ACOs could widen racial care delivery gap

While the creation of accountable care organizations (ACOs) could lead to improved quality of care and cost savings, they also could create networks that exclude minorities and further widen healthcare disparities, according to commentators writing in this week's Journal of the American Medical Association.

In the long run, the process of creating ACOs could reinforce racial/ethnic differences in sites of care by "further concentrating patients from certain racial/ethnic groups within particular healthcare organizations," write authors Craig Pollack, MD, of Johns Hopkins University, and Katrina Armstrong, MD, of the University of Pennsylvania.

They note that while many integrated delivery systems and multispecialty group practices already could qualify as ACOs, other hospitals and independent practices must enter into contractual relationships to become such. Profitable practices will be more "desirable partners" for these relationships--with wealthier hospitals likely to have a greater ability to compete for such practices.

While the intent of creating ACOs is not to explicitly select patients by race, ethnicity, or socioeconomic status, the reality is that profitability in healthcare will be "strongly correlated with caring for fewer low-income patients" and low-income patients are disproportionately represented by minority groups, Pollack and Armstrong say.

To address the disparity issue, the authors suggest that ACOs could improve coordination of care across private practices and hospitals by encouraging them to work closely together on inpatient and outpatient care. Cancer care, for example, could be enhanced with "patient navigators" who coordinate services.

Also, measures should be used to evaluate the process of creating ACOs from an antitrust/market consolidation perspective, they say. In particular, measures of quality should include details about the patient population by race and ethnicity within ACOs.

For more details:
- see the JAMA extract