What Drives Racial and Ethnic Gaps in the Medicare Quality Agenda?

Over the past 10 years, the Medicare system has attempted to improve the quality of health care received by millions of older Americans, while slowing rising costs to the federal budget, by encouraging health care providers to join Responsible Care Organizations (ACOs).

Today, ACOs coordinate care for 11 million people, most with traditional Medicare coverage. The more successful the ACOs, the more they are rewarded.

But the improvements have not reached all older Americans equally. ACOs that include a higher percentage of black, Hispanic, Native American, or Asian patients have lagged behind those with a higher percentage of white patients when it comes to preventive care and keeping patients out of hospital.

Now, a new study shows that some of that inequity stems from how patients in an ACO get their primary care. Even if they see medical specialists belonging to an ACO, seniors are not required to see a primary care provider belonging to the same ACO.

In the new issue of JAMA Health Forum, a team from the University of Michigan shows that ACOs with higher percentages of members of racial and ethnic minority groups also tend to have higher percentages of out-of-network primary care. This meant that the patient’s routine care was provided by a provider unaffiliated with the ACO, and therefore without potential financial benefit if it met the quality criteria.

The study used data from nearly 4 million Medicare participants whose providers belong to 538 Shared Savings Program ACOs. The percentage of patients who obtained their primary care outside the ACO was almost 13% in the ACOs that had the highest percentage of participants from racial or ethnic minorities, compared to about 10% of patients in the others. CO.

But even when the researchers left out the ACOs that had the highest percentage of out-of-network primary care, they still found differences in the quality of care. Older adults in ACOs with the highest percentages of minority participants were less likely to have diabetes and cholesterol checks, and those who had been hospitalized were more likely to end up in hospital within a month.

In contrast, in ACOs that had the lowest percentage of patients who obtained their primary care outside the ACO network, there were no differences in quality performance between ACOs with different percentages of members from minority groups.

These results suggest that efforts by CCOs to encourage the use of networked primary care can reduce health care disparities among racial and ethnic minority patients, which has policy implications for the healthcare program. shared savings which includes most ACOs,” says John HollingworthMD, MS, the UM physician and health care researcher who led the analysis with Shivani Bakre, a former research associate at UM.

Hollingsworth and several co-authors are members of the UM Institute for Healthcare Policy and Innovation; Hollingsworth and his team are part of the Michigan Medicine Department of Urology Dow Division of Health Services Research.

The Centers for Medicare and Medicaid Services, the federal agency that oversees Medicare and the ACO program, recently announced a new type of ACO that will launch in 2023, called ACO REACH. It focuses specifically on health equity and brings the benefits of the ACO model to underserved communities.


Association between organizational quality and out-of-network primary care

Among accountable care organizations caring for high or low proportions patients from racial and ethnic minority groups

JAMA Health Forum. 2022;3(4):e220575. doi:10.1001/jamahealthforum.2022.0575

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