Health equity is becoming an integral part of the accountability framework for healthcare systems amid a slew of requirements that emerged in recent years.
Healthcare companies these days are responsible for collecting specific types of patient data, including quality and safety information stratified by race and conducting social needs screenings. To keep apace with demands from regulators and private accrediting organizations—and to further the goal of reducing disparities in access and outcomes—providers, health insurance companies and others are developing strategies and leadership roles specifically dedicated to health equity.
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The Centers for Medicare and Medicaid Services aims to advance health equity through Medicare provider payment policy and regulations governing Medicare Advantage and Part D insurers. In addition, states regulate healthcare development, promote access and connect low-income residents to social services.
The Joint Commission and other influential third-party auditors have instituted standards healthcare operations must meet to earn high scores. Some offer honorary certifications that recognize providers actively advancing health equity.
“[Health equity] is now becoming a requirement," said Dr. Deborah Rhodes, chief quality officer at Yale Medicine in New Haven, Connecticut. "We are setting ourselves up to do this on a routine basis so that we will always know whether we're providing equal care and where we need to focus for equitable care.”
CMS regulations
In 2022, CMS issued its Framework for Health Equity, which sets goals for the next decade. The agency intends to expand its internal infrastructure to address disparities and to remove barriers to federally funded services. CMS is encouraging healthcare organizations to improve their own capacities to identify and eliminate inequities, efforts that include more data reporting and analysis, better access to language and health literacy services, culturally competent care and greater accessibility for people with disabilities.
Starting this year, hospitals have to provide CMS with health equity plans that include collecting information from patients such as race and social determinants of health. Providers must analyze outcomes data by race and ethnicity, undergo quality improvement activities targeting disparities, and conduct senior leadership reviews of progress. CMS also introduced new measures for social determinants of health screenings patients that will take effect next year.
In one specific area, CMS is monitoring hospital participation in perinatal quality improvement collaborative programs and the implementation of evidence-based maternity care. Utilizing this metric, CMS has introduced a "birthing-friendly" hospital designation for facilities that meet its standards.
Next year, CMS will incorporate equity into reimbursements. Medicare will begin paying providers in underserved areas, such as community health workers. CMS will offer health equity reimbursement bonuses to hospitals treating high proportions of patients enrolled in both Medicare and Medicaid and special payments for hospitals caring for homeless patients.
Health insurance companies also are subject to new CMS health equity policies. The agency created a health equity index that will influence Medicare Advantage insurers' quality measures under the star ratings program. Medicare Advantage plans also will need to improve access for members with limited English proficiency.
And CMS is considering directing Medicare Advantage carriers to appoint health equity leaders and conduct annual health equity assessments on their prior authorization practices in response to concerns that precertification rules disproportionately affect underserved enrollees.
Accreditation requirements
The Joint Commission, which accredits more than 22,000 healthcare organizations, integrated health equity standards into its programs last year.
Mandatory actions include appointing executives to lead health disparities efforts and screening patients for social determinants of health. Accredited organizations are required to include demographic breakdowns in quality and safety reports and to track progress and provide regular updates to executives and employees.
“One of the first things they want to know is: 'What you are doing for your health equity project?'” Dr. William Isenberg, chief medical and quality officer for Sacramento, California-based Sutter Health said at the Modern Healthcare Social Determinants of Health Symposium last month.
The Joint Commission introduced a separate health equity distinction program for hospitals and critical access facilities that emphasizes leadership, data collection, community collaboration and patient care, and aims to coordinate and standardize efforts toward ending disparities.
The National Committee for Quality Assurance is implementing new requirements that insurers stratify Healthcare Effectiveness Data and Information Set measures by race and ethnicity. Last year, 92% of health insurers reported they could track these data. In 2024, insurers will need to demographically break down metrics of hospitalizations for mental health conditions, cervical cancer testing, prenatal and postpartum depression screenings, childhood and prenatal immunizations, and kidney and eye exams for diabetes patients.
NCQA has transformed its longstanding Multicultural Healthcare program into a Health Equity Accreditation program that focuses on overhauling operations, data collection and provider network adequacy. The organization issued guidelines for collecting information on race, ethnicity, language, gender identity and sexual orientation to better understand and address unequal outcomes among policyholders.
URAC and the National Minority Quality Forum launched an optional health equity accreditation program this year. The initiative recognizes companies that deploy programs to reduce disparities in their communities. The organizations built this around the CMS Framework for Health Equity as a way to help healthcare companies prepare for further regulations in areas such as culturally and linguistically appropriate healthcare.
State actions
States are tackling health equity through a variety of policies, including some that regulate healthcare development, hold hospitals accountable for addressing health disparities and support better access.
Forty states have advanced 155 pieces of health equity legislation since last year, according to a report the Chartis Group published last month. These laws aim to increase access, tackle social determinants of health, provide behavioral health services and improve maternal health outcomes. In addition, 41 states have launched Medicaid initiatives that target racial and ethnic disparities, according to the report.
For example:
- Washington state allocates funds to analyze and address health disparities in access and outcomes among Medicaid beneficiaries.
- In Maryland, nonprofit hospitals must report on their efforts to track and reduce disparities.
- Minnesota hospitals with obstetric care and birth centers must provide anti-racism and implicit bias training to employees and contractors who treat pregnant and postpartum patients.
- Healthcare providers in New York that want to expand are obligated to commission health equity impact assessments during the certificate-of-need review process.
- Starting next year, California will expand Medicaid eligibility to an estimated 700,000 low-income undocumented immigrants, which has compelled Medicaid carriers and providers to enhance language services and community-based organization networks.
