Quality of care and racial disparities in Medicare among potential ACOs
Open accessAbstract
Background 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.Objective 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.Main measures Four process measures of quality, hospitalization for ambulatory care-sensitive conditions (ACSCs) related to cardiovascular disease or diabetes, and hospitalization for any ACSC.Key results 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.Conclusions 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.
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Larger provider groups attenuated racial disparities in some areas, but did not change disparities on other metrics, such as hospitalization rates.
“Although larger provider groups attenuated racial disparities in some areas, they did not change disparities on other metrics, such as hospitalization rates (107).”
From The CardioMetabolic Health Alliance (2015) · cites this paper as [107]
African-American beneficiaries with T2D were less likely to receive LDL testing and retinal examinations and were more likely to be hospitalized than Caucasian beneficiaries.
“African-American beneficiaries with T2D were less likely to receive LDL testing and retinal examinations and were more likely to be hospitalized than Caucasian beneficiaries.”
From The CardioMetabolic Health Alliance (2015) · cites this paper as [107]
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Sperling, L. S., Mechanick, J. I., Neeland, I. J., Herrick, C. J., Després, J.-P., Ndumele, C. E., Vijayaraghavan, K., Handelsman, Y., Puckrein, G. A., Araneta, M. R. G., et al. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.06.1328 · Cited by 294 · see citing works
- Authors
- Anderson, R. E., Ayanian, J. Z., Zaslavsky, A. M., & McWilliams, J. M.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- McWilliams, J. Michael
- Venue
- Journal of General Internal Medicine
- Published
- 2014-05-31
- Volume
- 29
- Issue
- 9
- Pages
- 1296-1304
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC4139518
- OpenAlex
- W1979021709
- Cited by
- 41
- References
- 35
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 3 · 2022: 5 · 2021: 3 · 2020: 3 · 2019: 4 · 2018: 5 · 2017: 2 · 2016: 6 · 2015: 4 · 2014: 3
- FWCI
- 12.40
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Doris Duke Charitable Foundation
- American Federation for Aging Research
- AcademyHealth
- Harvard University (UL1RR025758)
- Harvard Catalyst (UL1-RR025758)
- National Institutes of Health
- Harvard Kennedy School
- National Institute on Aging (K08AG038354, P01AG032952)
- National Center for Research Resources (UL1RR025758)
- National Institute on Minority Health and Health Disparities
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- accountable care organizations, racial disparities, quality of care, Medicare, cardiovascular disease, diabetes mellitus, ambulatory care sensitive conditions, LDL cholesterol testing, health equity, black-white disparities, integrated care
- MeSH terms
- Aged, Aged, 80 and over, Black or African American, Cardiovascular Diseases, Diabetes Mellitus, Female, Medicare, Humans, Male, Quality of Health Care, United States, Black People, White People, Healthcare Disparities, Accountable Care Organizations, Racism
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