Celebrate Women’s Equality Day on August 26 by Accelerating ACO Adoption

Women’s health is in the spotlight this week as our nation celebrates Women’s Equality Day. Notably, August 26 marks the enactment of the 19th Amendment, which recognized a woman’s right to vote and gave voice to a wide range of health and other issues. While much has changed since this landmark decision in 1920, women still face significant healthcare challenges, not the least of which includes a higher incidence of misdiagnoses than their male counterparts.

Diagnostic Inequality

Of the 12 million adults who are misdiagnosed each year, women and racial/ethnic minorities are 20-30% more likely to experience a diagnostic error. Research shows that women are 50% more likely to be misdiagnosed following a heart attack and 30% more likely following a stroke. Diagnosing an autoimmune disease can take approximately five years, while female-specific conditions (e.g., endometriosis, adenomyosis, fibroids, etc.) often take 10 years or more for accurate identification and diagnosis.

In the McKinsey Health Institute article, “Closing the women’s health gap: A $1 trillion opportunity to improve lives and economies,” the authors cite a study conducted in Denmark over a 21-year period that revealed women were diagnosed later than men for more than 700 diseases. For cancer, it took women two and a half more years to be diagnosed. For diabetes, the delay was four and a half years. Analyses of U.S. health records and studies indicate that fewer than half of women living with endometriosis have a documented diagnosis.

While it is not entirely clear why women suffer longer than men, here are two explanations:

1. Women are often labeled “too emotional” – Historically, clinicians used the term “hysteria” to characterize a woman’s emotional nature. Even in this age and time, physical symptoms such as difficulty breathing, sweating, nausea, or abdominal pain can be dismissed as manifestations of anxiety or stress. As a result, physical examinations may not be conducted to determine the cause conclusively.
2. Inadequate medical school training – Medical school curriculums could be a contributing factor, providing outdated training on reproductive system and female-specific conditions. Also, medical students are often taught to look for “patterns” to make an accurate diagnosis, and this can cause a misdiagnosis if a patient does not fit within specific parameters.

Closing the Disparity Gap

Regardless, it is incumbent on our healthcare system to close the women’s healthcare disparity gap. One answer is more personalized care through a value-based care model. The Centers for Medicare and Medicaid Services (CMS) goal is to bring every Medicare patient into a value-based care (VBC) arrangement by 2030. Pioneered by Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP), this model is proven to deliver high-quality care and improved patient experience, while generating Medicare savings. In a VBC model, providers work together to manage a patient’s overall health, factoring in personal goals and needs. Greater emphasis is put on the whole-person integrated care model, a patient-centric approach that addresses a person’s needs holistically by considering physical, mental, behavioral, social, and environmental factors.

While adoption of the VBC-based ACO model has been slower than CMS had hoped (as of January 2024 only half of current Medicare beneficiaries are aligned with an ACO), the model has proven to be successful at improving care, patient experience, and lowering costs, particularly when deploying advanced primary care. All providers should embrace VBC and ACOs to support broad transformation.

Aligning Pillars to Adopt VBC

Here are four pillars healthcare providers can incorporate to align with an ACO and successfully shift to a VBC-based practice:

1. Full risk-sharing – Accountability remains with providers, who participate in the economic savings associated with improving clinical results. In 2022, providers operating under the Direct Contracting Model delivered $484 million in net savings for the federal government while delivering high-quality care for patients. Building off success creates clear and transparent incentives for providers.
2. Upfront capitated payments – VBC depends on capitation payments to create financial stability for practices, enabling them to focus on patient care. These funds support infrastructure needs and facilitate flexible provider contracting to attract new clinicians and incentivize high-value care.
3. Financial predictability – To protect providers, one approach is limiting the impact of retrospective trend adjustment, helping ACOs to budget and invest with more certainty to better care for beneficiaries. Risk score adjustment beyond existing caps is proposed for underserved communities where lack of primary care access may inhibit full clinical documentation, helping to overcome unpredictable payments.
4. Sustainable Payment Formulas – Providers should be rewarded for meeting goals, ensuring the sustainability of value-based ACOs over the long term. One solution is shifting benchmarks to regional or national spending averages instead of an ACO’s historical performance, which protects the incentive to participate.

Ultimately, shifting to VBC is good for women’s health, providers, and the U.S. healthcare system. Focusing holistically on the entire person’s health needs and increasing care coordination to encourage broader population health management are ways to level the playing field, helping to reduce misdiagnoses and other health inequities.