Finally, Some Bright Spots in Health Equity

Some exciting news — we’re starting to make progress on one of the most stubborn challenges in healthcare: health disparities. This wave of innovation isn’t happening in a scientific lab, but in exam rooms, in clinics, and, surprisingly, at the desks of government workers and health plan employees. Health care inequity has been a massive, intractable problem: despite public and private efforts to reduce disparities, they have actually gotten worse over the past 20 years. But in light of the renewed focus on these disparities, we are seeing small steps toward new payment models, better care at home, and community health.

1.     New Payment Models

New value-based arrangements, where providers are paid based on the quality of health outcomes, not the number of services they provide, incentivizes preventive care and helps get care in places that need it the most.

Last year, CMS launched ACO REACH — a new and improved version of a program that is designed to move more people into value-based care: and also offers many of the same benefits of Medicare Advantage, like transportation, within the traditional Medicare program. What’s more, CMS took the important step of explicitly mandating that increased health equity is the goal.

The benefits and savings of this program are real. The latest results of the GPDC Program (the predecessor to ACO REACH) published by CMS show that @VillageMD generated total gross savings of nearly $24 million total net savings of more than $12 million through its participation in the program — and nearly half of all Village Medical locations support federally designated underserved areas, helping patients manage chronic conditions and get needed preventative care.

CMS also announced a new care model — the Making Care Primary (MCP) Initiative, providing primary care physicians with the resources that they need to gradually transition to value-based care with the goal of improving behavioral health and driving equitable access to care. This has the ability to make primary care more coordinated and accountable and helps build value-based arrangements in small rural communities, where many have more difficult time accessing care.

2. Health at Home

Despite a difficult environment across digital health investment, funding is still pouring into health-at-home solutions — and for good reason! People want to receive care in more convenient settings, and what’s more convenient than your home? Payers also like health-at-home care because they see the potential to lower their costs. But the value of moving more care to the home is more than about convenience or cost — it’s the key to building health by addressing social determinants of health. When care is delivered in the home, we gain insights into non-medical factors that affect health, like income or food security, and can help bridge those gaps. 

As we have been shifting more health care at home, we have seen real savings and improvements in health outcomes. For example, recent data showed that hospital-at-home programs may lower the cost of care by as much as 30 percent, while still allowing for people to get great care and keeping needed hospital beds open. And much of the health care journey — from preventive and primary care to serious illness care — can happen at a lower cost and with high outcomes when the home is the setting.

3. Community Health

While delivering care at home is important, we also need to look at the communities in which these homes are located and other places to put resources for the entire neighborhood or town. This is where retail pharmacies can deliver tremendous value. Pharmacies are deeply connected and trusted in the communities they serve, and nearly 90 percent of all Americans live within five minutes of a pharmacy. Across the board, we are seeing more of these organizations venture into value-based arrangements with health plans and partnerships in order to deliver more comprehensive health care offerings. For example, one of our priorities @Walgreens has been to place more health advisors in our retail locations, making more comprehensive screenings available. This is also work that we do with payers, getting people critical, lifesaving screenings through pick-up and mail in kits.

It will take all of these strategies, and many more, to really bridge the huge disparities that plague health care. But just because the problem feels so big, it doesn’t mean that we are hopeless. These three advances, while not comprehensive solutions, each do a small part of make health care more accessible, more affordable, and more effective for more and more people.