Health Equity a Key Theme of Health Care Value Week

By Matt Devino, MPH, Director of Cancer Care Delivery and Health Policy, ACCC

From January 24-28, 2022, ACCC co-sponsored Health Care Value Week, a series of virtual events with the purpose of supporting the advancement of value-based care. By highlighting the success stories of value-based payment models, the event celebrated the progress they have had in providing more equitable, accessible, and affordable care in the United States. The programming featured roundtable discussions with prominent industry thought leaders as well as participation by top Administration officials from the Centers for Medicare and Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI).

A key topic of many of the week’s conversations was the CMS Innovation Center strategy refresh, which was summarized in a white paper published by the agency in October 2021. The strategic refresh identified five objectives for advancing health system transformation during the next decade, including the goal of advancing health equity. In her remarks during Health Care Value Week, CMMI Chief Medical Officer Dora Hughes, MD, MPH, highlighted the following actions necessary to achieve this strategic objective:

• Embed health equity in the development of all new and existing Innovation Center models
• Increase safety net provider participation in value-based payment models to ensure models serve more diverse communities
• Evaluate models for their impact on health equity and apply lessons learned to new and current models
• Improve data collection to capture not only beneficiaries’ demographic data, but also data on their social needs and social determinants of health

As summarized in the white paper, analyses of several of CMMI’s largest alternative payment models have indicated that Medicare beneficiaries aligned to these models are more likely to be white, less likely to be dual eligible for Medicaid, and less likely to live in rural areas compared to the overall population of Medicare beneficiaries in a particular region. To address this disparity, CMMI’s goal is to ensure that 100% of new models include safety net providers, including community health centers and disproportionate share hospitals, to reach more poor and vulnerable populations. This, however, is easier said than done, considering the myriad obstacles that make it challenging for community providers to participate in these models.

Barriers to Change

CMMI is aware of the financial and operational barriers to participating in alternative payment models and is trying to identify strategies to mitigate them. CMMI Director Elizabeth Fowler, JD, PhD, stated in her opening remarks that the agency is looking closely into opportunities to provide upfront financial and technical support to new program participants, as was done in the ACO Investment Model for providers joining the Medicare Shared Savings Program. Other speakers astutely pointed out that providers in these underserved communities already lack sufficient resources to support comprehensive care, so this type of support is needed throughout the duration of a model, not just up front.

The other challenges CMMI must grapple with are data collection and standardization in order to appropriately risk stratify and evaluate models while making strides to reduce inequities in care. According to Dr. Hughes, business and IT specialists within CMMI are already focused on this work, seeking to create FHIR-based questionnaires that providers can use to collect demographic and social needs information and easily share it with CMMI. It will also be important that CMMI integrate appropriate incentives and sufficient reimbursement into these models to ensure that the additional reporting burden doesn’t fall on community providers alone.

It is clear that CMMI still has much to figure out in turning its strategic objectives into actionable tools and programs. As the agency works to implement its health equity initiatives, providers should take this opportunity to share their experiences with treating disadvantaged patients and their practical concerns with the implementation of new data collection requirements. Oncology practices and programs interested in contributing their thoughts on this strategy refresh may submit their feedback directly to CMMI by emailing CMMIStrategy@cms.hhs.gov, and they are encouraged to contact Matt Devino, MPH, Director of Cancer Care Delivery and Health Policy at ACCC, with their concerns.