How Health Equity Payment Models Are Impacting Hospice Staff Diversity

Recent health equity initiatives in hospice reimbursement may reverberate impacts into providers’ staff recruitment and retention strategies, particularly when it comes to leadership roles.

The Center for Medicare & Medicaid Innovation (CMMI) in 2021 announced a “strategy refresh” that included focus on health care equity in payment model design. The Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) program is among the first new models to use this approach.

Effective Jan. 1, the model requires participating providers to 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.


While equity-focused reimbursement channels like ACO REACH hold promise in helping to reduce disparities, unknowns exist around how providers should shape their care delivery approaches and where to pour operational and financial resources, according to Hospice of Acadiana CEO Keith Everett.

“The framework that’s been building up around health equity in payment has some real beneficial things happening,” Everett told Hospice News. “Whenever there’s these shifts it can bring a sense of unknown in hospice that uncertainty can be a little scary and hold a degree of fear in what the future holds.”

A key for hospices to understand about health equity payment programs is that strategies to improve disparities can come in a variety of ways, which can be both a challenge and opportunity for providers, Everett said.


“There’s opportunity in these new care models, but hospices have to be strategic to determine what’s best for the patient populations in their community,” he said. “It’s key to bridge better community partnerships [and] to be really resilient around staffing challenges.”

One area of focus is to grow a more diverse employee base — not just in terms of interdisciplinary staff who interact with patients and families, but also among leadership teams, according to André Lee, co-founder and administrator of Heart ’n Soul Hospice.

The hospice industry at large lacks leaders of color, which can hinder organizations’ ability to understand the barriers experienced among underserved populations, Lee indicated.

Having executive staff from diverse racial, ethnic and cultural backgrounds can help hospices gain a bigger picture around the breakdowns in access and awareness within their communities, which in turn could steer diversity and inclusion efforts, he said.

“We’re slowly getting to a place of more diversity in hospice, but by and large there are not many minority-owned organizations,” Lee said. “We still don’t have a great minority representation at board and C-suite levels, so it can be difficult to establish good relationships in the community and show that you welcome minority patients. It’s also difficult to then recruit those from different backgrounds if they don’t see leaders who look like them and empathize with their challenges. It makes it that much harder when you don’t have greater representation to help break down disparities in hospice access.”

Community collaborations are key to knowing where to search for hospice professionals from diverse backgrounds, according to Agrace Hospice & Supportive Care CEO Lynne Sexten.

The Wisconsin-based hospice provider partners with several community organizations in traditionally underserved and underrepresented communities, such as indigenous tribes of the Ho-Chunk Nation, the Latino Health Council and the LGBTQ+ Chamber of Commerce, among others.

The community collaborations have helped foster conversations around career opportunities in hospice that might otherwise be unknown among underserved groups, Sexten stated.

Having a stronger relationship with different community groups has helped fuel diversity among Agrace’s staff, she said during the Hospice News Staffing Summit. Roughly 16% of the hospice provider’s workforce are those from communities of color, Sexten said.

“We’re building and constantly working to become the kind of environment where folks feel like this is an organization they can belong,” Sexten told Hospice News. “[These] organizations are so important to the fabric of some of the underrepresented communities. [Diversity, equity and inclusion (DEI)] is something we invest resources in, it’s not an adjunct to just a few people’s jobs. It’s been rewarding to watch all of the work we do pay off.”

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