Researchers: ACOs Have Not Meaningfully Boosted Socially Vulnerable Patients

A research article by a team of researchers has found that the development of accountable care organizations—particularly of the ACOs participating in the Medicare Shared Savings Program (MSSP) has not in itself advanced the development of work on the social determinants of health (SDOH). That’s the conclusion of an article published in the July issue of Health Affairs.

The authors—Dhruv Khullar, William L. Schpero, Lawrence P. Casalino, Reekari Pierre, Samuel Carter, Yasin Civelek Manyao Zhang, and Aelia M. Bond—write in “Meeting The Needs Of Socially Vulnerable Patients: Views Of ACO Leaders On Moving From Intent to Action”—that “The Centers for Medicare and Medicaid Services has placed growing emphasis on social drivers of health, but little is know about how accountable care organizations (ACOs) aim to meet the needs of vulnerable patients.”

Per that, they write, “During September-December 2022, we interviewed leaders of forty-nine ACOs participating in the Medicare Shared Savings Program (MSSP). Participants were asked about strategies to identify socially vulnerable patients, programs that addressed their needs, and Medicare reforms that could support their efforts. Seven themes emerged: ACOs were in the early stages of collecting social needs data; leaders were frustrated by an incomplete ability to act on such data; ACOs tended to stratify patients by medical, rather than social, risk; some ACOs have introduced pilot programs to address challenges, including social isolation and drug costs; programs were often payer agnostic; rural ACOs faced unique challenges; and Medicare reforms related to reimbursement, logistical support, quality metrics, and patient benefits could support ACO efforts.” Given all that, “These findings suggest that the MSSP alone has not been sufficient to promote consistent investment in social needs provision at most ACOs. Policy makers may want to consider more direct support and incentives for healthcare organizations, or greater investment in non-healthcare sectors, to help socially vulnerable patients,” they write.

What’s more, even the Accountable Health Communities model under Medicare, “through which organizations were incentivized to screen patients for social needs and refer those to social service providers, suggests that the model has had mixed results,” the researchers write.

In the end, they conclude, referring to their research and to its findings along multiple dimensions, “These results, along with our interviewees’ perceptions, raise thorny questions about whether healthcare organizations are the appropriate mechanism to address social needs, or if increased investment in other sectors, such as housing, transportation, or public safety, is a better strategy.”