Tackling Implicit Bias in Health Care

Abstract

Accountable care organizations (ACOs) are a critical component of the goals of the Centers for Medicare and Medicaid Services (CMS) to advance health equity; support high-quality, person-centered care; and promote afford-ability and sustainability in Medicare. ACOs bring together groups of doctors, hospitals, and other providers to deliver coordinated care to beneficiaries. They are also essential to achieving CMS's goal of having all beneficiaries in the traditional Medicare program cared for by providers who are accountable for costs and quality of care by 2030. The CMS Medicare ACO portfolio consists of the Center for Medicare's Shared Savings Program and the Center for Medi-care and Medicaid Innovation's ACO models. The Shared Savings Program, now 10 years old, includes 483 ACOs serving more than 11 million Medicare beneficiaries and more than 525,000 participating clinicians. Such ACOs have been found to perform better on certain patient-experience and performance measures than physician groups participating in the Merit-Based Incentive Payment System (see table). The Innovation Center has tested several ACO models, of which the Pioneer ACO and ACO Investment Models have achieved net savings; others, including the Advance Payment ACO Model and the Next Generation ACO Model, have not. The Pioneer ACO program , which allowed providers with experience coordinating pa-tients' care to move more rapidly from a shared-savings payment model to a population-based payment model, was associated with significant reductions in emergency department visits and in-patient admissions. The ACO Investment Model provided advance payments to participating organizations to make infrastructure investments aimed at improving care; such payments could be recouped by CMS by means of earned shared savings. The ACO Investment Model resulted in more providers in rural and underserved communities signing on to participate in ACOs. These new ACOs invested in better care coordination, and savings have been attributed to fewer unnecessary acute hospitalizations , fewer emergency department visits, and fewer days in skilled nursing facilities among beneficiaries. The ACO Investment Model generated $381.5 million in net Medicare savings between 2016 and 2018.