We use sophisticated statistical modeling to examine
the effects of ACO programs on disparities in patient outcomes such as hospital utilization.
Accountable care organizations (ACOs) are on the rise, covering approximately 32 million people in the United States in 2017. These groups of physicians and other health care providers are financially responsible for their patients’ quality of care and costs of care.
The effect of this innovative new program model on the health outcomes of disadvantaged patients is unclear. On one side, the incentives for quality improvement may encourage providers to focus on improving care for the sickest patients, who are disproportionately poor and non-white. This effort could lead to reduced disparities and substantially improved care for vulnerable patients. In contrast, there is a danger that this performance-based system may lead to gaming behavior among providers in pursuit of high performance, such as avoiding patients deemed difficult or focusing more attention on patients who providers perceive are more likely to adhere to treatment. This work seeks to understand what ACOs are doing and how ACOs and similar programs may be best designed to improve equity as well as efficiency in the U.S. health care system.
Researchers at The Dartmouth Institute are using data from several sources for this project. We use the National Survey of ACOs (NSACO), a survey conducted by Dartmouth Institute researchers that collects comprehensive data on ACO characteristics and activities, and links these data to administrative claims data on Medicare beneficiaries. We use sophisticated statistical modeling to examine the effects of ACO programs on disparities in patient outcomes, such as hospital and emergency department utilization and patient experience. Similarly, we are examining the extent to which ACOs engage in patient avoidance or “cream skimming” as they enter programs. Data from the National Survey of ACOs allows us to understand what characteristics or types of ACOs are best positioned to reduce disparities. Our work is funded by the National Institute on Aging and Agency for Healthcare Research and Quality.