A challenge for rural and low-income areas under the ACA outcome-based model is a lack of data infrastructure to collect outcome metrics.

• A. Lack of data infrastructure for outcome metrics
• B. Abundant data and privacy concerns
• C. Excess funding for infrastructure
• D. Too much follow-up care

Answer: (A)

Outcome-based payment relies on reliable data about health outcomes to determine reimbursement and track progress. In rural and low-income areas, data infrastructure is often limited—there may be gaps in electronic health records adoption, interoperability between systems, and enough staff to manage and analyze data, plus scarce funding for data systems. Without strong infrastructure to collect, standardize, and report outcome metrics, providers can’t demonstrate value or meet reporting requirements, making participation in value-based models difficult. The other options don’t fit this real-world barrier: data abundance and privacy concerns aren’t the primary hurdle here, while excess funding and excessive follow-up care are not typical challenges in these settings.