Families USA’s Health Equity Task Force for Delivery and Payment Transformation offered a new report that highlighted the issues of inequities in healthcare with advice on how to protect patients.
Though payment and delivery reforms can help improve equity, the report warned that it could lead to even more systemic inequities.
The consumer group said areas to address for “health equity-focused transformation” include: payments that reward high quality, equitable care; investments in safety net and small community providers; partnerships with well-resourced community groups; transparency and improvement in health system research, so it represents a diverse patient population; linking payments to equity-focused metrics; and a diverse healthcare workforce.
Payers, providers and healthcare organizations have increasingly focused on social determinants of health (SDOH) as a way to improve population health. That requires programs that involve community groups and organizations to supplement services while patients are not within a doctor’s office or hospital.
Families USA urged policymakers to develop programs “with the explicit intent of advancing health equity.” The group added that including voices of communities of color and other disadvantaged groups in the decision-making should be a priority.
New programs should focus on inequalities in numerous areas, including race, ethnicity, sex, sexual orientation, English proficiency, immigration status, income and geographic location, according to the report.
The group suggested three areas to review when creating new payment models to make sure it doesn't adversely impact particular communities, such as low-income people; allow for risk adjustment for clinical and social risk; and address resource inequities, such as making sure safety net, rural and community hospitals receive proper funding.
“Safety net and small community providers face unique barriers to implementing new value-based payment models. Many of these models require significant upfront investments that these providers may be unable to make. However, they are often essential sources of culturally centered, geographically and language accessible care that should be supported, so they succeed in a value-based healthcare world,” according to the report.
One example of the use of SDOH is how providers, payers and community groups are coming together to tackle opioid abuse. They’re doing this through sharing data on factors like poverty rates and transportation available to find higher-risk cases before they reach a critical status.
Payers, especially Medicaid, can play a crucial role in population health programs that tackle SDOH. The National Quality Forum recently said Medicaid managed care organizations collect data that can be integrated with provider encounter data to get a complete look at a patient.
Massachusetts kicked off a project this year that looks to address SDOH issues. The accountable care organization in the commonwealth’s Medicaid program called MassHealth includes community partners to help providers and payers work with patients beyond the healthcare offices.
The ACO project will allow for participants to combine the claims data that Medicaid collects with Medicaid managed care payers and provider information that's on electronic health records and during a provider's upfront patient assessment. Payers can take that data and flag providers of patients with possible higher risks.