvements for low-income individuals, focusing on areas with the largest baseline disparities, or introducing programs with longer time horizons.
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