Reducing Racial and Ethnic Disparities in Alzheimer's Disease: Role of ACOs
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SUMMARY According to the US Department of Health and Human Services, the age 85 and older population will be increasingly Black and Hispanic. Relative to non-Hispanic Whites, rates of cognitive impairment are higher among Blacks and Hispanics, and a growing body of evidence documents that minorities are diagnosed with later stages of Alzheimer's Disease (AD), experience poorer treatment outcomes, and have higher mortality rates. Taken together, these trends make clear a need to identify strategies that can reduce racial and ethnic disparities within AD. One commonly proposed strategy has been care coordination. People with AD frequently need care from a wide range of providers, including geriatricians, specialists, nurse aides, and home health care workers. Given the multidisciplinary nature of AD care, improved care management can ensure that the requisite services are provided in a timely manner, particularly among minority populations which struggle with access to care. However, we lack empirical evidence on whether and how incentives for care coordination affect disparities. In this proposal, we examine the role of Medicare ACOs in reducing racial and ethnic disparities within AD. Consisting of providers who are incentivized to coordinate and provide care for a defined population, ACOs have emerged as a prominent model of care. Existing literature has highlighted quality improvements at lower costs, but the ability of ACOs to affect prevailing disparities, particularly within AD, remains understudied. Relying on rich administrative data and a quasi-random experimental approach, we will estimate the causal impact of Medicare ACOs on the diagnosis of AD and use of medical services among AD patients by race. We will also assess the role of various patient- and system-level factors in reducing health disparities. Specifically, we will examine how the racial concordance between physicians and patients and how the racial composition of ACO physicians, the ACO governance board, and the ACO market area affect the ability of ACOs to reduce health disparities. In light of the expanding aging population and increasing share of minorities, this research provides needed evidence on how incentives for care coordination impact the health outcomes of minority AD populations.
