Achieving health equity is increasingly becoming a priority for any organization committed to transforming the health of individuals and populations. 虽然这一承诺传统上是由供应商承担的, 供应商的组织, 以及专门的社区组织, 卫生公平对支付方越来越重要, 包括作为一个因素或激励在新的金融模式, 也.
正如心电图的博客文章所述 与健康有关的社会需要和基于价值的护理, social determinants of health (SDOH) are being addressed through health-related social needs in innovation models. SDOH往往是实现保健公平的障碍.
在这篇博文中, we outline current and emerging payer approaches to incentivize health equity improvement and the implications for providers and health systems.
当前付款人卫生公平方法
医疗保险, 商业纳税人, 州医疗补助计划在不同程度上纳入了健康公平的要求和活动. 下面概述了付款人业务部门的详细要求和活动.
医疗保险
CMS在其医疗保险和医疗补助战略计划中将医疗公平确定为“第一优先事项”.¹²卫生公平框架侧重于数据收集的标准化, 分析数据以了解当前的不公平现象, 制定解决差距的政策, 支持供应商管理差距, 改善对云顶集团不足人群的云顶集团, 以改善卫生公平的方式增加可及性和覆盖面. 迄今为止,该框架已以以下方式纳入医疗保险计划:
- 医疗云顶集团收费(FFS): 在传统医疗保险FFS中, CMS的重点是将健康公平相关措施纳入强制性质量计划, 例如增加卫生公平编码类别(例如.g., ICD-10 Z codes) within the Hospital Inpatient Quality Reporting Program³˒⁴ and SDOH screening in the Merit-based Incentive Payment System.
- 医疗保险优惠(MA): 目前, MA plans are required to provide free language and translation services and incorporate a provider’s cultural and linguistic capabilities within provider directories.展望2027年, the MA Star Ratings program⁶ will incentivize plans to improve care for patients with social risk factors such as disabilities, dual-eligible状态, 通过建立与社会经济地位相关的健康公平指数因子.
- 医疗保险共享储蓄计划(mssp): CMS’s largest accountable care organization (ACO) program for traditional 医疗保险 beneficiaries has created participation incentives for providers serving dual-eligible and low-income beneficiaries, 例如,为开发人员和技术基础设施而提前支付投资, 只有较长时间的上行风险, 以及修改后的作业方法, 更好地认识双重资格和低收入者入学的影响.⁷
- CMS医疗保险和医疗补助创新中心(CMMI)模型: CMMI models vary in their incorporation of health equity but are relatively advanced compared to traditional 医疗保险 programs. 例如, ACO实现股权, 访问, 社区卫生(ACO REACH)项目整合了数据收集要求中的卫生公平因素, 病人检查, 金融基准方法.“以护理为先”模式包括根据病人的健康风险提高云顶集团费用.⁹ The All-Payer Health Equity Approaches and Development Model includes health equity as one of three programmatic pillars¹⁰ and states that participants in this model are required to develop a statewide health equity plan, 包括创建针对社会风险进行调整的支付方法.
州医疗补助
作为云顶集团不足社区的最大支付者, 州医疗补助机构在实现更广泛的医疗公平方面发挥着至关重要的作用. 各国旨在通过各种方法解决公平差距,包括:
- 为与司法有关的个人重新进入社会发展桥梁项目.¹¹
- Expanding data collection and coding requirements to reflect HRSNs and promote service referrals to meet identified needs.¹²
- 扩大社区组织提供的非临床云顶集团的支付和覆盖范围.¹³
- 为护理协调云顶集团提供国家资金, 产能扩张, 质量改进, 通过不以访问为基础的付款进行人口保健活动.¹⁴
- 根据患者的视敏度,包括hrsn (i.e.,社会风险调整).¹⁵
商业纳税人
将健康公平纳入商业计划的情况因付款人组织和产品而异. 到目前为止, 许多商业支付方仍然把重点放在对患者和提供者的教育上, 而其他人则做得更加离散, 程序化的变化. The organizations that have advanced beyond education have often focused on data collection by following CMS’s frameworks to gather additional demographic information and screen for HRSNs. Some 商业纳税人 have also developed local programs through philanthropic grants that provide access to services to address various HRSNs. 支付人活动的例子包括:
- UnitedHealthcare has implemented improved data collection and coding for HRSNs to identify barriers to health equity.¹⁶
- Aetna通过年度健康风险评估收集SDOH数据,并推广使用Z代码.
- 信诺已经开发了几个项目, 包括父母健康活动,以减少边缘化社区的障碍, 一个将患者与社区资源联系起来的糖尿病项目, 以及LGBTQ+健康项目,包括性别确认护理.¹⁷
- Blue Cross Blue Shield Association has a national health equity strategy focused on decreasing disparities in parental health¹⁸ and improving outcomes for parents and babies.¹⁹
供应商的影响和如何准备
由于支付方继续优先考虑卫生公平并相应地调整其福利, 云顶集团40011官网和提供者团体将需要为其报销激励措施的变化做好准备, 临床项目, 以及报告功能. 在心电图的经验中, 我们发现,在卫生公平方面,提供者组织需要对三个关键领域进行评估. 在每个领域内, 在制定近期和中期战略计划时,供应商应该考虑几个行动项目. 通过积极地将健康公平纳入组织战略, 提供者可以提高病人的护理和访问, 保持还款, 并确保与付款伙伴保持一致.
领域一:数据和技术开发
Providers will need to collaborate with payers (where feasible) to ensure health equity and HRSN data is captured and measured accurately. This may require adjustments to electronic health record platforms or systems to support additional patient entry assessments. 建议考虑的因素包括:
- Developing a methodology and capability to track and risk-stratify patient populations based on not only disease state but also social risk factors.
- Determining technology requirements to collect and analyze HRSN information on both patient and population levels. 这将包括随时间跟踪数据以衡量和管理性能的能力.
- Preparing staff for additional coding and billing requirements to capture required HRSN screenings and associated interventions.
- Ensuring that data input and capture are available at every touch point to facilitate care delivery and decision-making.
领域二:财务分析、建模和收益周期评估
Providers will need to have a detailed understanding of how newly released health equity measures may impact value-based care bonus payments, 传统FFS项目要求, 整体管理医疗的财务表现. 建议的行动项目包括:
- Analyzing historical quality data to estimate current performance on newly implemented metrics and determine the associated financial impact.
- Tracking the financial return of various health equity interventions to understand sustainability and determine whether interventions will meet financial priorities and payer/provider goals.
- 发展纳入记录卫生公平指数的能力(例如.g., 面积剥夺指数, 社会脆弱性指数), 有效性, 以及在资源分配决策中考虑因素的倾向.
领域三:操作和战略一致性
医疗云顶集团提供者需要修改医疗云顶集团模式, 简化工作流程, and develop community-based partnerships to ensure full integration of health equity priorities into the organizational culture. 这将包括:
- Incorporating near- and midterm health equity priorities and goals as part of the broader system strategic plan.
- Deploying a multimodality approach to communication with stakeholders that includes opportunities for frequent updates, 利益相关者的反馈, 分享成功.
- Establishing an inclusive governance and management structure to monitor patient- and population-level outcomes.
- Educating and retraining the workforce on health equity priorities and goals and achievement of success in outcomes.
马特·马斯林编辑
¹http://www.cms.gov /优先级/创新/ strategic-direction-whitepaper.
²http://www.cms.gov/newsroom/fact-sheets/fy-2024-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective.
³http://www.cms.gov/newsroom/fact-sheets/fy-2024-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective.
⁴http://qualityreportingcenter.com/globalassets/2023/04/iqr/scrnsocdrvrs_-scrn_pos_specs-thi-edits-v2508.pdf.
⁵http://www.cms.gov /文件/文档/ health-equity-fact-sheet.pdf.
⁶http://www.cms.gov /新闻/说明书/ 2024 -医疗保险优势-和- d -最后一部分——规则- cms - 4201 f.
⁷http://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule-medicare-shared-savings-program.
⁸http://www.cms.gov /优先级/创新/媒体/文档/ aco-reach-health-equity-slides.
⁹http://www.cms.gov /优先级/创新/媒体/文档/ mcp-ovw-webinar-slides.
¹⁰http://www.cms.gov /优先级/创新/创新模型.
¹¹http://www.cms.gov /文件/文档/ health-equity-fact-sheet.pdf.
¹²http://www.也是ohsu.edu/sites/default/files/2021-06/Oregon%20Medicaid%20addresses%20SDOH%20and%20health%20equity1.pdf.
¹³http://www.凯萨.org/policy-watch/a-look-at-recent-医疗补助计划-guidance-to-address-social-determinants-of-health-and-health-related-social-needs.
¹⁴http://www.州长.ny.hochul gov /新闻/州长- -宣布开创性医疗补助- 1115豁免-修改-强化-新-纽约.
¹⁵http://www.医疗补助计划.gov /网站/违约/文件/ 2024 - 01 /纽约-医疗补助rdsgn -团队appvl - 01092024.pdf.
¹⁶http://www.uhc.com/content/dam/uhcdotcom/en/B2B-Newsletters/b2b-pdf/Advancing-Health-Equity-to-Improve-Outcomes.pdf.
¹⁷http://www.thecignagroup.com/our-impact/esg/healthy-society/health-equity.
¹⁸http://www.bcbs.com/the-health-of-america/healthequity/top-ten-maternal-health-equity-actions.
¹⁹http://www.bcbs.com/the-health-of-america/healthequity/how-maternity-navigator-victoria-brown-breaks-down-barriers-healthy-pregnancies.
出版于2024年10月17日