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How the health of the poor may be left behind in Accountable Care Organizations

One of the big policy propositions of the Affordable Care Act was the establishment of “Affordable Care Organizations” (ACOs).  These new kind of HMOs are to be paid for taking care of the whole patient and rewarded for keeping that person healthy.  The first ACOs were rolled out in December 2011 and geared at Medicare patients.

There is an excellent commentary by Mr. El-Sayed that explains how the poor, usually the sickest, will likely be left out of this new type of health care arrangement.  He compares their likely inability to achieve equity to that which happened in schools trying to improve educational outcomes of students in poor areas.  Too many other social determinants impact both educational and health outcomes to expect either schools or health care systems to provide services adequate to overcoming those deficits and producing better outcomes.  It will just too expensive for these ACOs to provide care to the poorest.