ACOs need screening tools and new quality bonuses to help address health equity, NAACOS says

The Biden administration needs to develop new quality measures and create bonuses to help ensure accountable care organizations can address health equity, an advocacy group says.

The National Association of ACOs (NAACOS) released a white paper Monday outlining key recommendations on how the Centers for Medicare & Medicaid Services can use ACOs to help close equity gaps. The white paper comes a few days after the agency released a strategic refresh that calls on value-based care to better tackle equity.

The Center for Medicare and Medicaid Innovation has so far not laid out detailed requirements for ACOs and other providers to tackle equity in value-based care, only that it wants them to gather more data on race and ethnicity of their patients.

“ACOs today are already required to collect and report on lots of data points on how they treat their patients,” said Clif Gaus, president and CEO of NAACOS, in a statement. “These requirements can easily be updated to better address health equity.”

NAACOS offered several recommendations beyond simply collecting race and ethnicity data, including updating a patient survey that ACOs are required to field. The survey should begin “incorporating equity questions, such as adding a domain focused on receiving timely access and culturally appropriate care,” the white paper said.

But other recommendations called for key changes to how ACOs are judged based on quality.

An ACO agrees to meet certain spending and quality benchmarks and keeps any share of savings to Medicare in addition to quality bonuses. But the ACO must repay Medicare if benchmarks are not met to a certain degree.

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NAACOS called on CMS to create new quality measures that address health equity at a population health level.

“There is currently a gap in the quality measure portfolio,” NAACOS said.

The group urged CMS to work with ACOs on developing the best quality measures to judge equity and create a standardized screening tool organizations can rely on.

The agency also needs to create new incentives for ACOs to improve quality scores for certain populations.

“This could be done through bonus or improvement points added to an ACO’s final quality score,” the white paper said.

Initial bonus points could be awarded to an ACO based on reporting race and ethnicity alongside other quality data.

“As accurate baselines develop, improvement points could be awarded for improvement within specific subcategories,” the group added.

The National Committee of Quality Assurance has already started to stratify quality measures by race and ethnicity. CMS also needs to create a subset of ACO measures that can be stratified by race and ethnicity.

“In order to do this successfully, however, there first must be accurate and complete data on race and ethnicity available to ACOs,” the white paper said.

The white paper offers a glimpse at where stakeholders hope CMS goes in addressing health equity in value-based care.

A separate white paper released by CMS last week called for identifying areas that can improve equity at the population level and how to get more safety net providers into value-based care.

“The Innovation Center is considering a variety of incentives to encourage and sustain participation, such as upfront payments, social risk adjustment, benchmark considerations and payment incentives for reducing disparities or screening for [social determinants of health],” the CMS white paper said.