[We Will Heal Regardless…
Hanne Rylaarsdam
Reports have shown significant gains in health insurance coverage during the 2021 and 2022 HealthCare.gov Open Enrollment periods among populations with historically higher uninsured rates such as Black and Latino consumers.
CMS continues to improve access to continuous coverage and quality of care in the postpartum period by working closely with states to encourage uptake of 12 months of extended postpartum coverage for pregnant people enrolled in Medicaid and CHIP.
CMS released a guide to help schools give care to children in Medicaid and CHIP, including behavioral health services. The guide provided states with claims guidance, technical assistance, and best practices.
Impact: Addresses the growing concerns in youth behavioral health, which disproportionately impact children and teens living in low-income communities, ethnic minority youth, LGBQ+ youth, and those with special needs.
Impact: These types of services are expected to be disproportionately used to help individuals from underserved communities. The new coding and payment for Social Determinants of Health (SDOH) risk assessment recognizes when practitioners spend time and resources assessing SDOH that may impact their ability to treat the patient.
CMS hosted its inaugural Health Equity Conference in June 2023 at Howard University. The conference convened leaders in health equity from federal agencies, health provider organizations, academia, community-based organizations, and others, both in person and virtually.
The CMS Health Equity Technical Assistance Program supports health care professionals, health plans and systems, State Medicaid Agencies, federal, state, tribal and territorial, and local health agencies, universities, community partners and all other external CMS stakeholders, as well as across CMS, as they we work together to embed health equity within CMS programs, policies, and operations.
Continued support and outreach for Medicare beneficiaries on Medicare Savings Programs and other cost-savings programs. During the Open Enrollment period we included messaging on MSP in the outreach campaign such as within a print advertisement and social media.1-800 MEDICARE representatives are also trained to provide education on the Medicare Savings Programs as well as other ways for beneficiaries to reduce their costs.
CMS is rewarding providers that provide quality care to a higher percentages of underserved populations with upside-only monetary award. Through this payment policy CMS is incentivizing excellent care, without lowering standards and avoiding unintended penalties on providers treating underserved populations.
CMS invested almost $100 million in grant funding to Navigator organizations for the 2024 Open Enrollment Period to provide increased and enhanced enrollment assistance to help consumers find the right health coverage option, complete their Marketplace application, and enroll in coverage in Federally-facilitated or State Partnership Marketplaces.
CMS holds quarterly National Stakeholder Calls provide an opportunity for CMS to share information related to policies or initiatives with the stakeholder community at large. All stakeholders who interact with CMS programs, policies, or initiatives or work with providers, beneficiaries, or consumers who rely on CMS services can join these calls.
ACOs are an important mechanism to reach more underserved populations and close disparities in access to care and outcomes. The ACO Realizing Equity, Access, and Community Health (REACH) Model and the Shared Saving Program have implemented health equity payment adjustments to account for social risk among underserved populations and increased ACO participation among safety net providers. ACO REACH also requires Health Equity Plans and Health Equity Data Reporting, as well as representation by beneficiary advocates on ACO governing boards who must hold voting rights.
The CMS Innovation Center launched a new health equity initiative in 2022, proposing to: develop new models and revise existing models to promote and incentivize equitable care; increase participation of safety-net providers; increase collection and analysis of equity data; and monitor and evaluate models for health equity impact.
Impact: New Innovation Center models are required to collect and report demographic and, where feasible, social needs data to CMS. In addition, the lessons learned from this model will inform future models and policies.
CMS has designed an interactive map, the Mapping Medicare Disparities (MMD) Tool, to identify areas of disparities between subgroups of Medicare enrollees in health outcomes, utilization, and spending. It is an excellent starting point to understand and investigate geographic and racial and ethnic differences in health outcomes.
Impact: Collecting sexual orientation and gender identity data will help to improve the Marketplace consumer experience by enabling consumers to attest in a way that better reflects and affirms their identities. These questions will also be used to analyze health disparities in access to coverage.
CMS is allocating 1,200 GME slots, phased in over multiple years, to enhance the health care workforce and fund additional positions in hospitals serving underserved communities. CMS has prioritized training slots to areas that demonstrate the greatest need for additional providers, as measured by the Health Professional Shortage Areas.
Impact: Utilization management policies and procedures, including prior authorization, may have a disproportionate impact on underserved populations and may delay or deny access to certain services.
To align with our goal of promoting equity, CMS is also acting internally to create a more diverse, equitable and inclusive workplace. In 2022, CMS published its first-ever DEI Strategic Plan. CMS understands and supports the value of diversity in improving organizational efficiency and effectiveness. We continually strive to promote a climate of innovation, opportunity, and success that capitalizes on the cultural, professional, and personal diversity of our workforce.
Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been disadvantaged by their social or economic status, geographic location, and environment.[1] Many populations experience health disparities, including people from some racial and ethnic minority groups, people with disabilities, women, people who are LGBTQI+ (lesbian, gay, bisexual, transgender, queer, intersex, or other), people with limited English proficiency, and other groups.
Across the country, people in some racial and ethnic minority groups experience higher rates of poor health and disease for a range of health conditions, including diabetes, hypertension, obesity, asthma, heart disease, cancer, and preterm birth, when compared to their White counterparts. For example, the average life expectancy among Black or African American people in the United States is four years lower than that of White people.[3] These disparities sometimes persist even when accounting for other demographic and socioeconomic factors, such as age or income.
Communities can prevent health disparities when community- and faith-based organizations, employers, healthcare systems and providers, public health agencies, and policymakers work together to develop policies, programs, and systems based on a health equity framework and community needs.
Social determinants of health are the conditions in the places where people live, learn, work, play, and worship that affect a wide range of health risks and outcomes. Long-standing inequities in six key areas of social determinants of health are interrelated and influence a wide range of health and quality-of-life risks and outcomes. Examining these layered health and social inequities can help us better understand how to promote health equity and improve health outcomes.
Racism determines opportunity based on the way people look or the color of their skin. It also shapes social and economic factors that put some people from racial and ethnic minority groups at increased risk for negative mental health outcomes and health-related behaviors, as well as chronic and toxic stress or inflammation.[11],[12] Racism prevents millions of people from attaining their highest level of health, and consequently, affects the health of our nation.
Not all workers have the same risk of experiencing a work-related health problem, even when they have the same job. Occupational health inequities are avoidable differences in work-related disease incidence, mental illness, or morbidity and mortality that are closely linked with social, economic, and/or environmental disadvantage, such as temporary work arrangements, socio-demographic characteristics (e.g., age, sex, gender identity, race, or class), and organizational factors (e.g., lack of worker safety measures, limited or no health insurance benefits).
People who have been historically marginalized, such as people from racial and ethnic minority groups, people with disabilities, and people with lower incomes, are disproportionately affected by inequities in access to high-quality education. [13][14] Policies that link public school funding to the tax base of a neighborhood limit the resources available in schools of lower income neighborhoods. This results in lower-quality education for residents of lower income neighborhoods, which can lead to lower literacy and numeracy levels, lower high school completion rates, and barriers to college entrance. In addition to educational barriers, limited access to quality job training or programs tailored to the language needs of some racial and ethnic minority groups may limit future job options and lead to lower paying or less stable jobs.
People from some racial and ethnic minority groups and other historically marginalized groups also face greater challenges in getting higher paying jobs with good benefits due to less access to high-quality education,[25] geographic location, language differences, discrimination, and transportation barriers. People with limited job options often have lower incomes, experience barriers to wealth accumulation, and carry greater debt. The historical practice of redlining and denying mortgages to people of color has also created a lack of opportunity for home ownership, and thus wealth accumulation, due to the inability to pass down property and build wealth. Such financial challenges may make it difficult to manage expenses, pay medical bills, and access affordable quality housing, education, nutritious food, and reliable childcare.
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