Health Disparities in Dementia and Other Chronic Disease Management: Role of ACOs

Racial and ethnic health disparities remain widespread, and for some chronic conditions including Alzheimer’s disease and related dementias (ADRD), disparities continue to widen. For example, Blacks and Hispanics have higher incidences and worse outcomes of ADRD, hypertension, diabetes, cancer, cardiovascular disease, and obesity. Because ADRD and other chronic diseases account for 75 percent of US healthcare expenditures, reducing their incidence and cost has been the focus of much research. However, the literature to date has offered limited evidence on how to best reduce health disparities.

We evaluate how Accountable Care Organizations (ACOs) affect existing racial and ethnic disparities in ADRD and other chronic disease detection and management. ACOs introduce organizational and financial innovations that incentivize care coordination and higher performance quality at lower costs. As such, ACOs are poised to improve the health outcomes of minority elderly populations, who can arguably benefit most from better access to care, comprehensive care planning, and extended outreach.

The quasi-random assignment of Medicare beneficiaries to ACOs allows us to employ a regression discontinuity approach that compares beneficiaries who are marginally assigned to an ACO with those who are marginally not aligned. On average, ACO providers have fewer Black and Hispanic patients, and they treat relatively healthier patients. Among ACO-aligned patients, Blacks and those with ADRD do not experience changes in claims or charges, suggesting that the selective formation of ACOs can worsen racial health disparities.