OBJECTIVES. Accountable care organizations (ACOs) have been successful in improving quality of care but little is known about who is benefitting from ACOs and through what mechanism. This study examines variation of potentially preventable hospitalizations (PPHs) for chronic conditions with co-existing depression in adults by hospital ACO affiliation and care coordination strategies by race/ethnicity.

METHODS. Eleven 2015 State Inpatient Databases were used to identify PPHs for chronic conditions with co-existing depression by race/ethnicity; the 2015 American Hospital Association’s Annual Survey to identify hospital ACO affiliation, and AHA’s Survey of Care Systems and Payment (collected January-August 2016) to identify hospital ACO affiliation and hospital-based care coordination strategies, such as telephonic outreach, and chronic care management. In 2019, multiple logistic regressions were used to test the probability of PPH by ACO-affiliation and race/ethnicity. A sub-sample analysis of ACO-affiliated hospitals repeated the tests by care coordination strategy.

RESULTS. PPHs were significantly lower among ACO-affiliated hospitals compared to ACO-unaffiliated hospitals. Lower PPHs rate were observed among White, African American, Native American, and Hispanic patients. Effective care coordination strategies vary by patients’ races. Results also showed variation of the adoption of specific care coordination strategies among hospitals affiliated in ACOs. Analysis further indicated effective care coordination strategies varies by patients’ race.

CONCLUSIONS. ACOs and specifically designed care coordination strategies can potentially improve PPH rates and racial disparities among patients with depression. Findings support the integration of mental and physical health services and provide insights for CMS risk adjustment efforts across race/ethnicity and socioeconomic status.