The Promise And Peril Of Accountable Care For Vulnerable Populations: A Framework For Overcoming Obstacles
- Valerie A. Lewis ( [email protected] ) is a research fellow and instructor at the Center for Population Health, Dartmouth Institute for Health Policy and Clinical Practice, in Lebanon, New Hampshire.
- Bridget Kennedy Larson is the director of health policy implementation at the Dartmouth Institute.
- Asha Belle McClurg is a health policy fellow at the Dartmouth Institute.
- Rebecca Goldman Boswell is a health policy fellow at the Dartmouth Institute.
- Elliott S. Fisher is the director of the Center for Population Health, Dartmouth Institute.
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.
