CMS is
encouraging providers to address the social determinants of health through
data-driven efforts and new resources.
April 29,
2019 - CMS is taking a data-driven approach to helping healthcare
providers address the social determinants of health.
With targeted ICD-10 codes and deeper dives into
Medicare and Medicaid data, the agency is hoping to bring more evidence-based
insights into the challenging task of managing vulnerable populations at scale.
“Each April marks
National Minority Health Month, providing the opportunity to acknowledge the
progress made in reducing disparities, as well as a chance to reflect on what
more needs to be done to achieve health equity,” wrote Cara V. James, PhD,
director of the CMS Office of Minority Health in a recent blog post.
The agency recognizes
the critical role of non-clinical factors, such as food and housing security,
loneliness, and educational attainment, in determining a patient’s capacity to
access care and adhere to treatments.
“These factors affect
access to care and health care utilization as well as outcomes. As we seek to
foster innovation, rethink rural health, find solutions to the opioid epidemic,
and continue to put patients first, we need to take into account social
determinants of health and recognize their importance,” said James.
“Data collection will
help us strengthen our understanding of the relationship between social
determinants of health and health care use across diverse populations, allowing
us to develop solutions and better connect patients to much needed services.”
CMS is approaching
the complex problem from multiple fronts, including encouraging providers to
take advantage of “Z-codes” in ICD-10.
These codes allow
providers to create structured information about the social determinants of
health, furthering the ability to analyze patterns and design impactful
interventions.
The American Medical
Association and UnitedHealthcare are working to expand the number and
scope of available Z-codes, the two organizations announced early in
April. Providers may soon have two dozen new options for recording
information about socioeconomic challenges.
James also
highlighted several other CMS initiatives to equip providers with strategies
and resources to manage population health.
Organizations can
leverage the Accountable Health Communities (AHC) social needs screening tool, the PREPARE tool from the National
Association of Community Health Centers, or the Health Leads Screening Toolkit to
better understand their patients’ challenges.
These quick
assessments allow providers to have meaningful conversations with patients
about their unique socioeconomic situations, and may help clinicians connect
patients to community resources or services to improve their experiences.
In conjunction with
these efforts, CMS is offering a deeper look into Medicare Advantage
populations and the significantly different experiences of white patients
versus those in other racial and ethnic groups.
Socioeconomic
challenges are strongly correlated with racial and ethnic patterns, rendering
it critically important to identify and address disparities along these lines.
In a new report produced with the RAND
Corporation, CMS notes that non-white Medicare Advantage beneficiaries fare
worse on many measures of clinical care and patient experience, including
getting appointments quickly and receiving certain preventive services.
“Despite advances in
health care access, increases in spending, and improvements in quality over the
last decade, there is well-documented evidence that members of racial and
ethnic minority groups continue to experience worse health outcomes,” CMS said in an accompanying FAQ sheet.
“To comprehensively
address and eliminate health disparities, it is first necessary to be able to
measure and publicly report – in a standardized and systematic way – the nature
and extent of these differences.”
“This information may
be useful for targeting quality improvement activities and resources,
monitoring health and drug plan performance, and advancing the development of
culturally appropriate quality improvement interventions and strategies.”
The detailed report
shows that some ethnic and racial groups experience worse chronic disease
management compared to white patients.
Hispanic and black
patients are significantly less likely to have access to controller medications
for asthma, for example. They are also less likely to have controlled
blood pressure and receive comprehensive diabetes care.
Closing these gaps
will require providers and CMS to work together to collect meaningful data and
share insights across the care continuum.
The Office of
Minority Health offers an online resource center for providers
that includes patient-facing information in multiple languages and information
about how to bring enhanced population health management into the community
setting.
“Adequately and
appropriately addressing social determinants of health will require the efforts
of all stakeholders including beneficiaries, community groups, and health care
providers,” James said.
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