NAACOS presents policies that would help ACOs address health inequalities

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The Centers for Medicare and Medicaid Services and Congress must do more to support the work of responsible healthcare organizations in addressing health inequalities, according to the National Association of ACOs.

NAACOS today released a white paper outlining a number of policy recommendations that could better position ACOs to address the social determinants of health.

“ACOs are already starting to work on SDOH to improve quality and control costs for the patients they serve. However, they cannot be globally effective or achieve desired results without appropriate funding and support,” says The report. “Implementing these recommendations will help ensure that ACOs are equipped to effectively measure, monitor and improve health equity in their work.”

Topping the list of policy recommendations is increased funding for ACOs to enable them to expand their social services. While many ACOs are already making plans to improve health equity, financial barriers are a major hurdle, especially for smaller physician-led ACOs, according to the report.

NAACOS offers several methods that CMS could use to increase ACO funding, including offering grants to organizations focused on underserved populations, updating the Medicare Shared Savings Program financial credentials, or establishing a model. MSSP for ACOs focused on health equity.

He also suggests that CMS adapt its model of community health and rural transformation to cover urban areas that meet the definition of a community in distress. Currently, the model focuses on disparities in rural areas by providing them with a way to transform their health care delivery systems through innovative financial arrangements.

“We encourage CMS to start an initial expansion of the model for ACOs that serve a high proportion of patients with negative SDOH, such as lack of education, unstable housing, food insecurity, poverty, unemployment , etc., “NAACOS said in the document. . “Next, the agency should scale up the model to make financial support available to meet SDOH’s needs beyond ‘distressed’ communities and into all value-based models.”

Another policy recommendation is to provide additional flexibilities within Medicare for ACOs working to improve health equity. NAACOS says providing care for patients with high social risks requires more time and resources, which providers won’t have unless they have the right flexibilities and funding.

He calls for flexibilities that would allow ACOs to offer benefits related to transportation, food, pest control, indoor air quality equipment, house structural modifications and more.

CMS should also encourage ACOs to report data on race, ethnicity and other social factors for their Medicare beneficiaries, according to NAACOS. He says this data could help ACOs create initiatives specifically targeted at vulnerable populations.

In addition to encouraging the collection of patient data, the white paper calls for improving access by ACOs to the data necessary for the coordination of care, in particular to data related to substance use disorders.

“While SUD affects all racial and ethnic groups, blacks and Latin Americans are less likely to complete SUD treatment,” NAACOS said in the newspaper. “By providing providers with the information they need for coordinated and comprehensive care, these disparities can begin to be corrected. “

NAACOS is also supporting broader telehealth coverage and wants many of the flexibilities granted during the COVID-19 pandemic to be made permanent for the ability of telehealth to improve access to care.


The COVID-19 pandemic has drawn attention to the deep-rooted health inequalities that exist in the United States. For example, studies show that the pandemic has had worse outcomes in communities with higher rates of racial / ethnic minorities and lower rates of education, English proficiency, or access to transportation.

ACOs provide an alternative to the fee-for-service system by holding groups of doctors, hospitals and other providers accountable for the cost and quality of a defined set of patients. They earn the right to share Medicare savings generated if certain spending and quality measures are met.

Since CCO finances are linked to patient health outcomes, they are well positioned to lead initiatives around health equity.


Last year, the MSSP ACOs saved $ 4.1 billion and Medicare $ 1.9 billion after factoring in shared savings payments. This represents the highest annual savings to date.

NAACOS regularly calls on the Department of Health and Human Services to expand ACO programs, citing how alternative payment models routinely leverage multidisciplinary approaches to care, assess social risk, partner with community organizations to increase access to non-medical services and leverage data to improve disparities in patient outcomes.

In March, when HHS Secretary Xavier Becerra was confirmed, NAACOS sent a letter urging the department to set a national goal of having a majority of traditional Medicare beneficiaries in an ACO by 2025.

Most recently, he was part of a group of national healthcare organizations that sent a letter to Becerra urging him to move forward with alternative payment models as part of the strategy to achieve l equity in health.

NAACOS is also one of the national healthcare organizations supporting the Value of Healthcare Act. Bill would increase Medicare shared savings rates, update risk adjustment rules, remove artificial distinction between “high” and “low” income COOs, solve COO “rural problem” , would restart the ACO investment model and more.


“ACOs are already starting to tackle negative SDOHs and close health equity gaps, but they cannot be globally effective or achieve their goals without proper funding and support,” said Clif Gaus. , President and CEO of NAACOS, in a statement. “CMS and Congress should work through ACOs to improve inequalities and address social determinants. Implementing these recommendations will ensure that all ACOs are equipped to advance health equity in their work while improving the quality of care and controlling costs. “

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