The Centers for Medicare & Medicaid Services (CMS) Office of Minority Health has released a 19-page plan to address health equity gaps for underserved Medicare beneficiaries, improve their access to care, and measure the success of this undertaking. The CMS Equity Plan for Improving Quality in Medicare was presented in early September at the 50th anniversary of Medicare and Medicaid conference and the 30th anniversary of the “Report of the Secretary’s Task Force on Black and Minority Health.” The plan represents the first-ever equity program to be developed by CMS.1
Oncology Practice Management asked Jonathan Rubenstein, MD, Director of Coding and Compliance, Chesapeake Urology, Baltimore, whether the new CMS Equity Plan is likely to reduce disparities in healthcare delivery or simply add administrative burden to community practices.
“Some may take a cynical view and believe this is another step in the movement of doctors and other healthcare providers to being merely cogs in the wheel of an ever-expanding and bureaucratic healthcare system, with more and more directors telling providers how to practice medicine, reducing physician judgment and individualized treatment,” responded Dr Rubenstein.
“However, if looking at a more global concept, if programs such as this do achieve their desired goals, overall there would be improved healthcare access, delivery, patient outcomes, and reduction of healthcare costs,” he said.
The 6 Steps to Improve Access, Care Delivery
Determined based on an evidence review and stakeholder input, the plan involves 6 priorities for achieving health equity among racial and ethnic minorities, sexual and gender minorities, people with disabilities, and rural residents, with an emphasis on chronic diseases.
“As we strive to create a health care system that provides better care, spends dollars more wisely and creates healthier people, CMS is committed to achieving equity for minority and other underserved populations and eliminating health disparities among Medicare beneficiaries,” said CMS Acting Administrator Andy Slavitt.1
CMS outlined the following steps to achieving equity in healthcare delivery, quality, and access to care for provider practices and other stakeholders2:
- Expand the collection, reporting, and analysis of standardized data
- Evaluate the impact of inequities and integrate solutions in CMS programs
- Develop and disseminate promising strategies to reduce health disparities
- Improve the healthcare workforce’s ability to meet the needs of disadvantaged populations
- Improve communication and access to care for people with limited English proficiency and those with disabilities
- Improve access to healthcare facilities for people with physical disabilities.
The plan involves a strong focus on evaluating and measuring the success of the program, and on using the findings to improve the program. The goals and strategies of the CMS Equity Plan are outlined in the Figure.
“We will identify, establish, and track specific performance metrics to assess progress across priorities and activities. Inherent in this evaluation is a continuous quality improvement process and feedback loop that will be used to make changes, when needed, and show improvement over time,” the report states.2
The Equity Plan will facilitate efforts to improve care quality “by disseminating best practices for the collection, reporting, and analysis of standardized data on race, ethnicity, language, sexual orientation, gender identity, and disability status so that stakeholders are able to identify and address the specific needs of their target audience(s) and monitor health disparities,” the report states.2 CMS will use data collection, reporting, and analysis to better allocate resources to meet needs.
Implications for Healthcare Providers
Among the plan’s goals are reducing hospital readmissions among vulnerable patients with more than 1 chronic condition, such as diabetes or cardiovascular disease, and increasing the quality of nursing home and hospital care through mechanisms such as the provision of culturally and linguistically appropriate services, for minorities and people with disabilities.
These goals will involve developing ways to equip healthcare workers with more cultural competence and increase their engagement with patients and their families, according to CMS, to produce more patient-centered care “not only through physician interactions, but also with nurses, pharmacists, health educators, community health workers, and dieticians who are equipped to reach patients where they are and communicate effectively with them.”2
There are several ways to view the plan’s purposes, according to Dr Rubenstein. “One, gathering data to see if certain ‘at-risk’ populations truly have reduced access to care and poorer outcomes or not. Two, an attempt to improve access and the health of certain populations that may have reduced access and poorer outcomes. And three, reducing healthcare costs to Medicare, if a disproportionate amount of money is spent on those with reduced access or those at higher risk,” Dr Rubenstein said.
- Centers for Medicare & Medicaid Services. CMS releases first ever plan to address health equity in Medicare. Press release. September 8, 2015. www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-09-08.html. Accessed October 2, 2015.
- Centers for Medicare & Medicaid Services; Office of Minority Health. The CMS equity plan for improving quality in Medicare. September 2015. www.cms.gov/About-CMS/Agency-Information/OMH/OMH_Dwnld-CMS_EquityPlanforMedicare_090615.pdf. Accessed October 2, 2015.