Working to Achieve Health Equity: The CMS Equity Plan for Medicare One Year Later

By: Cara V. James, Ph.D., Director of the Office of Minority Health at the Centers for Medicare & Medicaid Services

One year ago, the Centers for Medicare & Medicaid Services (CMS) launched its first ever Equity Plan for Improving Quality in Medicare at a conference commemorating the 50^th anniversary of Medicare and Medicaid and the 30^th anniversary of the Report of the Secretary’s Task Force on Black and Minority Health. The CMS Equity Plan for Improving Quality in Medicare is an action-oriented plan that focuses on six priority areas and aims to reduce health disparities among vulnerable populations including, racial and ethnic minorities, sexual and gender minorities, and people with disabilities.

The foundation of the CMS Equity Plan for Improving Quality in Medicare, is our 3-part ‘path to equity’ framework. The path involves: (1) increasing understanding and awareness of disparities, (2) developing and disseminating solutions, and (3) taking sustainable action and evaluating progress. Our path to equity enables us to take a comprehensive approach to addressing health disparities because it promotes progress regardless of where stakeholders are in their efforts to achieve health equity. In addition, the path to equity can be adopted by a wide range of stakeholders and organizations and applied from the individual level up to the community, state, and policy levels. The priorities and activities described in the Equity Plan for Medicare were developed during a rigorous year-long process, which included examining evidence, identifying opportunities, and gathering input from a broad array of stakeholders across the country. The plan includes six priority areas and an array of activities.  They are:

Priority 1: Expand the Collection, Reporting, and Analysis of Standardized Data
Priority 2: Evaluate Disparities Impacts and Integrate Equity Solutions across CMS Programs
Priority 3: Develop and Disseminate Promising Approaches to Reduce Health Disparities
Priority 4: Increase the Ability of the Health Care Workforce to Meet the Needs of Vulnerable Populations
Priority 5: Improve Communication and Language Access for Individuals with Limited English Proficiency and Persons with Disabilities
Priority 6: Increase Physical Accessibility of Health Care Facilities

Since the launch of the CMS Equity Plan for Improving Quality in Medicare, we have been actively working to increase our understanding of disparities among Medicare beneficiaries with limited English proficiency and disabilities, and our knowledge of how to better prepare our workforce to meet the needs of vulnerable populations. To assist stakeholders in identifying disparities at a local, state, or regional level, we launched our Mapping Medicare Disparities Tool earlier this year.  The Mapping Medicare Disparities Tool is an interactive map, which can be used to identify areas of disparities between subgroups of Medicare beneficiaries in health outcomes, utilization, and spending. To assist in the identification of disparities within Medicare health plans, we released for the first time national and contract level quality data stratified by race and ethnicity.

We have been working to develop solutions to help spur sustainable action. As part of our Building an Organizational Response to Health Disparities portfolio, we released the Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries. This guide gives an overview of key issues related to readmissions for racially and ethnically diverse Medicare beneficiaries, as well as useful resources for hospital leaders to take action to address readmission. Our guide offers case examples of strategies and initiatives. We also released a compendium of resources for standardized demographic and language data collection to help organizations collect and analyze their own data, so that they may begin to increase understanding and awareness of disparities that may exist within their own organization.

To ensure that actions around equity at CMS are sustainable, we have been working with our colleagues across the Agency to identify where equity can be embedded. To that end, reducing disparities, focusing on social determinants of health, and advancing health equity have been called out in a number of models and initiatives. Within the Merit‐Based Incentive Payment System (MIPS), achieving health equity is one of the areas for clinical practice improvement activities. At the heart of the Accountable Health Communities Model is identifying and addressing the health-related social needs of beneficiaries.

While we have reached a number of milestones this year, we know that there is still much work to be done to achieve health equity. As we continue implementing the CMS Equity Plan for Medicare, we will focus on building on our accomplishments, strengthening our partnerships, and monitoring and evaluating our progress. We cannot do this work alone, so we encourage you to join us on the path to equity. By working together, we can truly achieve care and services that are high quality, effective, and equitable.

To learn more about our accomplishments regarding achieving health equity in Medicare and other activities underway at the CMS Office of Minority Health, visit: go.cms.gov/omh.

CMS Finalizes its Measures Under Consideration List for Pre-rulemaking

By: Kate Goodrich, M.D., M.H.S., Director, Center for Clinical Standards & Quality, CMS

Medicare and other payers are rapidly moving toward a health care system that rewards high quality care while spending taxpayer dollars more wisely. Foundational to the success of these efforts is having quality measures that are meaningful to patients and providers alike, and that drive improvement and better outcomes for patients. Each year, CMS publishes a list of quality and cost measures that are under consideration for Medicare quality and value-based purchasing programs, and collaborates with the National Quality Forum (NQF) to get critical input from multiple stakeholders, including patients, clinicians, commercial payers and purchasers, on the measures that are best suited for these programs. Ultimately, these measures may help patients and families choose the nursing home, hospital, or clinician that is best for them, and can help providers deliver the highest quality of care to their patients.

I am happy to announce that CMS posted the final Measures under Consideration List on the CMS website and has sent them to NQF in preparation for this multi-stakeholder input. They can be found on the CMS website, at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Pre-Rule-Making.html and on the National Quality Forum’s (NQF) website, at http://www.qualityforum.org/Setting_Priorities/Partnership/Measure_Applications_Partnership.aspx).

This year’s MUC list contains 97 measures that have the potential to drive improvement in quality across numerous settings of care. CMS is considering new measures for nursing homes, hospitals, clinician practices, and dialysis facilities, among other settings, and continues to focus on important measures of patient outcomes, appropriate use of diagnostics and services, cost, and patient safety. This year, 39 percent of measures on the Measures under Consideration List are outcome measures, and an increased number of measures were submitted for consideration by specialty societies. CMS is committed to working with specialty societies and other stakeholders on the development and use of measures that are most meaningful to patients and clinicians for our programs.

The Affordable Care Act (ACA) (P.L. 111-148, enacted on March 23, 2010) added Section 1890A to the Social Security Act (the Act), which requires that the Secretary of the Department of Health and Human Services (HHS) establish a federal “pre-rulemaking process” for the selection of certain categories of quality and efficiency measures for use in various Medicare quality programs.  These measures and programs are described in section 1890(b)(7)(B) of the Act. One of the steps in this process requires that the Secretary make publicly available a list of quality and efficiency measures by December 1st that CMS is considering for adoption, through the annual rulemaking process, for use in these Medicare programs.  Additionally, this provision requires HHS to contract with a consensus-based entity (currently the National Quality Forum) to “convene multi-stakeholder groups to provide input on the selection of quality measures” for the programs specified in the law.

Subsequent to the posting of the Measures under Consideration List, NQF will accept comments on the list and convene the multi-stakeholder from the public on behalf of and for consideration by the Measure Applications Partnership (MAP) to review and provide input on which measures are most suitable for Medicare’s quality and value-based purchasing programs. This is the sixth year that CMS has collaborated with NQF on this pre-rulemaking process, and together we have worked to make the process more efficient and the feedback more meaningful. The input that we receive from the MAP is invaluable, and reflects the viewpoints of many experts in the field of quality and value, most importantly patients and consumers.

We invite you to review the Measures under Consideration List in detail and to participate in the public process during the MAP review. We believe it is critically important to hear all voices in the selection of quality and efficiency measures that are used for accountability and transparency purposes and look forward to another successful pre-rulemaking season. We are committed to working with patients, clinicians and others on how to best measure the quality and value of care while reducing burden on providers and driving improved outcomes for patients at lower costs.

For more information regarding the MAP’s purpose, meetings, 2016 Measures under Consideration List deliberations and voting, visit the NQF website, at http://www.qualityforum.org/map/.