NIH Awards Grant to Study Effects of ACOs on Child Asthma Care

The National Institutes of Health (NIH) awarded a $3 million grant to Sarah Goff, MD, PhD, a health services researcher at the University of Massachusetts Amherst, to study the effects of accountable care organizations (ACOs) on childhood asthma care, according to a recent announcement.

About 6 million children aged zero to 17 have asthma in the US, according to the Centers for Disease Control and Prevention (CDC). Asthma can be managed with medication, but CDC data shows that almost half of children with prescribed asthma medications do not regularly use them.

"As a clinician, I would see families struggling to figure out how to manage this chronic disease that's impacted by so many social determinants of health," Goff explained in the announcement. "And there are so many challenges to interface with—a fragmented health care system that can be difficult to navigate and so on."

Goff witnessed firsthand the impact of childhood asthma when working in Springfield, MA, the Asthma and Allergy Foundation of America’s (AAFA) top asthma capital in the US in 2019 and 2020. The NIH grant will allow Goff to analyze the new Medicaid ACOs in Massachusetts, which are in part intended to address social determinants of health.

Accountable care organizations were created with the intention of moving toward a value-based healthcare system and improving patient outcomes. But many have expressed concerns about ACO quality reporting measures.

In addition, CMS recently announced that the Next Generation ACO Model will end by the close of 2021, despite requests to extend it. The Next Generation ACO Model saved Medicare $558 million in 2019 alone.

Throughout the five-year study, Goff will analyze data from 17 Massachusetts Medicaid ACOs launched in 2018, looking at health outcomes for Medicaid-insured children with asthma compared to children with commercial insurance and Medicaid-insured children with non-ACO plans.

She also noted that Black and Latinx populations are significantly more likely to have asthma, pointing to social determinants of health and poor chronic disease management as deterrents to positive health outcomes among children.

"A substantial and growing number children with asthma in populations at risk for disparate health outcomes receive care in ACOs, but their effect on asthma quality of care, outcomes and disparities is not known,” Goff said in the announcement. “I'm really interested in healthcare reform and this question of whether value-based care will make a difference."

Goff and her team will also analyze claims data to determine patterns of ACOs over time. They will then conduct surveys and interviews with the ACOs to understand their care models. Goff also acknowledged that significant changes may happen gradually, and time will tell what positive or negative impacts ACOs are having on pediatric health outcomes.

“But after the first few years, in theory, the increased focus on care coordination and addressing social determinants of health could improve pediatric asthma care and outcomes for Medicaid-insured children in Massachusetts," she continued in the announcement. "It is also possible that, due to the complexity of the health care system and other factors, we may find minimal change, which is important to know, too."