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

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 (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 Romana Hasnain-Wynia , PhD, Denver Health Policy Research Philip Alberti, PhD, Association of American Medical Colleges Lisa Iezzoni, MD, MSc, Harvard Medical School Susannah Bernheim , MD, MHS, Yale New Haven Health System David Nerenz , PhD, Henry Ford Health System Center for Outcomes Research and Evaluation Yolanda Ogbolu , PhD, CRNP-Neonatal, University of Maryland Michelle Cabrera , SEIU California Baltimore, School of Nursing Bob Rauner, MD, MPH, FAAFP, Partnership for a Healthy Juan Emilio Carrillo , MD, MPH, Weill Cornell Medical College Lincoln Lisa Cooper , MD, MPH, FACP, Johns Hopkins University School Eduardo Sanchez , MD, MPH, FAAFP, American Heart of Medicine Association Sarah Hudson Scholle , MPH, DrPH, National Committee for Ronald Copeland , MD, FACS, Kaiser Permanente Quality Assurance Thomas Sequist , MD, MPH, Partners Healthcare System José Escarce , MD, PhD, UCLA David Geffen School of Medicine 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 2

NQF Staff  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 3

Agenda  National Quality Forum  Sociodemographic Status Risk Factor Adjustment Trial Period  Roadmap to Reduce Disparities 4

National Quality Forum  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. 5

NQF Disparities Standing Committee  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? 6

Reports – www.qualityforum.org  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) 7

Trial Period: Adjusting for Social Risk Factors in Performance Measures  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 8

Roadmap to Reduce Disparities Step 1: Prioritize Disparities Sensitive Measures  Prevalence  Disparities quality gap  Impact 9

Step 2: Identify Interventions to Reduce Disparities • Interventions should be applied at all levels of the US health care system 10

Step 3: Select and Use Health Equity Measures 11

Step 4: Incentivize the Reduction of Disparities through Measurement  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 12

Implement Health Equity Measures  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 13

Incentivize Health Equity Through Payment Reform  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 14

Payment Reform 2  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 15

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  Additional payment when beyond organization’s control  Coaching in QI and disparities reduct  Monitor financial impact  Include in incentive programs 16

Demonstration, Evaluation, and Research  Demonstration projects  Policy simulations  Economic analyses from multiple perspectives 17