Quality of Care and Racial Disparities in Medicare Among Potential ACOs
- Ryan E. AndersonAffiliated withHarvard Kennedy School of GovernmentWashington University School of Medicine
- , John Z. AyanianAffiliated withDepartment of Health Care Policy, Harvard Medical SchoolDivision of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical SchoolInstitute of Healthcare Policy and Innovation, University of Michigan
- , Alan M. ZaslavskyAffiliated withDepartment of Health Care Policy, Harvard Medical School
- , J. Michael McWilliamsAffiliated withDepartment of Health Care Policy, Harvard Medical SchoolDivision of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School Email author
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The Medicare Accountable Care Organization (ACO) programs encourage integration of providers into large groups and reward provider groups for improving quality, but not explicitly for reducing health care disparities. Larger group size and better overall quality may or may not be associated with smaller disparities.
To examine differences in patient characteristics between provider groups sufficiently large to participate in ACO programs and smaller groups; the association between group size and racial disparities in quality; and the association between quality and disparities among larger groups.
DESIGN AND PARTICIPANTS
Using 2009 Medicare claims for 3.1 million beneficiaries with cardiovascular disease or diabetes and linked data on provider groups, we compared racial differences in quality by provider group size, adjusting for patient characteristics. Among larger groups, we used multilevel models to estimate correlations between group performance on quality measures for white beneficiaries and black–white disparities within groups.
Four process measures of quality, hospitalization for ambulatory care-sensitive conditions (ACSCs) related to cardiovascular disease or diabetes, and hospitalization for any ACSC.
Beneficiaries served by larger groups were more likely to be white and live in areas with less poverty and more education. Larger group size was associated with smaller disparities in low-density lipoprotein (LDL) cholesterol testing and retinal exams, but not in other process measures or hospitalization for ACSCs. Among larger groups, better quality for white beneficiaries in one measure (hospitalization for ACSCs related to cardiovascular disease or diabetes) was correlated with smaller racial disparities (r = 0.28; P = 0.02), but quality was not correlated with disparities in other measures.
Larger provider group size and better performance on quality measures were not consistently associated with smaller racial disparities in care for Medicare beneficiaries with cardiovascular disease or diabetes. ACO incentives rewarding better quality for minority groups and payment arrangements supporting ACO development in disadvantaged communities may be required for ACOs to promote greater equity in care.
KEY WORDSdelivery of health care accountable care organizations medicare disparities quality of health care
- Quality of Care and Racial Disparities in Medicare Among Potential ACOs
Journal of General Internal Medicine
Volume 29, Issue 9 , pp 1296-1304
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- delivery of health care
- accountable care organizations
- quality of health care
- Industry Sectors
- Author Affiliations
- 1. Harvard Kennedy School of Government, Cambridge, MA, USA
- 2. Washington University School of Medicine, St. Louis, MO, USA
- 3. Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA, 02115, USA
- 4. Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- 5. Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA