Accountable care organizations and Medicare payments for residents with ADRD in disadvantaged neighborhoods

Abstract

INTRODUCTION

Accountable care organizations (ACOs) are well positioned to promote care coordination. However, robust evidence of ACOs’ impact on Medicare payments for residents with Alzheimer's disease and related dementias (ADRD) in disadvantaged neighborhoods remains limited.

METHODS

Using a 2016 to 2020 longitudinal dataset, we examined the effects of ACO enrollment on Medicare payments for people newly diagnosed with ADRD, focusing on the neighborhood Social Vulnerability Index (SVI) and its subcategories. Multivariable generalized estimating equation (GEE) models were applied.

RESULTS

ACO enrollment was associated with significantly reduced total payments across all SVI subcategories. The highest cost savings were observed among ADRD patients living in neighborhoods with high proportions of racial and ethnic minorities. Results also showed that higher quality ACOs were associated with lower total payments.

DISCUSSION

ACOs have a great potential to save health-care costs for beneficiaries with ADRD living in socially vulnerable neighborhoods, particularly for those residing in areas with higher proportions of racial and ethnic minority populations.

Highlights

• Accountable care organizations (ACOs) reduced Medicare payments for Alzheimer's disease and related dementias across neighborhood disadvantage levels.
• The cost reductions varied by specific indicators of social vulnerability.
• Highest cost savings were found among residents living with high proportion of racial/ethnic minorities.
• Cost savings were the greatest among the highest quality ACOs.