title: The promise and peril of accountable care for vulnerable populations: a framework for overcoming obstacles.
abstract: Accountable care organizations (ACOs) are a promising payment model aimed at reducing costs while also improving the quality of care. However, there is a risk that vulnerable populations may not be fully incorporated into this new model. We define two distinct vulnerable populations, clinically at-risk and socially disadvantaged, and we discuss how ACOs may benefit each group. We provide a framework to use in considering challenges for both vulnerable patients and health systems on the path to accountable care. We identify policies that can help overcome these obstacles: strategies that support ACO formation in diverse settings and that monitor, measure, and reward the performance of providers that reach all patients, including vulnerable populations.
authors.affiliation: Center for Population Health, Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, New Hampshire, USA. Valerie.A.Lewis@Dartmouth.edu
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Lewis
authors.forename: Bridget Kennedy
authors.initials: BK
authors.lastname: Larson
authors.forename: Asha Belle
authors.initials: AB
authors.lastname: McClurg
authors.forename: Rebecca Goldman
authors.initials: RG
authors.lastname: Boswell
authors.forename: Elliott S
authors.initials: ES
authors.lastname: Fisher
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics / Q000458:organization & administration; D002908:Chronic Disease / Q000628:therapy; D006291:Health Policy; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D017146:Models, Organizational; D016134:Organizational Policy; D011204:Poverty Areas; D011787:Quality of Health Care; D012052:Reimbursement, Incentive; D062487:Social Marginalization; D014481:United States; D035862:Vulnerable Populations