The Centers for Medicare and Medicaid (CMS) has released an updated framework for health equity which includes their five main priorities for 2022-2032. This framework encourages all parts of the health care ecosystem to consider what they can do to address social determinants of health (SDOH) and outlines the programs CMS is working on to facilitate improvement. The five priorities are as follows:
Priority 1: Expand the Collection, Reporting, and Analysis of Standardized Data
Priority 2: Assess Causes of Disparities Within CMS Programs, and Address Inequities in Policies and Operations to Close Gaps
Priority 3: Build Capacity of Health Care Organizations and the Workforce to Reduce Health and Health Care Disparities
Priority 4: Advance Language Access, Health Literacy, and the Provision of Culturally Tailored Services
Priority 5: Increase All Forms of Accessibility to Health Care Services and Coverage
Here we examine the role those in the Home and Community Based Services (HCBS) space will play in meeting the needs of their underserved or disadvantaged participants and improving their participants’ outcomes.
Priority number one for CMS is capturing risk data. The framework discusses the importance of data collection for social risk factors, patient demographic data, and disability status. CMS specifically calls out those in Post-Acute Care and HCBS as being well-positioned to collect this data as well as connect participants with social services.
The recent developments in health IT are making it possible for providers to gather better data and give payers a more accurate picture of potential disparities among the populations they serve. Technology is and will continue to be a critical tool for gathering SDOH data and is something CMS plans to use to better support healthcare organizations and meet the social needs of patients.
CMS is already implementing programs to help facilitate this collection. For example, the CMS Innovation Center will require all new model participants to collect and report demographic data of their enrollees and, as appropriate, data on SDOH. In addition, Medicaid and CHIP are focused on making sure their data is accurate and consistent. According to the framework, “to advance these aims, CMS will work with states to improve the measurement of health disparities across a core set of stratified metrics.”
HHAeXchange understands the importance of this data collection, and how it can ultimately improve participant outcomes, which is why we created our Care Insights tool. This tool empowers caregivers by enabling them to easily collect and record observations related to SDOH at the point of care.
The second priority CMS outlines is about looking inward. CMS recognizes that they have a responsibility to improve access to health care coverage for underserved populations. This means expanding and strengthening health care coverage, through Medicaid, CHIP, Medicare, and Health Insurance Marketplaces. Despite the expansion of Medicaid and Health Insurance Marketplaces, which has helped millions of Americans receive coverage for the first time, there are still major disparities. The systemic inequalities present in our society mean that many people in disadvantaged communities still have gaps in coverage, which often results in poor health outcomes and unnecessary tragedy.
CMS hopes to evaluate their current programs and policies to see where they can improve their approach to better address health equity. One area they include as an example of a positive change that could be made is regarding HCBS. They mention leveraging SDOH data to identify people who could use social supports or HCBS and then bringing those services to the person. This would be especially impactful in underserved communities who may lack access to care normally.
According to CMS, “We are taking a whole-person view when investing in appropriate, targeted health equity interventions: identifying areas for reducing inequities at the population level, such as avoidable admissions, and setting targets for reducing those inequities, and considering how to make investments in populations with especially large disparities.”
CMS understands that participant care is only going to be as good as the health care organizations administering that care. That is why their third priority aims to better equip health care professionals with more resources, as well as knowledge about how to improve health equity in their communities.
One way they intend to do this is by addressing workforce shortages and network coverage. As those in the homecare community can attest, caregiver shortages are affecting the number of members providers can serve. According to the 2022 Home Care Pulse Benchmarking Report, 85% of homecare agencies had to turn down cases as a result of the caregiver shortage. And according to CMS these workforce shortages are having a greater impact in rural areas, tribal communities, and communities who have experienced historical inequities. Allocating the proper resources to improve the workforce challenges these communities are facing will mean that homecare professionals can serve these vulnerable populations and help improve their access to the care they need.
Language barriers and low health literacy can hinder people from receiving proper care and can become a patient safety risk, cause negative health outcomes, and prevent people from enrolling in health coverage. And according to CMS, nearly nine percent of the U.S. population are persons with limited English proficiency and nearly 36 percent have low health literacy.
To improve health equity and outcomes, CMS is working to develop resources and tools in multiple languages and for different health literacy levels. These include frameworks and plans, toolkits, and guides to meet the needs of specific populations.
Addressing language and health literacy is especially important for those in the homecare ecosystem because according to CMS, people on Medicaid are at increased risk of low health literacy. In order to improve communication effectiveness, those in the homecare field should make sure that the tools they use are offered in multiple languages. Beyond this, to facilitate the highest level of care and to reduce disparities, participant/caregiver matching should be top of mind. By providing individuals with caregivers who speak their language, members may see improved health outcomes.
The final priority on the CMS framework seeks to improve accessibility for people with disabilities. They highlight that the rates of disability increase with age and are higher among racial and ethnic minorities. Not only that, but those with disabilities are more susceptible to chronic conditions and infectious diseases. Making sure people with disabilities have equal access to quality care is an important responsibility of CMS and that means making sure care is physically accessible. Navigating health care buildings can be a barrier for someone who has a disability, which is why it’s important that health care organizations make changes to their facilities to guarantee they are meeting the needs of their patients. This also means increasing access to HCBS. CMS plans to work with health care organizations to increase awareness of programs for people with disabilities such as Medicaid programs for individuals who need help with Activities of Daily Living, Home and Community Based Services (HCBS), and Disability Competent Care Training Resources.
According to CMS, “we will continue to work with Congress and other federal partners to advance HCBS improvement and reform and to make continued investments in this area.”
As policy increasingly supports the goal of improving health disparities and bettering participant outcomes through value-based care, homecare providers find themselves in a particularly impactful position to support these initiatives. Clinicians in hospitals and outpatient facilities can only rely on self-reported data when it comes to participants’ social needs and social determinants of health. Caregivers on the other hand are in the home and can observe the member’s environment firsthand. This allows homecare providers to step in and connect their members to the resources that could help improve their SDOH, and ultimately keep them healthy and avoid unnecessary hospitalizations.
HHAeXchange is dedicated to supplying homecare payers and providers with the tools they need to capture this critical member data. Further, the interoperability of our software allows this important data to be shared across the homecare ecosystem. Improving health equity is a goal everyone across the healthcare continuum can agree on, and now with newer technology, homecare providers and payers can play a major role in its improvement.
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