Health Equity a Driver in New CMS Payment Models

The U.S. Centers for Medicare & Medicaid Services (CMS) has been working health equity components into new alternative payment models.

Much movement has taken place in the payment and policy realms towards closing disparities among underserved populations, according to Hope Glassberg, senior policy advisor at the Coalition to Transform Advanced Care (C-TAC) and president of Decipher Health Strategies.

To date, these have only struck the tip of the iceberg when it comes to addressing barriers, Glassgerg said, speaking at a recent C-TAC-Center to Advance Palliative Care (CAPC) Leadership Summit in Washington D.C

“There’s a separation that’s often too wide between policy and on-the-ground practice,” Glassberg said at the summit. “But we are at an interesting moment in the policy environment, with a lot of windows of opportunities and attention focused on health equity. Health equity itself is worth quite a lot of unpacking. We’re in this unique moment of activity with lots more to be done. It’s not enough, but there’s some really interesting windows that we should capitalize on and walk through.”

Glassberg previously served as special assistant to the Medicaid director at CMS, as well as policy fellow at the U.S. Department of Health & Human Services’ (HHS) Office of Health Reform.

CMS has gradually been implementing policies and programs designed to improve health equity, according to Glassberg. This includes the integration of health equity components in new payment model demonstrations.

But unpacking the myriad challenges is no easy feat in a complicated health care system that can at times be “abstract” or “distant” from the actual needs of underserved communities, Glassberg stated.

For instance, individuals with behavioral health conditions and cognitive disorders on top of a serious illness often hit roadblocks when it comes to hospice and palliative care, along with those with intellectual, developmental and physical disabilities, she said. Hospice and palliative care providers are part of a “multifactorial balance” that involves many health sectors, with forthcoming policies that could be “quite promising” in piecing together better support for these and other patients, Glassberg said.

Case in point, CMS’ Office of Minority Health (OMH) recently launched an $18 million project in collaboration with the National Committee for Quality Assurance (NCQA) aimed at supporting health equity advancement and reducing disparities affecting underserved populations. Dubbed the Health Equity Accelerator, the project includes a five-year partnership between NCQA and subcontractors The RAND Corporation and Rainmakers Strategic Solutions LLC.

The initiative will work to assess chronically ill patients’ mental and behavioral health needs, as well as social determinants of health issues that often lead to hospital readmissions. Additionally, the project will examine ways to design supportive services through data-driven evidence around the impacts of artificial intelligence on health care.

Policymakers have an opportunity to build systems that could improve outcomes among populations facing health care inequities, according to Dr. Kimberly Angelia Curseen, director of outpatient supportive care at Emory Healthcare’s Palliative Care Center. She is also director and clinician at the Supportive Oncology Clinic at the Emory Winship Cancer Institute.

Hospice and palliative care providers have a unique window into underserved populations at the most vulnerable points in their health trajectories. Nevertheless, more change is necessary at the system level, Curseen indicated.

“What we are able to do in our day-to-day practices as clinicians to reduce racial disparities is [devote more financial resources to assess health equity], because we’re witnessing the manifestation of structural inequities and structural racism, biases and inefficiencies in our system,” Curseen said at the C-TAC-CAPC Leadership Summit. “We can identify what these are and take that to our policymakers and advocate for structural things that are important.”

Another move came when CMS launched the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) model on Jan. 1, which replaced the Global and Professional Direct Contracting (GPDC) models. The ACO REACH payment system is in part designed to increase the impact of the agency’s Health Equity Benchmark Adjustment, which rewards participants that are doing a good job of improving equal access and quality across patient populations.

CMS has also gradually added health equity elements to the hospice component of the value-based insurance design (VBID) model.

Now is the time for hospice providers to become more engaged in addressing health equity, according to Curseen. This should include advocating for their patients with policymakers, she said.

“We have an opportunity to meet our policymakers and bring solutions that are created by the people who actually need them,” Curseen said. “We will never fix these disparities unless we strive for justice and ensure these communities are resourced in a right, fair and equitable way.”