# The impact of population and episode-based payment models on surgical disparities

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2022 · $658,935

## Abstract

Project Summary
As a prominent leader in the nationwide shift towards value-based payment, Medicare has implemented large
fee-for-service population- and episode-based alternative payment models (APMs) that hold organizations
financially accountable for the quality and costs of care. However, these APMs are not designed to protect
access or outcomes for racial/ethnic minorities and individuals with low socioeconomic status. These
vulnerable groups already face significant surgical disparities compared to other individuals. These disparities
could worsen further under both APM types if participating providers engage in patient selection that reduces
vulnerable patients’ access to surgical procedures or changes their care after participating. Because
policymakers must make critical decisions about how to use different APMs to catalyze nationwide reform,
insight about how population- and episode-based APMs affect surgical disparities for vulnerable patients can
help policymakers determine how to best design, refine, implement policy adjustments, and scale up different
models to safeguard the care of vulnerable patients. This study examines how prominent Medicare fee-for-
service population- and episode-based APMs that are highly relevant to surgical care affect disparities in
surgical access and outcomes for vulnerable patients, across insurance coverage type, and whether effects
vary by providers’ financial attributes related to APM incentives. We hypothesize that APM participation will be
associated with widened disparities in surgical access and outcomes (quality, utilization, and cost) for
vulnerable vs. non-vulnerable patients after providers begin participating in APMs. We also hypothesize that
the impact on surgical disparities will vary by providers’ financial attributes – experience with financial risk and
payer mix – related to APM incentives.

## Key facts

- **NIH application ID:** 10494060
- **Project number:** 5R01MD015055-02
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Said A Ibrahim
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $658,935
- **Award type:** 5
- **Project period:** 2021-09-23 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10494060

## Citation

> US National Institutes of Health, RePORTER application 10494060, The impact of population and episode-based payment models on surgical disparities (5R01MD015055-02). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10494060. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*