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ACA Programs, Seen to Address Health Disparities, Now in Jeopardy

By Tinker Ready  
   January 26, 2017

Improvement in care has been seen for privately insured low-income patients and for those at federal health centers. Whether those programs will survive the GOP's plans for the Affordable Care Act is uncertain.

Despite a push to address health care disparities, inequity in delivery and outcomes remains a problem.

Minorities are still more likely than whites to be uninsured and experience bad outcomes. "Blacks and American Indians and Alaska Natives fare worse than Whites on the majority of examined measures of health status and outcomes," according to a 2016 report from the Kaiser Family Foundation.

"Disparities in health and health care remain a persistent challenge in the United States," the report notes.

Coverage for Chronically Ill Rose 5% Under ACA

Now, just as the Trump administration is setting the groundwork to repeal and replace the ACA, two new studies suggest that some Affordable Care Act provisions may be getting at the disparity problem.

Whether those programs will survive the GOP's plans for the ACA is uncertain.

While many of the Obamacare programs are too new to have generated much data yet, one program at Blue Cross Blue Shield of Massachusetts has taken an approach that is similar the ACA accountable care organizations.

Researchers from Harvard Medical School examined the impact of the insurers "Alternative Quality Contract"on spending, as well as process and outcome measures. They compared changes for higher and lower income enrollees from 2006 to 2012. Quality improved for all enrollees, but the improvement in some measures was higher for low income enrollees.

The trend could suggest "a potential narrowing of disparities," according to the team's findings published in the current issue of Health Affairs.

"The hope is that the lessons we can draw from the early Massachusetts experiment… can be useful for other states, other payers, even Medicare, as they embark on payment reform," said Zirui Song, a clinical fellow at Harvard Medical School and lead author of the study.

The authors describe the Blue Cross program as a population-based, global budget model that has "two-sided incentives: It rewards physicians for savings below the risk-adjusted budget (shared savings) but also requires them to share in deficits with Blue Cross Blue Shield of Massachusetts for spending above the budget (shared risk)."

The insurer's website includes a video endorsement of the approach from Sandra L. Fenwick, the CEO of Children's Hospital Boston.

Tinker Ready is a contributing writer at HealthLeaders Media.

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