Podium Session

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PD06-08: Disparity in Minority Representation within Medicare Accountable Care Organizations

Friday, May 12
10:40 AM - 10:50 AM
Location: BCEC: Room 161

Presentation Authors: Daniel Lee*, Robert Gambrel, Amy Graves, Melinda Buntin, David Penson, Matthew Resnick, Nashville, TN

Introduction: Minority health care is frequently concentrated among relatively few providers that tend to have incrementally fewer financial resources. The development of accountable care organizations (ACOs) serves to improve the value of care delivered to populations with emphasis on care coordination. However, it is not known if minority patients have equal representation or access to ACOs.

Methods: The distribution of race within 220 Medicare Shared Savings Program ACOs was ascertained from the 2013 MSSP Public Use File. The ZIP Code Tabulation Areas (ZCTA) in each ACO were weighted according to its representation within the ACO. The distribution of race was then calculated for the ZCTAs that an ACO covered according to the 2010 U.S. Census and compared to the distribution in the ACO. The degree of disparity was calculated as: (% minority in community - % minority in ACO) / % minority in community.

Results: Overall, the median disparity between the representation of all minorities in the community compared to the ACO was 41.6% [interquartile range (IQR) 25-51%, see Fig.]. Among black beneficiaries, the median disparity was 27.1% (IQR 11-48%). There was a median 65.6% disparity (IQR 52-79%) among Hispanics and 57.5% disparity (IQR 43-67%) among Asians. The vast majority of ACOs exhibited large degrees of disparity, with 77.7% and 64.6% of the ACOs having a disparity of more than 50% among Hispanic and Asian communities, respectively. Thirteen ACOs (5.9%) had a large negative disparity, where the proportion of minorities within the ACOs was larger than in the community. Federally qualified health centers (FQHC) were largely represented in these ACOs with a negative disparity; on average there were 11 FQHC represented in ACOs with a negative disparity compared to 0.9 FQHC in ACOs with a positive disparity (p<0.01).

Conclusions: Our findings show that all minority patients are consistently under-represented in early MSSP ACOs. This raises concerns that minority patients in the community have less access to physicians and provider groups who participate in ACOs and the potential benefits conferred by this delivery system innovation. The development of ACOs may ultimately exacerbate known racial disparities germane to urologic practice unless incentives are aligned to promote inclusion of minority populations in alternative payment models.

Source Of Funding: American Cancer Society (MSRG-15-103-01-CHPHS to MJR), AUA/Urology Care Foundation Rising Stars in Urology Research Program

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