Accountable care organization changes in equity of ambulatory care quality by patient race and ethnicity, 2019-2022

There is limited information about accountable care organization (ACO) variation in equity of ambulatory care quality. We examine whether equity of care changed for racial and ethnic minority patients from 2019 to 2022 and the extent to which equity of care performance varied for 11 ACOs in Massachusetts over time. We analyzed ACO-level changes in equity of care for 8 ambulatory care quality measures for Asian, Black, and Hispanic patients, measured as the percentage point difference between each group and the majority non-Hispanic White patient group. Cervical cancer screening (3.54 percentage point change, P < 0.001), colorectal cancer screening (3.54 percentage point change, P < 0.001), and eye exams for adults with diabetes (3.56 percentage point change, P = 0.008) had the largest performance declines. Equity of ambulatory care quality did not significantly change over time. The one exception was for breast cancer screening, where equity declined for Asian patients (3.52 percentage point change, P = 0.04). Although equity of care generally did not significantly change over time across ACOs, high variation in equity of care performance between ACOs highlights opportunities to identify and share the strategies that enable physician practices and healthcare systems to advance equity of care for racial and ethnic minority patients.