Where is Equity in the National Quality Agenda? Marshall H. Chin, - PowerPoint PPT Presentation

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Where is Equity in the National Quality Agenda? Marshall H. Chin, MD, MPH Richard Parrillo Family Professor RWJF Finding Answers: Solving Disparities Through Payment and Delivery System Reform University of Chicago A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Disclosures / Funding  AHRQ T32 HS00084 , K12 HS023007, U18 HS023050  Merck Foundation  NIDDK P30 DK092949  Robert Wood Johnson Foundation  Co-Chair, NQF Disparities Standing Committee  CMS (NQF collaboration), CMMI (technical assistance)  Former President, SGIM  AMA, AHA, Joint Commission, Families USA, VA, America’s Essential Hospitals, NACHC, Instit Medicaid Innovation, CDC, AAMC, NCQA, NIMHD A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Background  Healthcare disparities persist  Shift from FFS (volume) to value-based payment (quality) – MACRA – MIPS and Advanced APMs  Quality metrics, Health IT, Cost accountability A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Where’s Equity? A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Moonshots, Opioids, and Incentives  “So, why do health disparities persist? A simple answer is that our country tolerates them.”  “way we pay for medical care largely does not support efforts to achieve health equity.” Chin MH. The Health Care Blog 2016 . A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Payment and Delivery System Reform  “Equity must be a priority in all health policy issues.”  Quality Agenda – Development and use of equity performance measures A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Value-Based Purchasing  Pay for performance  Infrastructure - Preventive and primary care – e.g. community health workers  Social determinants of health / population health A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change RWJF Finding Answers: Solving Disparities Through Payment and Delivery System Reform 2014-2018  “to develop evidence that payment and delivery system reform designs that at- tempt to manage extrinsic and intrinsic incentives for overall quality and effi- ciency , while also explicitly attempting to reduce health care disparities , can produce positive results for each goal.” DeMeester et al. Health Affairs 2017. A National Program of the Robert Wood Johnson Foundation at the University of Chicago

National Quality Forum Disparities Standing Committee Select and Use Health Equity Measures 9

Incentivize the Reduction of Disparities through Measurement 10

Implement Health Equity Measures  Invest in the collection of social risk factor data  Stratify performance scores by social risk factor data 11

Incentivize Health Equity Through Payment Reform  Redesign payment models to support health equity ▫ Upfront payment for infrastructure and address social determ of health ▫ Pay-for-performance for equity ▫ Mixed models ▫ Combo of improvement over time, absolute thresholds, and reduction in disparities 12

Support Organizations Disproportionately Serving Patients with Social Risk Factors  Risk adjust for social risk factors when appropriate and stratify performance measures  Consider peer-to-peer comparisons 13

Demonstration, Evaluation, and Research  Demonstration projects  Policy simulations  Economic analyses from multiple perspectives 14