For the first time, the CMS has adopted a plan to target racial and ethnic health disparities among the 55 million elderly and disabled people enrolled in Medicare.
The plan, released Tuesday by the CMS Office of Minority Health, will include targeted measures for improved access and reduced readmissions. The goal is to prevent disproportionately high burdens of disease, lower quality of care and barriers accessing care. The deadline to meet these goals is 2020.
The CMS has moved aggressively to target readmissions with new penalties and financial incentive programs under the Affordable Care Act.
“We will address this issue by developing and testing approaches to improve post-hospital discharge care coordination for priority populations (racial and ethnic minorities, sexual and gender minorities, and persons with disabilities) who also have a mental illness and other chronic conditions,” according to the plan.
The vast majority of Medicare beneficiaries, more than 80%, are white. Yet, according to a 2012 survey by the Medicare Payment Advisory Commission, blacks and Latinos account for the top decile of Medicare spending.
For individuals with kidney disease, which is a fast-growing share of the Medicare population, the rate of hospital admissions for short-term complications is significantly higher for blacks than for other ethnic groups, according to the study.
The CMS plan introduced Tuesday will coordinate efforts already underway within HHS' Office of Minority Health and in other federal programs, said Cara James, director of the CMS Office of Minority Health. HHS in 2011 released an action plan to reduce racial and ethnic health disparities and separately published a strategy for health equity.
In coming months, the CMS Office of Minority Health will release measures and targets for improved access and outcomes that will be used to monitor success of the plan.
The Affordable Care Act created the CMS minority health office and other similar offices within HHS agencies. The newly created CMS office launched a yearlong effort to develop the new Medicare disparities action plan, she said.
New equity proposals from the CMS are in line with other quality initiatives that suggest the agency increasingly behaves "not only as a payer for healthcare services, but also an agent of change and a driver of improvement across a number of different quality areas," said Casey Schwarz, policy and client services counsel for the Medicare Rights Center. "It's definitely in keeping with that shift."
Now advocates will watch closely for reporting and results of the plan's targets, she said. "There's been attention paid to health disparities from a lot of different angles and avenues, but what is interesting and exciting to us about this document is that it's a comprehensive strategy from someone with as much reach and influence as CMS," she said.
Nearly 100 hospital officials, advocates and quality experts helped define the plan's priorities, James said. The plan seeks to leverage CMS' influence over quality improvement and relationships with hospital networks, public agencies and providers. The CMS wants to standardize and collect more patient data, such as race, sexual orientation or language, under the plan. The more comprehensive data can be analyzed to direct resources. Programs under Medicare will be evaluated by how well they improve—or worsen—existing disparities. Strategies that work best will be widely promoted.
The plan also calls for nursing homes to increase culturally appropriate care and remove language barriers. It promotes more roles for community health workers. Better communication with patients is among the plan's priorities, along with improved access to care for those with disabilities.
“Communication should take into account an individuals' social background, including preferred language, health literacy level, culture, and disability status,” the plan said. “Effective communication results in informed shared decisionmaking between providers, patients and their families, and higher quality of care and better health outcomes.”
