Center for Population Health, Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, New Hampshire, USA.
Health Aff (Millwood). 2012 Aug;31(8):1777-85. doi: 10.1377/hlthaff.2012.0490.
Accountable care organizations (ACOs) are a promising payment model aimed at reducing costs while also improving the quality of care. However, there is a risk that vulnerable populations may not be fully incorporated into this new model. We define two distinct vulnerable populations, clinically at-risk and socially disadvantaged, and we discuss how ACOs may benefit each group. We provide a framework to use in considering challenges for both vulnerable patients and health systems on the path to accountable care. We identify policies that can help overcome these obstacles: strategies that support ACO formation in diverse settings and that monitor, measure, and reward the performance of providers that reach all patients, including vulnerable populations.
责任医疗组织（ACO）是一种有前途的支付模式，旨在降低成本的同时提高医疗质量。然而，弱势群体可能无法完全融入这种新模式，这存在一定风险。我们定义了两种不同的弱势群体，即临床高危人群和社会弱势群体，并讨论了 ACO 如何使每个群体受益。我们提供了一个框架，用于考虑在实现责任医疗的道路上，弱势患者和卫生系统所面临的挑战。我们确定了一些可以帮助克服这些障碍的政策：支持 ACO 在不同环境中形成的策略，以及监测、衡量和奖励为所有患者（包括弱势群体）提供服务的提供者的绩效的策略。
