title: Physicians' Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities.
abstract: Early evidence suggested that accountable care organizations (ACOs) could improve health care quality while constraining costs, and ACOs are expanding throughout the United States. However, if disadvantaged patients have unequal access to physicians who participate in ACOs, that expansion may exacerbate health care disparities. We examined the relationship between physicians' participation in both Medicare and commercial ACOs across the country and the sociodemographic characteristics of their likely patient populations. Physicians' participation in ACOs varied widely across hospital referral regions, from nearly 0 percent to over 85 percent. After we adjusted for individual physician and practice characteristics, we found that physicians who practiced in ZIP Code Tabulation Areas where a higher percentage of the population was black, living in poverty, uninsured, or disabled or had less than a high school education-compared to other areas-had significantly lower rates of ACO participation than other physicians. Our findings suggest that vulnerable populations' access to physicians participating in ACOs may not be as great as access for other groups, which could exacerbate existing disparities in health care quality.
authors: Laura C. Yasaitis (yasaitis@wharton.upenn.edu) is a postdoctoral research fellow at the Perelman School of Medicine and a fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania, in Philadelphia.
authors: Laura C
authors: LC
authors: Yasaitis
authors: William Pajerowski is a doctoral candidate at the Wharton School and a fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania.
authors: William
authors: W
authors: Pajerowski
authors: Daniel Polsky is executive director of and the Robert D. Eilers Professor in Health Care Management and Economics at the Leonard Davis Institute of Health Economics, University of Pennsylvania.
authors: Daniel
authors: D
authors: Polsky
authors: Rachel M. Werner is a professor of medicine and health care management at the University of Pennsylvania and a staff physician at the Crescenz Veterans Affairs Medical Center, in Philadelphia.
authors: Rachel M
authors: RM
authors: Werner
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006801:Humans; D016014:Linear Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011203:Poverty; D010818:Practice Patterns, Physicians' / Q000191:economics*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D035862:Vulnerable Populations / Q000706:statistics & numerical data
keywords: Disparities; Health Reform; Physicians