Public Health.

Area of Science:

• Health Economics
• Geriatric Care
• Health Policy

Background:

• Accountable Care Organizations (ACOs) show potential for improving care coordination and cost savings in Alzheimer's disease and related dementias (ADRD).
• Residents of socially disadvantaged neighborhoods, often facing higher social vulnerability, are less likely to enroll in ACOs.
• Understanding ACO impact on Medicare payments for ADRD patients in vulnerable areas is crucial for equitable healthcare policy.

Purpose of the Study:

• To assess the cost-saving potential of ACOs for Medicare beneficiaries newly diagnosed with ADRD.
• To examine the influence of neighborhood social vulnerability (SVI) on ACO cost-saving effects.
• To evaluate the impact of ACO quality and continuous enrollment on Medicare expenditures.

Main Methods:

• Analysis of Medicare data (2016-2020) for 293,173 newly diagnosed ADRD patients.
• Integration of Medicare Shared Savings Program (MSSP) ACO data and Social Vulnerability Index (SVI).
• Stratification by SVI levels and ACO enrollment; multivariable generalized estimating equation models with interaction terms.

Main Results:

• ACO enrollment significantly reduced total Medicare payments across all SVI subcategories.
• The most substantial savings were observed in high-minority neighborhoods.
• Higher quality ACOs and continuous enrollment were associated with progressively lower total Medicare payments, with a 7% reduction in the highest quality ACOs.

Conclusions:

• ACOs effectively reduce Medicare spending for ADRD patients, particularly in socially vulnerable populations.
• Targeted policies and interventions are needed to expand ACO enrollment in underserved communities.
• Enhancing ACO quality and promoting continuous enrollment can maximize cost savings in dementia care.