Health Equity: An Emerging New Reality Among America’ s Hospitals

Last week, the chief medical officer (CMO) for the Centers for Medicare & Medicaid Services (CMS), Dora Hughes, MD, MPH, published a blog in Health Affairs Forefront, calling out the progress since the October 2021 of the release of the 2030 vision from the CMS Innovation Center, “A health system that achieves outcomes through high quality, affordable, and person-centered care.” (Hughes, D., 2023).

The blog posting discussed the progress that has been made thus far, however I think it will be relevant for today’s discussion to cover what has and is still expected for 2023.

Thus far we have seen the release and refinement of the health-related social needs (HRSN) screening with additional toolkit information for implementation.  In addition, I have reported on the release of the fiscal year (FY) 2024 proposed rule for the Inpatient Patient Prospective Payment System (IPPS) initiatives related to health equity, specifically the social drivers of health initiative and additional quality bonusing for hospitals with high proportions of Medicaid-Medicare patients.

CMS states they are committed to continue the support for safety-net providers by evaluating and building future model designs that encourage care for Medicaid beneficiaries.

In the article, Dr. Hughes provides a high-level picture of the forthcoming initiatives from the CMS Innovation Center including the following:

• Identifying and expanding the opportunities for care delivery to people with disabilities;

• Investing more in rural health, particularly geographically isolated communities;

• Exploring social risk adjustment factors for payment which may include measures such as frailty, eligibility for the Part D Low Income subsidy, and life expectancy;

• Methods to help address high-cost drugs, and increase access to life-changing drug therapies. Specifically called out was the Cell and Gene Therapy Access Model. This initiative also calls for a generic drug maximum copayment of $2 a month for Medicare beneficiaries; and,

• A method to identify implicit bias in CMS initiatives to avoid the further perpetuation of inequality.

I think we have seen in recent weeks a shift in the air as many hospitals are laying off personal as they combat the financial woes of the healthcare industry.  This news will likely continue for health systems as we continue in our collision with a new wave of healthcare in which social complexity is acknowledged and financially rewarded in a value-based structure that is clashing with the Medicare fee for service (FFS) models of today.

Reference:

Advancing Health Equity Through The CMS Innovation Center: First Year Progress And What’s To Come | Health Affairs