What factors contribute to racial and ethnic disparities in Medicare’s quality program?
People who work in health care have been encouraged by the Medicare system for the last 10 years to join Accountable Care Organizations, which help older people get better health care while also cutting down on how much money the government spends on health care costs.
ACOs now coordinate the treatment of 11 million people, the majority of whom are covered by traditional Medicare. The more the ACOs do well, the more they are rewarded.
However, not all older Americans have benefited equally from the advancements. ACOs with a higher proportion of black, Hispanic, Native American, or Asian patients have fallen behind those with a higher proportion of white patients in terms of delivering preventative care and keeping patients out of the hospital.
According to a new study, some of this unfairness stems from how ACO patients receive primary care. Older people are not obligated to see a primary care provider who is a member of the same ACO, even if they consult a specialist who is.
A team from the University of Michigan reports in the new issue of JAMA Health Forum that ACOs with larger percentages of members of racial and ethnic minority groups also had higher percentages of out-of-network primary care.
To make things even worse, the patient’s usual care was given by a provider who wasn’t part of the ACO and didn’t have to meet the quality goals for money.
The study analyzed data from roughly 4 million Medicare beneficiaries whose physicians are part of the Shared Savings Program’s 538 ACOs.
Patients in the ACOs with the highest percentage of participants from racial or ethnic minorities received roughly 13% of their primary care outside the ACO, compared to 10% of patients in the other ACOs.
Even after excluding the ACOs with the greatest share of out-of-network primary care, the researchers found variations in service quality.
Older people in ACOs with the largest percentages of minorities were less likely to have their diabetes and cholesterol checked, and those who had been hospitalized were more likely to be readmitted within a month.
There were no variations in quality performance between ACOs with varying percentages of members from minority groups, in the ACOs with the lowest percentage of patients who acquired their primary care outside of the ACO network.
“These findings suggest that ACO efforts to encourage in-network primary care may reduce health care disparities among racial and ethnic minority patients, which has policy implications for the Shared Savings Program, which includes most ACOs,” says John Hollingsworth, M.D., M.S., a U-M physician and health care researcher who led the analysis with Shivani Bakre, a former research associate at U-M.
Hollingsworth and other co-authors are members of the University of Michigan Institute for Healthcare Policy and Innovation; Hollingsworth and his team are part of Michigan Medicine’s Dow Division of Health Services Research.
The Centers for Medicare and Medicaid Services, which controls Medicare and the ACO program, has unveiled ACO REACH, a new type of ACO that will begin operations in 2023. It is focused on health equity and giving the ACO model’s benefits to people who don’t usually get them.