Key ideas from NEHI's Health Equity Roundtable webinar.
Data, analytics, and value-based care will play a key role in the current phase of the movement towards health equity.
On May 26, 2022, NEHI hosted a webinar on data-driven strategies to drive health equity through value-based health care payment. The discussion highlighted initiatives launched by NEHI members and others to close health disparities, and the goals that public and private sector payers have outlined for achieving equity through payment reforms.
The conversation focused on 5 key takeaways for health equity stakeholders.
Effective health equity initiatives must follow patients for years of their lives. Peoples’ social needs change over a lifetime, along with their health needs and associated costs.
Melissa Sherry, MPH, PhD, Vice President of Social Care Integration at Unite Us, illustrated this point: “A lack of healthy food as a child leads to obesity and diabetes. It’s so hard to disentangle people’s lives from those quality outcomes.”
Sustaining this effort over years will be a challenge for health care payers, constrained as they are by annual budgets. “One of the central challenges of health care is, ‘what’s the ROI for one year’s time?’,” Sherry said. “To imagine how one hot meal delivery might save money in the long run is hard, but thinking about how we can systematically help someone’s needs is transformational.”
Thinking about how we can systematically help someone's needs is transformational.
Embedding equity goals into payment can encourage longer-lasting savings for health care payers and providers. Sherry added: “Even if there’s not a clear return on investment, how can we think about investing in children so they don’t grow up to be expensive adults?”
Tom Hubbard, MPP, Vice President of Policy Research at NEHI, agreed: “The best results are those that need to play out over time.”
Sherry illustrated the point by imagining a health care professional who might advise a patient of the location of a food bank or homeless shelter. “To me, that’s more of a feel-good thing of, ‘I told them where to go,’” she said. “But you need to know: did they go? Did they actually get help? Was it even open when they went?”
In response, Christina Severin, MPH, CEO of Community Care Cooperative (C3), referenced the MassHealth Accountable Care Organization Flexible Services program. This program provides an accountable care organization like C3 with an annual budget to contract with social service organizations. The SSOs provide services such as home modification and medically-tailored meals.
“We see about 85 percent closed-loop referral success” with this program, said Severin. For example, members with diabetes and a hemoglobin a1c starting point greater than 9, which is generally an indicator for a condition not well-controlled, lowered that measure below 9 by six months post-nutritional intervention.
Social services and medical care are traditionally disparate sectors. Successful health equity initiatives require that these care providers share systems and languages.
Sherry illustrated, “Is ‘one night in a homeless shelter’ the same as ‘one night in temporary housing?’“ That language could vary depending on the patient’s care manager.
Melissa Sherry, MPH, PhD, Unite Us
Many in healthcare are familiar with CPT codes and other technical language. “Historically, that language has not even existed for social care,” Sherry said. “As a result, it’s very difficult for a community-based organization to fill out a claim.” Z-codes are social care’s answer to this issue, and initiatives like the Gravity Project are working to standardize those codes and streamline payment for social services.
Social and health care providers must also strike the right balance between each other’s work. For example, should a social service employee need to log into a medical provider portal, submit a claim, and deal with possible denials? “We have to protect community-based organizations from having to hire coders or clinicians,” Sherry added.
Quality metrics hold the key to determining the effectiveness of closed-loop care systems. Detailed starting-point data is an important part of those metrics, but it shouldn’t stall a health equity initiative.
Nora Dennis, MD, MSPH, Lead Medical Director of Behavioral Health and Health Equity at Blue Cross Blue Shield of North Carolina (BCBSNC), recounted a focus group of Black birthing people to understand their lived experience and inform BCBSNC’s future strategy in maternal health care.
“We didn’t say, ‘sorry, ladies, we’ll get back to you once we have 100% self-reported race data,” Dr. Dennis said. “We can do both.”
Initial data can be incomplete for many reasons. Patients may be reluctant to share their health data based on mistrust of the medical industry. Providing this data in a social service setting may be less intimidating than in a doctor’s office.
Nora Dennis, MD, Blue Cross Blue Shield of North Carolina
Dr. Dennis mentioned BCBSNC’s reporting of imputed data to their ACOs while they collected member self-reported data simultaneously. “We’re saying, ‘this is where we are now, and we’re committed to making it better, but let’s let the truth be good enough in terms of where we’re starting.”
Providers that reflect their patient population can improve the quality of care and health equity data. Again recalling BCBSNC’s focus group, Dr. Dennis mentioned: “[Patients] were delaying the initiation of prenatal care because it was important to them to find a Black OBGYN, and there weren’t many. Finding a doctor took longer, so initiating prenatal care later results in poor provider quality scores on the timeliness of prenatal care."
Equitable support for health care providers is crucial. Severin noted that many federally-qualified health centers (FQHCs) and safety-net systems receive lower payments than academic/hospital medical systems. “We need to have a conversation about how payment disparities contribute to the persistence of health disparities,” Severin said.
On the social care side, involving smaller community organizations benefits patients and their communities. “Safety net organizations who are more likely to serve nonwhite, nonaffluent populations have been paid less than other providers,” Severin said. “We need to work on creating an equal starting line.”
NEHI looks forward to further research and program work to achieve health equity from multiple angles. View our related work and resources in equitable access to innovation.
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