Payers, Providers Work to Keep Health Equity in the Spotlight

Concern is mounting around whether current health equity initiatives will be a flash in the pan or yield long term improvement on reducing disparities in hospice care among communities of color.

Racial disparities in end-of-life care access have long proliferated, but in recent years health care providers and regulators have been paying closer attention, particularly after the pandemic exposed cracks in a fragmented health care system.

Black Americans died at 1.4 times the rate of caucasians nationwide due to COVID-19, representing 15% of all pandemic-related deaths as of March 2021, according to data from the U.S. Centers for Disease Control and Prevention (CDC). American Indian or Alaska Native populations ranked as the second highest group of lives lost to the deadly virus, while Hispanic and Latino individuals represented the third, the CDC report found.


Payers and providers must work together now to ensure lasting improvement in health equity, according to Chiquita Brooks-LaSure, administrator of the U.S. Centers for Medicare & Medicaid Services (CMS).

“There was some fragility certainly before the pandemic, but there is much more fragility than 10-15 years ago,” Brooks-LaSure said during the HLTH Conference in Las Vegas. “We have a particular moment in time where health equity and health disparities are being talked about in circles where we didn’t talk about them. We have to make sure this moment isn’t just a blip … but that it becomes part of how we approach our health care system and really embedded in everything we do.”

Only 20% of all Medicare hospice patients in 2018 were people of color, compared to caucasians that represented the remaining 80%, according to the National Hospice and Palliative Care Organization (NHPCO).


This means many people of color who could benefit from hospice are not getting the care they need, according to Diane Deese, vice president of community affairs at VITAS Healthcare, a subsidiary of Chemed Corp. (NYSE: CHE) .

Misconceptions and a lack of understanding of the nature of hospice are among the most prevalent contributing factors, Deese indicated.

“Many people who could benefit from hospice are not getting the care they deserve,” Deese told Hospice News in an email. “We can improve hospice utilization in these communities by addressing the factors that limit access to end-of-life care. In particular, helping people learn about hospice, how it’s paid for, and the benefits of receiving the care, so that patients and families can make a decision that is right for them.”

Health equity has been at the core of several payment initiatives designed to expand access among underserved communities, as well as reduce costs and improve quality.

One example is the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) program that the Center for Medicare & Medicaid Innovation (CMMI) is rolling out to replace the Global and Professional Direct Contracting (GPDC) model.

Effective Jan. 1, 2023, the ACO REACH program opens doors for hospices to collaborate with participating providers and share in cost-saving arrangements aimed at improving care delivery among underserved communities.

CMS has also worked in health equity benchmarks into other payment models in the hospice landscape, such as the value-based insurance design model (VBID) demonstration, creating financial incentives to stoke providers’ diversity, equity and inclusion efforts.

“It’s really important that as we think about all of these innovative models that we make sure people can actually get them,” Brooks-LaSure said. “It’s so critical as we think about how to move forward to really make sure that we build back our health care system in a much stronger way. The last couple of years have taught us that when we’re not taking care of the least among us it affects all of us.”

A key component of fostering health equity involves recruiting and retaining a diverse workforce, according to Deese. Diverse representation in staff translates to more inclusive patient care, she added.

VITAS recently received recognition from the American Association for Men in Nursing (AAMN) for creating an inclusive and diverse environment for patients and families. The home health and hospice provider was the first business to receive AAMN’s Inclusion & Diversity Excellence Award, typically issued to individuals influencing change in their communities.

“We work to build an inclusive and diverse workplace by recruiting and attracting a workforce that reflects the communities we serve,” Deese said. “It is vitally important to cultivate an inclusive and welcoming environment for staff, as it empowers them to bring their authentic selves to work, which leads to better patient care. Employees bring their experiences and backgrounds, both personal and professional, to work each day, which enables them to connect with patients and their loved ones in a unique and meaningful way.”

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