Could ACOs Reinforce Disparities Among Patient Populations?

First, the Centers for Medicare & Medicaid Services should mandate the reporting of quality indicators by race and ethnicity within ACOS to determine this impact, both positive and negative, on disparities, they suggest.

Second, they recommend that CMS should examine whether distribution of patients by race and ethnicity between ACOS is associated with quality of care Medicare beneficiaries receive. "Understanding these system level differences is critical for determining program effectiveness and improving its design."

Third, the program should monitor should monitor which clinicians and patients are excluded or choose not to participate. And incentives might ensure adequate representation of diverse patients and healthcare systems.

And fourth, active steps to avoid patient and practice cherry picking may be necessary, although monitoring and enforcing the practice will be challenging.

"ACOS are unlikely to reduce and may even exacerbate disparities in care without active intervention to monitor and incentivize equity within and across ACO populations," they concluded.