Health Equity

Health equity means every person has the opportunity to attain their full health potential and individuals are not disadvantaged from achieving this potential due to social determinants such as race, sexual orientation, gender, disability, age, socioeconomic status, or geographic location.

The primary steps to addressing health equity in a healthcare organization include:

• Understanding the core social determinants of health (SDOH) questions using AHC Screening Tool as a guide
• Mapping each of the SDOH questions back to a resource in your organization or community
• Communicating the identified SDOH resources to staff
• Screening patients for SDOH
• Coordinating the SDOH resources with patients

The Dartmouth Institute for Health Policy and Clinical Practice recent study found that few physician practices and hospitals in the United States screen patients for all five key social needs associated with health outcomes.

While it is always better for a face-to-face encounter, actual collection of the data from as many patients as possible is a better outcome.

Digital questionnaires at kiosks, mobile and web apps to assist in screening for the five social needs—food insecurity, housing instability, utility and transportation needs, and experience with interpersonal violence would connect more people with the right resources more quickly.

Other options are to include digital questionnaires in your Chronic Care Management (CCM) or Remote Patient Monitoring (RPM) program processes. Reimbursement is available in these programs for staff to assist Medicare patients in 20-minute intervals of time.

RESOURCES

The following are a few great resources to use in formulating your organization's health equity plan and processes:

CDC Health Equity Law

CDC Health Equity

CMS Screening Guidelines

Using Social Determinants of Health (SDOH) Z Codes

NCQA Health Equity

Disparities Impact Statement

Atlas map

ACO REACH (Direct Contracting Model)

REACH ACOs will be required to develop and implement a Health Equity Plan starting in 2023 to identify underserved patients within their beneficiary population and implement initiatives to measurably reduce health disparities. Medicare has recommended the Disparities impact statement as a guide to ACO REACH applicants.

To promote health equity plans and resource availability, a beneficiary-level adjustment will be applied to increase the benchmark for those REACH ACOs serving higher proportions of underserved beneficiaries to mitigate the disincentive for ACOs to serve underserved patients by accounting for historically suppressed spending levels for these populations

ACO REACH Health Equity Benchmark Adjustment:

• Top 10% receives a $30 PMPM positive adjustment
• Bottom 50% receive a $6 PMPM negative adjustment

Atlas map is a great resource for identifying underserved beneficiaries.

Link to ACO REACH webinar recording.

Upcoming Webinar:

Digital Collection of SDOH During Health History Processes

Register Here

Kris Gates, gates@healthendeavors.com, 480.912.1209