Could ACOs inadvertently be making healthcare disparities worse?

Accountable care organizations — which are designed to help improve healthcare quality and constrain costs — could be exacerbating disparities in healthcare, according to a study published in the August issue of Health Affairs.

This is because physicians who participate in ACOs are more likely to practice in affluent areas. They found an inverse relationship between ACO participation and the percentage of the population a physician served that was black, living in poverty, uninsured or disabled or had less than a high school education. This means patients who are already more vulnerable have less access to the benefits of ACOs.

"These findings raise concerns that ACOs may increase existing disparities between the quality of health care received by vulnerable populations and the quality of care received by other groups," the authors wrote.

The authors suggest this trend may be the result of several factors. First, they suggest ACOs may form in populations that are easier to treat or may exclude physicians who care for vulnerable populations to more easily achieve good quality scores. They also hypothesize that physicians serving the most vulnerable patient populations may deem ACO participation too difficult because of the quality and spending goals, or the capital required to get an ACO contract off the ground.

Healthcare policies may need to adjust to expand the quality improvements seen in early ACOs to vulnerable patient populations. However, "[T]he quality improvements documented for early ACOs — which were likely achieved among relatively affluent patient populations — may differ as ACOs expand to care for more diverse populations," the authors conclude.


More articles on accountable care:

New Aetna network combines Duke, WakeMed providers
Mount Sinai CIN, Cigna form accountable care partnership
UCSF, John Muir add 7 hospitals, 3 medical groups to ACO

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