In an analysis of racial and ethnic disparities in patient outcomes among accountable care organizations (ACOs), researchers found that ACOs with a high proportion of minority patients are more apt to perform poorly on quality measures than are ACOs with smaller proportions of minority patients. 

The researchers relied on first- and second-year performance data from the Medicare Shared Savings Program (MSSP), along with results from a national survey of ACOs. Data from both sources were available for 214 ACOs. 

ACOs in the top quartile (in terms of their proportion of minority patients) had a patient population consisting of at least 24 percent minority patients. In general, these ACOs were not significantly different from other ACOs with regard to their provider composition, but they were significantly less likely to offer routine specialty care, outpatient rehabilitation, pediatric health care, and palliative and hospice care. They also tended to have patients who were higher risk, sicker or more costly to treat, and possibly otherwise disadvantaged (e.g., being enrolled in Medicaid) in comparison with patients at other ACOs. 

After the researchers adjusted for patient and ACO characteristics, the analysis revealed that the proportion of minority patients was associated with worse performance on 25 of 36 measures—an association found across all four domains of quality scores: patient experience; care coordination and patient safety; preventive health; and patients at risk because of chronic health conditions such as diabetes, hypertension and coronary artery disease. 

The researchers noted that the ACOs with a high proportion of minority patients also had a lower overall quality composite score, on average, as compared with other ACOS, so they were eligible for a smaller share of the savings they generated. Further, ACOs with a higher proportion of minority patients did not improve their quality performance any more than other ACOs during the second performance year of the MSSP. 

“Our findings suggest that ACOs with a high share of minority patients may struggle with quality performance under ACO contracts, especially during their early years of participation—maintaining or potentially exacerbating current inequities,” the authors concluded.

The study was published in the January issue of Health Affairs.

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