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

Finding Answers: Disparities Research for Change A National Program of the Robert Wood Johnson Foundation at the University of Chicago

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

Solving Disparities Through Payment and Delivery System Reform

Finding Answers: Disparities Research for Change A National Program of the Robert Wood Johnson Foundation at the University of Chicago

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

Solving Disparities Through Payment and Delivery System Reform

Finding Answers: Disparities Research for Change A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Background

• Healthcare disparities persist
• Shift from FFS (volume) to

value-based payment (quality)

– MACRA – MIPS and Advanced APMs

• Quality metrics, Health IT, Cost accountability

Solving Disparities Through Payment and Delivery System Reform

Finding Answers: Disparities Research for Change A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Where’s Equity?

Solving Disparities Through Payment and Delivery System Reform

Finding Answers: Disparities Research for Change A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Moonshots, Opioids, and Incentives

• “So, why do health disparities

persist? A simple answer is that

• ur 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.

Solving Disparities Through Payment and Delivery System Reform

Finding Answers: Disparities Research for Change A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Payment and Delivery System Reform

• “Equity must be a priority in all health

policy issues.”

• Quality Agenda – Development and use of

equity performance measures

Solving Disparities Through Payment and Delivery System Reform

Finding Answers: Disparities Research for Change A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Value-Based Purchasing

• Pay for performance
• Infrastructure - Preventive and

primary care

– e.g. community health workers

• Social determinants of health / population

health

Solving Disparities Through Payment and Delivery System Reform

Finding Answers: Disparities Research for Change A National Program of the Robert Wood Johnson Foundation at the University of Chicago

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.

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

11

• Invest in the collection of social risk

factor data

• Stratify performance scores by social

risk factor data

Incentivize Health Equity Through Payment Reform

12

• 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

Support Organizations Disproportionately Serving Patients with Social Risk Factors

13

• Risk adjust for social risk factors

when appropriate and stratify performance measures

• Consider peer-to-peer comparisons

Demonstration, Evaluation, and Research

14

• Demonstration projects
• Policy simulations
• Economic analyses from multiple

perspectives