In 2015, the Centers for Medicare and Medicaid Services (CMS) set out to help reconcile the perceived disparities in the care their funding provides to minority groups versus the rest of the general population. According to the CMS, the Equity Plan contains a three-part path to equity framework: increasing understanding and awareness of care disparities, solution development and dissemination, and sustainable action that can be evaluated on an ongoing basis. The CMS Equity Plan includes six primary objectives. These are:
- To expand data collection and reporting,
- To evaluate disparities and integrate appropriate solutions,
- To develop and implement approaches to reduce health disparities,
- To help healthcare workers meet the needs of vulnerable populations,
- To improve communications and language access for non-English speakers and people with disabilities, and
- To increase physical accessibility of healthcare facilities.
The plan focuses on Medicare populations that have disproportionately high burdens of disease, worse quality of care and other barriers that restrict healthcare access. The CMS Equity Plan was also developed to give greater attention to chronic diseases that pose a significant human and financial burden to the healthcare system. These may include diabetes, chronic kidney disease, and cardiovascular disease.
CMS recognizes that health equity plays a critical role in better care, better outcomes and system savings. Until the creation of the CMS Equity Plan, the CMS did not have an established or consistent method to assess program impact on health equity. The goal is to understand the impact of existing CMS programs on vulnerable Medicare populations and to make sure that new programs do not extend those disparities.
Goals of the Program
One outcome of the CMS Equity Plan would be to identify approaches to reduce disparities and provide guidance to stakeholders in how to reduce hospital readmissions for people suffering from multiple chronic conditions. Another goal is to improve the quality of nursing home care experienced by racial and ethnic minorities, sexual and gender minorities, and people with disabilities.
The CMS wants to increase the provision of culturally and linguistically appropriate care in nursing homes. Training nursing home caregiver in cultural competency related to ethnicity, language, disability, and sexual orientation or gender minority will help reduce discriminatory practices while increasing culturally sensitive treatment. Culturally competent care in nursing homes would add to the quality of life experience these individuals would have at a Medicare-funded nursing home facility. In other words, the more sensitive a caregiver is toward a patient, the better that patient will do in a nursing home environment.
Increasing physical access to healthcare facilities for Medicare-served populations also will help increase quality of care and health across the population. People with disabilities often experience significant disparity in health status, which makes them less likely to obtain preventive services and can delay medical care. The lack of available or known settings where these people can get quality care remains a challenge.
How the Plan Works
The CMS Equity Plan for Medicare can impact change in the healthcare system via several levels. Unique to the CMS, these mechanisms include the core CMS functions and resources of the agency and stakeholders, including QIN-QIOs, CMS Programs, Policy, Data, Access to Stakeholders and Communication Tools.
Progress of the Plan
CMS made great strides to track the Equity Plan’s progress and created a Mapping Medicare Disparities Tool to help identify the areas of disparity between subgroups of Medicare beneficiaries. From a brief glance at the color-coded map, it seems that the greatest disparities occur in metropolitan regions known to have greater numbers of minority groups, with the least disparity showing in the country’s western region, including Colorado, Nevada, and Utah.
Collecting the necessary data to track the progress of the plan has been challenging. Because the collection of ethnic information or other minority group details is voluntary, not every person who accepts CMS-funded care self-identifies as a covered party for the plan.
In a statement to HealthITAnalytics, Director of the CMS Office of Minority Health Cara V. James, PhD noted that getting a complete picture of cultural disparity can be challenging given the voluntary nature of self-reported data. But the information they can get helps to improve systems across the board, which is an ongoing effort of the CMS Equity Plan.