Exhibit 3. Differences in quality performance measures from first to second year and coefficients from linear models regressing the change in each quality measure on the proportion of an ACO’s patients that are racial and ethnic minorities.

Mean change scores from of quality performance measures first to second year and coefficients from linear models regressing the change in each quality measure on the proportion of an ACO’s patients that are racial and ethnic minorities (unadjusted and adjusted for performance in first year), N=191; data from the Medicare and Medicaid Services Shared Savings Program ACO Public Use File, authors’ calculations

		Mean change	(SD)	Unadjusted	Adjusted for PY1
Patient/Caregiver experience	Getting timely care	−0.8	(3.0)	1.8	−1.0
	How well your doctors communicate	−0.4	(1.2)	1.8***	0.8
	Patient’s rating of doctor	−0.2	(1.3)	0.2	−0.4
	Access to specialists	−1.1	(2.4)	−1.3	−3.7***
	Health promotion and education	0.6	(2.8)	2.6**	2.4
	Shared decision making	0.1	(2.3)	−0.5	−2.4
	Health status/functional status	0.5	(1.8)	−1.0	−2.4***
Care coordination and patient safety	All-cause, unplanned readmissiona	0.2	(0.7)	−0.2	0.3
	Admissions: COPD or asthmaa	−0.1	(0.2)	0.1	0.2
	Admissions: CHFa	0.0	(0.2)	0.1	0.2*
	PCPs qualifying for EHR incentive pay	11.9	(12.8)	5.5	−11.6*
	Medication reconciliation after discharge	8.5	(23.9)	16.5	11.5**
	Screening for fall risk	14	(19.2)	−9.1	−13.3
Preventive health	Influenza immunization	5.2	(11.9)	−2.9	−8.7*
	Pneumococcal vaccination	5.5	(11.1)	3.5	−6.7
	Adult weight screening and follow-up	8.9	(14.0)	−8.9	−9.2
	Tobacco assessment & cessation intervention	4.7	(14.8)	−2.3	−11.0
	Depression screening	15.4	(20.7)	−12.5	−12.3
	Colorectal cancer screening	1.6	(11.0)	5.3	−4.4
	Mammography screening	2.5	(10.6)	−3.1	−13.6***
	Screening for high blood pressure	−10.5	(25.2)	2.0	15.6*
At-risk populations	Diabetes composite (hemoglobin A1c control, LDL control, blood pressure control, tobacco non-use, aspirin use, hemoglobin A1c poor controla)	5.7	(9.5)	4.3	−6.1
	Hypertension: controlling high blood pressure	2.6	(6.4)	1.9	−1.7
	IVD: complete lipid panel & LDL control	4.9	(10.1)	10.5**	−1.8
	IVD: aspirin use	5.7	(11.7)	6.1	−9.6*
	Heart failure: beta-blocker therapy for LVSD	2.1	(17.3)	−10.3	−2.6
	CAD composite (drug therapy for lowering LDL-cholesterol, ACE inhibitor or ARB therapy)	5.0	(14.2)	1.6	−3.0
ACO Quality Compositeb		3.0	(4.5)	0.0	−5.3**

Source: Authors’ analysis of Centers for Medicare and Medicaid Services Shared Savings Program (MSSP) ACO Public Use Files, 2013 and 2014 (see Notes 24 and 25 in the text).

Notes: N=191. Data are from first year and second year of MSSP contracts. PY1 is [INSERT]. Analysis on individual measure components of the diabetes composite and CAD composite was conducted and are similar to the composites, so are not shown here for parsimony.

^aIndicates a measure where positive results are worse, such as readmissions; this is the reverse of most measures.

^bThe quality composite is a 0–100 score that is multiplied by the total possible sharing rate to calculate the final sharing rate. For example, ACOs in Track 1 of the MSSP are eligible for up to 50% of savings generated. A quality score of 100 would mean the ACO would receive the full 50% of savings generated; a quality score of 50 would mean the ACO would receive 25% of savings generated. PCP is primary care physician. EHR is electronic health record. CHF is congestive heart failure. COPD is chronic obstructive pulmonary disease. LDL is low density lipoprotein. IVD is ischemic vascular disease. LVSD is left ventricular systolic dysfunction. CAD is coronary artery disease.

^*p < 0.10

^**p < 0.05

^***p < 0.01

^****p < 0.001