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One commenter appreciated CMS's efforts to implement a HEBA and acknowledged the challenge of developing a methodology to identify underserved beneficiaries for purposes of an ACO benchmark adjustment, noting that the proposed HEBA is a starting point and not necessarily the optimal approach. Another commenter supported the proposal to incentivize ACOs to treat rural and underserved beneficiaries through the establishment of the HEBA. Some of the supportive commenters encouraged CMS to find additional ways to support providers caring for underserved beneficiaries. The majority of supportive commenters believed that this adjustment will also improve beneficiary access to ACO providers in underserved areas, encourage equitable care for all beneficiaries, especially for dual-eligible beneficiaries who often face compounded health disparities, and improve participation in the Shared Savings Program by ACOs serving higher-risk beneficiaries

Exposure to a social stressor alters the structure of the intestinal microbiota: implications for stressor-induced immunomodulation

Goekkurt et al., 2009) with more survival (Goekkurt et al., 2006