Examining Collaboration, Health Equity, and Performance in Accountable Care Organizations: Insights into Racial Equity and Healthcare Outcomes

This study examines the role of collaborative governance in addressing racial and ethnic health disparities within Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program (MSSP). Racial and ethnic minorities in the United States often face greater healthcare barriers, resulting in poorer outcomes and heightened health risks. By focusing on collaborative structures within ACOs, this research aims to uncover how governing bodies address equity-related goals and assess the relationship between these initiatives and ACO performance. Specifically, the study will explore the association between ACO characteristics and the focus on racial and ethnic equity in governance practices, such as during meetings and in goal-setting processes. Using Emerson and Nabatchi's (2015) integrative framework for collaborative governance, we will analyze how collaborative dynamics, actions, and outcomes within ACOs influence equity initiatives and organizational performance. Data for this study will be gathered through surveys with ACO governance board members across the U.S. and combined with public data from the MSSP. This dual data approach will provide a comprehensive view of ACO governance practices related to racial equity and performance. Findings will inform whether ACOs with a higher concentration of minority patients place a stronger emphasis on racial equity, and if this focus correlates with performance outcomes. The results could guide policy recommendations on enhancing racial equity in healthcare and strengthening the MSSP’s capacity to address disparities effectively. By understanding how ACO governance structures address these complex issues, the study aims to offer actionable insights for policymakers and healthcare leaders committed to reducing healthcare disparities and improving equity in care delivery.