A data tool developed by UW–Madison researchers showing health-relevant metrics for every neighborhood in the United States is guiding a national model to help Medicare beneficiaries from under-resourced communities access health care more effectively.
The model, called Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH), was announced by the Centers for Medicare and Medicaid Services in February 2022. It was put into use in January 2023 for 132 Accountable Care Organizations, which are entities that focus on providing higher quality health care for Medicare patients at lower cost.
ACO REACH takes a new approach to advancing health equity by providing adjustments to ACOs serving under-resourced communities using the UW–Madison Neighborhood Atlas, a data tool that was created by a team led by Dr. Amy Kind, professor of medicine and associate dean for social health sciences and programs at the UW School of Medicine and Public Health.
The Atlas consists of the Area Deprivation Index (ADI), a validated measure of socioeconomic disadvantage at the neighborhood, or census block-group level, that is strongly linked to health outcomes. The ADI is determined from census data and consists of seventeen factors in the areas of income, education, employment and housing. These factors are combined to create neighborhood rankings across the United States.
This is a groundbreaking approach to health policy, according to Dr. Ann Sheehy, associate professor of medicine and associate director of health policy research at the UW–Madison Center for Health Disparities Research.
“This is the first time Medicare payment policy has ever incorporated an equity adjustment, which may mean substantial new resources for hospitals and communities that need them most,” Sheehy said.
The model creates an entirely new incentive for health systems to reach directly into locations most in need such as inner cities, rural areas and Native American communities, and has potential to scale further, according to Sheehy.
“Because private insurance companies and smaller entities such as states and cites often follow the lead of the Centers for Medicare and Medicaid Services, this approach has the potential to spread rapidly in many new areas,” Sheehy said.
ACOs allow health care providers such as physicians and hospitals to be held financially accountable for the quality, cost and experience of care of an assigned Medicare beneficiary population. ACOs that meet quality standards for patient care while spending less than a historical benchmark for their Medicare population will receive a portion of the overall savings achieved. But if costs go up, the ACO will repay a penalty. In this way, the program incentivizes innovations that promote patient health while reducing overall costs.
Each ACO identifies how it will improve care for their Medicare beneficiaries, typically through primary care initiatives such as facilitating teamwork and communication among all providers treating Medicare patients, reducing hospital readmissions, avoiding unnecessary emergency department visits and improving patients’ ability to adhere to their treatment plans. According to CMS, the total shared savings for the program was $2 billion in 2021.
There are currently 456 ACOs corresponding to 10.9 million Medicare beneficiaries. Of these, 132 ACOs are operating under the ACO REACH model, encompassing 131,772 health care providers serving an estimated 2.1 million beneficiaries, according to the CMS.
The new model enables each ACO to identify how they will reduce health disparities among the Medicaid patients they serve using tailored tactics, according to Sheehy.
“In addition to the benchmark adjustment related to the ADI, ACO REACH requires ACOs to produce a health equity plan that describes how underserved beneficiaries will be cared for under the plan. UW Health’s participation in ACO REACH really allows us to focus on advancing health equity in our community in a new and important way,” Sheehy said.
The UW–Madison researchers only learned that CMS would use the Neighborhood Atlas in ACO REACH when the model was announced by the agency. Kind’s team decided in 2018 to make their data tool widely accessible, resulting in broad uptake and uses by researchers, organizations, municipalities, public health units and state and federal agencies.
“In just five years, the Atlas has been downloaded more than half a million times, and hundreds of research studies have cited the Atlas. Sharing this resource has the potential to advance health equity across the country in ways that would not otherwise have been possible,” Sheehy said. “To have a federal agency select our UW–Madison tool to advance health equity throughout the country is truly the Wisconsin Idea at work, but on a national scale.”