Health and Health Care Disparities Marshall H. Chin, MD, MPH - - PowerPoint PPT Presentation

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Health and Health Care Disparities Marshall H. Chin, MD, MPH - - PowerPoint PPT Presentation

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National Quality Forum: Reducing Health and Health Care Disparities Marshall H. Chin, MD, MPH Co-Chair, NQF Disparities Standing Committee AcademyHealth, June 25, 2017 NQF Disparities Standing Committee Disparities Committee Members

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National Quality Forum: Reducing Health and Health Care Disparities Marshall H. Chin, MD, MPH Co-Chair, NQF Disparities Standing Committee

AcademyHealth, June 25, 2017

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NQF Disparities Standing Committee

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Disparities Committee Members

(co-chair) Marshall Chin, MD, MPH, FACP, University of Chicago Nancy Garrett, PhD, Hennepin County Medical Center (co-chair) Ninez Ponce, MPP, PhD, UCLA Center for Health Policy Research Romana Hasnain-Wynia, PhD, Denver Health Philip Alberti, PhD, Association of American Medical Colleges Lisa Iezzoni, MD, MSc, Harvard Medical School Susannah Bernheim, MD, MHS, Yale New Haven Health System Center for Outcomes Research and Evaluation David Nerenz, PhD, Henry Ford Health System Michelle Cabrera, SEIU California Yolanda Ogbolu, PhD, CRNP-Neonatal, University of Maryland Baltimore, School of Nursing Juan Emilio Carrillo, MD, MPH, Weill Cornell Medical College Bob Rauner, MD, MPH, FAAFP, Partnership for a Healthy Lincoln Lisa Cooper, MD, MPH, FACP, Johns Hopkins University School

  • f Medicine

Eduardo Sanchez, MD, MPH, FAAFP, American Heart Association Ronald Copeland, MD, FACS, Kaiser Permanente Sarah Hudson Scholle, MPH, DrPH, National Committee for Quality Assurance José Escarce, MD, PhD, UCLA David Geffen School of Medicine Thomas Sequist, MD, MPH, Partners Healthcare System Traci Ferguson, MD, MBA, CPE, WellCare Health Plans, Inc. Christie Teigland, PhD, Inovalon, Inc. Kevin Fiscella, MD, University of Rochester Mara Youdelman, JD, LLM, National Health Law Program

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NQF Staff

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  • Helen Burstin - Chief Scientific Officer
  • Erin O’Rourke - Senior Director
  • Andrew Anderson - Senior Project Manager
  • Suzanne Theberge - Senior Project Manager
  • Tara Rose Murphy - Project Manager
  • Mauricio Menendez - Project Analyst
  • Madison Jung - Project Analyst
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Agenda

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  • National Quality Forum
  • Sociodemographic Status Risk

Factor Adjustment Trial Period

  • Roadmap to Reduce Disparities
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National Quality Forum

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  • NQF is a not-for-profit, nonpartisan,

membership-based organization that works to catalyze improvements in healthcare.

  • Mission is to lead national

collaboration to improve health and healthcare quality through measurement.

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NQF Disparities Standing Committee

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  • Monitor trial period in which

performance measures evaluated for adjustment for social risk factors

  • Develop roadmap to reduce

disparities – How can performance measurement be used in reporting and payment programs to reduce disparities?

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Reports – www.qualityforum.org

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  • Disparities in Healthcare and Health

Outcomes

  • Effective Interventions in Reducing

Disparities

  • Health Equity Measures and a

Conceptual Framework

  • Evaluation of Trial Period for Risk

Adjustment of Social Risk Factors

  • Policy Recommendations (Sept.

2017)

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Trial Period: Adjusting for Social Risk Factors in Performance Measures

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  • Usually adjustment for social

risks did not impact results

  • Caveats

▫Limited availability social risk data ▫Methods for adjustment ▫Heterogeneity of models and

approaches among developers

  • Need more experience and

perhaps standardization

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Roadmap to Reduce Disparities Step 1: Prioritize Disparities Sensitive Measures

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  • Prevalence
  • Disparities quality gap
  • Impact
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Step 2: Identify Interventions to Reduce Disparities

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  • Interventions should be applied at

all levels of the US health care system

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Step 3: Select and Use Health Equity Measures

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Step 4: Incentivize the Reduction of Disparities through Measurement

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  • Implement health equity measures
  • Incentivize health equity through payment

reform

  • Support organizations that

disproportionately serve individuals with social risk factors

  • Develop and implement demonstration

projects, evaluation, and research to achieve equity through use of equity measures in payment and quality improvement

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Implement Health Equity Measures

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  • Invest in the collection of social risk

factor data

  • Stratify performance scores by social

risk factor data

  • Access and quality equity domains

for accountability Culture, structure, partnerships for QI

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Incentivize Health Equity Through Payment Reform

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  • Invest in preventive and primary care

for pts with social risk factors

  • Directly adjust payment for social

risk factors

  • Link equity measures to

accreditation

  • Support outpatient and enabling

services with additional payment

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Payment Reform 2

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  • 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

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Support Organizations Disproportionately Serving Patients with Social Risk Factors

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  • Risk adjust for social risk factors

when appropriate and stratify performance measures

  • Consider peer-to-peer comparisons
  • Additional payment when beyond
  • rganization’s control
  • Coaching in QI and disparities reduct
  • Monitor financial impact
  • Include in incentive programs
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Demonstration, Evaluation, and Research

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  • Demonstration projects
  • Policy simulations
  • Economic analyses from multiple

perspectives