ACO REACH’s Health Equity Benchmarks: A Primer for Hospices

The diversity, equity and inclusion components of Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) program show promise for expanding access to care.

But it means participating hospices will need to devote scarce resources to meet program requirements.

The Center for Medicare & Medicaid Innovation’s (CMMI) last year announced a “strategy refresh” that included a renewed focus on health care equity in payment model design. ACO REACH is among the first new models to use this approach.

The program, set to launch in 2023, replaces the Geographic Direct Contracting Model and the Global and Professional Direct Contracting (GPDC) models.  

Participating providers must develop and implement a robust health equity plan that both identifies underserved communities and lays out initiatives aimed at measurably reducing health disparities within their beneficiary populations.

“Overall, this is a really great step in the right direction in trying to improve access to care. This is about defining the problem, and then working on explaining what your solution is in that area,” Annie Acs, senior director of policy and innovation for the National Hospice and Palliative Care Organization (NHPCO), said. “It goes back to how you track data and outline the requirements that you’re setting forth in your application, and then identify both timelines and approaches to measuring and monitoring your progress. There may be more data collection requirements, and that is always a challenge with workforce issues.” 

Acs outlined a three-pronged approach to meeting these requirements, starting with identifying data sources that help define the health disparities or the underserved communities within your service area.

Secondly, providers would need to explore various interventions for reaching the underserved communities that they have identified. The third pillar would be to establish partnerships with community organizations to identify and leverage existing resources.

Racially diverse and LGBTQ+ communities are among those that have been historically underserved by hospice and the health care system at large.

NHPCO reported that in 2018 more than 80% of overall Medicare hospice patients were Caucasian, while African Americans, Asians and Hispanics made up less than 20% combined.

Though data on hospice utilization among LBGTQ+ communities are limited, research has indicated that these groups lack access to hospice care, come on to services too late or avoid it entirely due to fears that they’ll face discrimination from providers.

ACO REACH was in part created with the intent to increase access for historically marginalized populations. This may offer benefits to providers as well as patients themselves, according to Nicole McCann Davis, director of strategic planning for Intouch Group.

One reason is that health care companies that prioritize diversity, equity and inclusion are 35% more likely to out-perform their competitors, McCann Davis told Hospice News.

“Our society continues to evolve with approximately 40% of the U.S. population composed of multicultural people, yet most hospice organizations are not prioritizing their marketing efforts here,” said McCann Davis. “Hospice organizations should look at this as an opportunity to expand innovation and not as a hindrance. A health equity plan should be approached with the same vigor as an organization’s overall strategic plan.”

Effective data collection regarding patient demographic and social determinants of health will be essential to hitting health equity benchmarks in ACO REACH. Ultimately, providers need to integrate equity, diversity and inclusion efforts into every aspect of a hospice patient’s (and employee’s) experience, McCann Davis told Hospice News. This requires engagement from organization’s operations, clinicians, human resources, marketing and its executive leadership.

The payment model includes financial incentives to reward providers for improving health equity. This comes in the form of a benchmark adjustment for payments to ACOs serving higher numbers of underserved beneficiaries.

To help prepare for ACO REACH, hospices should update patient screening tools and ramp up staff education on how to identify and manage unmet high-needs populations, according to Brian Bertram, vice president and co-founder of Infinity Hospice Care and Care and managing partner of Nevada Care Connect in Las Vegas.

Participating hospices should work health equity initiatives into their compliance programs and perform self-assessments on their ability to deploy screening tools, develop equity plans, and test and report on their effectiveness, Bertam told Hospice News. This will include training staff to think differently and ask different types of questions.

“Health equity strategies need to be as diverse as the populations they serve,” Bertram said. “There is no one-size-fits-all approach. We have to think about resources in human capital in a different way in a demonstration project with the ability to look at data and provide more information than we were in the past.”