As we think about caring for the most vulnerable in our society, we need to ensure health equity by reducing disparities in care among different populations. At this moment in time, we have two historical events clashing together as one: we have the catastrophic public health crisis and resultant economic fallout from the COVID-19 pandemic, and we have the plight of racial injustice in our society.
The industry movement to value-based care emerged more than two decades ago to improve quality while containing costs. However, its impact on racial health disparities has been limited. That is now being rectified by policy leaders looking to reengineer payment models to include health equity as a key financial measure for success. The future of value-based care necessitates evolution to continue and accelerate forward progress towards health equity.
As Mark McClellan (one of the ACLC co-founders) and his co-authors wrote in a recent Health Affairs blog, more purposeful accountability and model design is necessary to improve health equity. This will require basing prospective payments to providers on interventions that support the delivery of services (e.g. nutritional support, transportation support) that can address social factors leading to disparities in health outcomes.
On October 20, 2021, the CMS Innovation Center (CMMI) released a Strategy Refresh white paper, cementing their vision for advancing health equity, as well as driving accountable care, supporting innovation, addressing affordability, and partnering to achieve system transformation.
As part of their commitment to partnership, CMMI is conducting listening sessions and inviting stakeholders to respond to questions such as:
The first listening session was held on Thursday, November 18 and included speakers from provider groups, associations, and others who – like the Accountable Care Learning Collaborative – support the transition to value in health care. A transcript and slides from this discussion have been posted to the CMMI website for Strategic Direction. I also want to share with you a high-level overview of the call.
The call began with remarks from CMMI leadership, including Liz Fowler, who described their commitment to improving transparency and communication, as well as understanding and addressing barriers to model participation for providers.
Stakeholders then provided feedback on the questions posed by CMMI, and the following themes emerged. I especially endorse the first three themes, and have heard similar concerns from many of you:
Stakeholders who shared their remarks with CMMI include:
In October of 2020, I interviewed Cheryl Lulias, the CEO of ACLC member organization Medical Home Network (MHN) and I appreciate the thoughtful comments posed by Misty Drake of MHN during the listening session. We need more leaders like those at MHN who are improving care for thousands of patients every day through innovation and transformation, especially via their commitment to advancing health equity and reducing disparities in health outcomes. I echo the recommendation to “leveling the playing field” that could result in improved health outcomes for patients and greater involvement in models by high quality organizations like MHN ACO.
I was also particularly struck by Allison Brennan’s comments on the level of “stamina” that is often necessary for navigating participation in Alternative Payment Models. Burnout is endemic across health care, and model administrative complexity should not be an additional pain point for our health systems to endure.
I appreciate the opportunity to participate in this listening session and the responses provided by CMMI leadership during the call. The next call, a roundtable discussion focused on health equity, is scheduled for December 8. I look forward to this next opportunity for dialogue and moving to action in collaboration with CMMI, so we can work together to remove barriers and engage more of the US health system in transformation.
As we’ve mentioned in recent ACLC newsletters, I will be interviewing CMMI Director Liz Fowler in December for an upcoming Race to Value podcast. This interview will be an important opportunity to emphasize the values of ACLC members and our alignment with the strategic direction of CMMI. Watch for that podcast episode to air in early 2022.
Eric Weaver, DHA, MHA, FACHE, FACMPE
Executive Director, ACLC