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Physician Participation in ACOs Less Likely in Areas With Vulnerable Populations


Accountable care organizations are becoming increasingly common in the United States, but they are more likely to be formed in regions of the country with populations that have a higher socioeconomic status.

Accountable care organizations (ACOs) can greatly improve healthcare quality at a low cost if all patients have equal access to physicians who participate in such ACOs. However, a new study points out the vast disparity in physicians’ participation in ACOs across hospital referral regions. It was found that disadvantaged patients do not have good access to physicians resulting in lack of good healthcare, according to a study published in Health Affairs.

While ACOs are growing, there are still certain vulnerable groups that aren't being catered to. In fact, there are concerns that ACOs are worsening existing disparities in healthcare quality, according to Laura C. Yasaitis, PhD, and colleagues.

Study Design and Results

Through data collected during 2013, the researchers studied and compared the participation of physicians in an ACO (public or commercial) updated by SK&A. They also identified each physician’s ZIP Code Tabulation Area to study the sociodemographic characteristics of the population that the physician was likely to care for. Variables at physician-level such as sex, number of physicians in the practice, whether the practice was a multispecialty, rurality of the practice location, and medical specialty were also included.

The findings after studying 521,543 US physicians were as follows:

  • 25.9% physicians participated in an ACO
  • Female physicians were more likely to participate in ACO than males
  • Rates of ACO participation were highest in the Northeast, mid-Atlantic, upper Midwest, and West
  • Where lower physician participation was registered, the patients tended to be black, disabled, poor and with less than a high school education

“We found that physicians practicing in ZIP Code Tabulation Areas with more blacks, higher poverty, more uninsured or disabled residents, or more people with less than a high school education were less likely to participate in ACOs than their counterparts practicing in areas whose populations of such vulnerable groups were smaller,” said Yasaitis, the lead researcher of the study and a postdoctoral research fellow at the Perelman School of Medicine.

Better Care for Vulnerable Groups Needed

ACOs are becoming increasingly common in the United States. Between Medicare and the commercial (or private) sector, almost 23.5 million Americans are being served by an ACO. However, the latest study points out that the ACOs are concentrated in regions with lower poverty rates creating a disparity in reach. Not all patients enjoy access to ACOs, especially the vulnerable and disadvantaged groups.

The researchers found evidence confirming that ACOs are more likely to be formed in regions of the country whose populations have higher socioeconomic status and a smaller percentage of blacks, compared to regions whose populations have lower socioeconomic status and a larger percentage of blacks.

“Greater consideration is warranted in creating policies to encourage the development of ACOs and physicians’ participation in them in areas with vulnerable populations,” the authors concluded. “Additionally, any changes in the care and health outcomes of these populations should be monitored to assess the potential effects of ACO implementation on healthcare disparities.”

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