• Eileen J Carter, Yuen Tsz Abby Lau, Laurel Buchanan, David M Krol, Jun Yan, and Robert H Aseltine.
• University of Connecticut School of Nursing, 231 Glenbrook Rd, Storrs, CT 06269. Email: eileen.carter@uconn.edu.
• Am J Manag Care. 2024 Oct 1; 30 (10): e282e288e282-e288.

ObjectivesTo examine associations between accountable care organization (ACO) membership and human papillomavirus (HPV) vaccination and to evaluate variation in HPV vaccination across ACO providers.Study DesignRetrospective cohort study.MethodsWe analyzed the records of commercially insured children and adolescents aged 11 to 14 years using Connecticut's All-Payer Claims Database from January 2012 to December 2017.ResultsA total of 23,911 adolescents receiving care from 933 ACO-attributable providers and 923 non-ACO-attributable providers were included. The mean rate of HPV vaccine initiation was 53% overall (51% among boys, 55% among girls). Among those who initiated the vaccine, the mean rate of HPV vaccine completion was 69% (67% among boys, 70% among girls). Adolescents receiving care at ACOs vs non-ACOs were significantly more likely to receive initial HPV vaccination (OR, 1.80; 95% CI, 1.69-1.91) and to complete the HPV vaccine series (OR, 1.12; 95% CI, 1.01-1.23). Among adolescents receiving care in ACOs, providers were responsible for 14% of variability in HPV vaccine initiation and 10% of variability in HPV vaccine completion and ACOs were responsible for less than 1% of variability in HPV vaccine initiation and completion.ConclusionsAdolescents receiving care from ACOs were significantly more likely to initiate and complete HPV vaccination than were adolescents receiving care in non-ACO settings. Variation in HPV vaccine uptake attributable to providers within ACOs dwarfed variation attributable to ACOs, indicating that vaccine uptake was more dependent on the provider irrespective of the ACO with which they were affiliated. Efforts to improve HPV vaccination rates may require provider-focused interventions regardless of the overall performance of their health care system or provider organization.

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