NAACOS outlines policies that would help ACOs address health inequities

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The Centers for Medicare and Medicaid Services and Congress need to do more to support accountable care organizations' work in addressing health inequalities, according to the National Association of ACOs.

NAACOS published a white paper today outlining a number of policy recommendations that could better position ACOs to address the social determinants of health.

"ACOs are already beginning to do the work of addressing SDOH to improve quality and control costs for the patients they serve. However, they cannot be broadly effective or achieve desired outcomes without proper funding and support," the report said. "The implementation of these recommendations will help to ensure that ACOs are equipped to effectively measure, track, and improve health equity in their work."

Topping the list of policy recommendations is providing more funding to ACOs to allow them to expand their social services. While many ACOs are already developing plans to improve health equity, financial barriers are a major obstacle, especially for smaller, physician-led ACOs, according to the report.

NAACOS offers several methods CMS could take to boost ACO funding, including offering grants to organizations focusing on underserved populations, updating the Medicare Shared Savings Program's financial benchmarks or establishing an MSSP model for ACOs focused on health equity.

It also suggests that CMS adapts its Community Health and Rural Transformation Model to cover urban areas that meet the definition of a distressed community. Currently, the model focuses on disparities in rural areas by providing a way for them to transform their healthcare delivery systems through innovative financial arrangements.

"We encourage CMS to begin an initial expansion of the model for ACOs that serve a high proportion of patients with negative SDOH, such as lack of education, housing instability, food insecurity, poverty, unemployment, etc.," NAACOS said in the paper. "Then, the agency should expand the model further to make financial support to address SDOH needs available beyond 'distressed' communities and within all value-based models."

Another policy recommendation is to provide additional flexibilities within Medicare for ACOs working to improve health equity. NAACOS says that providing care for patients with high social risks requires more time and resources, something providers won't have unless given appropriate flexibilities and funding.

It's calling for flexibilities that would allow ACOs to deliver benefits related to transportation, food, pest control, indoor air quality equipment, structural home modifications and others.

CMS should also incentivize ACOs to report data on race, ethnicity and other social factors for their Medicare beneficiaries, according to NAACOS. It says this data could help ACOs create initiatives specifically targeted at vulnerable populations.

In addition to incentivizing the collection of patient data, the white paper calls for improving ACOs' access to data needed for care coordination, especially data related to substance use disorder.

"While SUD affects all racial and ethnic groups, Black and Latinx Americans are less likely to complete treatment for SUD," NAACOS said in the paper. "By equipping providers with the necessary information for coordinated, whole-person care, these disparities can begin to be addressed."

NAACOS also supports broader telehealth coverage and wants to see many of the flexibilities granted during the COVID-19 pandemic be made permanent for telehealth's ability to improve access to care.

WHY THIS MATTERS

The COVID-19 pandemic brought attention to the deeply rooted health inequities that exist in the United States. For example, studies show that the pandemic had worse outcomes in communities with higher rates of racial/ethnic minorities and lower rates of education, English proficiency or transportation access.

ACOs provide an alternative to the fee-for-service system by holding groups of doctors, hospitals and other providers accountable for the cost and quality of a defined set of patients. They earn the right to share the Medicare savings generated if certain spending and quality metrics are met.

Because ACOs' finances are tied to patient's health outcomes, they are well-positioned to lead initiatives around health equity.

THE LARGER TREND

Last year, ACOs in the MSSP saved Medicare $4.1 billion and $1.9 billion after accounting for shared savings payments. This represents the highest annual savings to date.

NAACOS routinely asks the Department of Health and Human Services to expand ACO programs, citing how alternative payment models routinely leverage multidisciplinary approaches to care, assess social risk, partner with community organizations to increase access to nonmedical services and leverage data to improve disparities in patient outcomes.

In March, when HHS Secretary Xavier Becerra was confirmed, NAACOS sent a letter urging the department to set a national goal to have a majority of traditional Medicare beneficiaries in an ACO by 2025.

More recently, it was among a group of national healthcare organizations that sent a letter to Becerra urging him to move forward on alternative payment models as part of the strategy to achieve health equity.

NAACOS is also one of the national healthcare organizations backing The Value in Health Care Act.The bill would increase Medicare Shared Savings rates, update risk adjustment rules, eliminate the artificial distinction between "high" and "low" revenue ACOs, address ACOs' "rural glitch," restart the ACO Investment Model and more.

ON THE RECORD

"ACOs are already beginning to address negative SDOH and close health equity gaps, but they cannot be broadly effective or achieve their goals without proper funding and support," Clif Gaus, NAACOS president and CEO, said in a statement. "CMS and Congress should work through ACOs to improve inequities and address social determinants. The implementation of these recommendations will ensure that all ACOs are equipped to advance health equity in their work while improving quality of care and controlling costs."

Twitter: @HackettMallory
Email the writer: mhackett@himss.org