Road Map to More Equitable Care From the Centers for Medicare and Medicaid Services

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Created more than a decade ago, the Office of Minority Health (OMH) and the National Institute of Minority Health and Health Disparities have a mission to advance the health of racial and ethnic minority populations through policies, programs, and partnerships at the Centers for Medicare and Medicaid Services (CMS). During the National Comprehensive Cancer Network (NCCN) Virtual Oncology Policy Summit, “Defining the ‘New Normal’ 2021 and the State of Cancer Care in America,” LaShawn McIver, MD, Director of the OMH, discussed the potential impact on health disparities of recent executive orders signed by President Joe Biden along with key tools that may help drive equity within the health-care system.

LaShawn McIver, MD

LaShawn McIver, MD

“As our office looks ahead to a new normal in equity, we’re excited to share the wealth of resources … that we hope will aid others on their path to equity,” said Dr. McIver.

Executive Order 13985

On January 20, 2021, President Biden signed an executive order titled “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government.” According to Dr. McIver, the executive order lays out a systemic approach to address inequities, which includes embedding fairness within the decision-making part of all federal government agencies.

The executive order defines “equity” as consistent and systematically fair, just, and impartial treatment of all individuals, including those who belong to underserved communities that have been denied such treatment: persons adversely affected by persistent poverty and inequality, tribal communities, people of color, and otherwise historically marginalized populations.

“With CMS being one of the largest payers of health care in the world, this is clearly an important executive order for our work ahead,” Dr. McIver said. “It takes a whole government approach to equity and provides a unique opportunity for our agency to impact underserved populations.”

The executive order also identifies methods to assess equity through data, discussing barriers to benefit and potential for new policy. This approach strongly overlaps with the core function of the OMH, which is to lead the development of an agency-wide data collection infrastructure for minority health activities and initiatives and monitor the impact of CMS programs.

Leveraging Key Tools to Drive Equity

To better inform policy decisions and efficiently target populations for interventions, the OMH has created an interactive map of geographic disparities in chronic disease among Medicare beneficiaries. The Mapping Medicare Disparities Tool identifies disparities in health outcomes, utilization, and spending by race and ethnicity as well as geographic location; it also provides data on the prevalence of 18 chronic conditions, Medicare spending, preventable hospitalizations, readmissions, and mortality rates. The tool also offers built-in benchmarking features to investigate disparities within counties and across racial and ethnic groups as well as within racial and ethnic groups across counties.

“It is an excellent starting point to investigate geographic and racial and ethnic differences in health outcomes,” said Dr. McIver. “Analysis of male Medicare beneficiaries, for example, has shown that Blacks and/or African Americans have a higher prevalence of prostate cancer compared with other groups.”

Another information product, called Data Highlights, presents national and regional data on Medicare populations to provide overviews of specific public health issues. Data Highlights also provides quantitative and qualitative analysis of CMS data and explains how these findings support or relate to policy initiatives.

In addition, the OMH offers Data Snapshots, which provides high-level information on different chronic conditions among Medicare fee-for-service beneficiaries and the impact on minority groups.

Addressing the Social Determinants of Health

Despite the many advancements achieved in cancer prevention, detection, and treatment, there are populations who have not had the same improvement across the care continuum, commented Dr. McIver. Racial and ethnic minorities tend to experience more cancers than other populations, and communities that are medically underserved lack access to sufficient cancer care due to social determinants of health.

“Some underserved populations may live in a food desert, a neighborhood that has limited public transportation, or an area that has higher air pollution,” she explained. “All of these factors can increase the burden of disease and create additional barriers when accessing preventive and treatment services.”

Launched in 2016, the CMS Disparities Impact Statement provides personalized technical assistance focused on strengthening quality improvement programs through a series of consultations from subject matter experts. Using Social Determinants of Health –related Z codes, for example, may help stakeholders to enhance quality improvement initiatives. 

DISCLOSURE: Dr. McIver reported no conflicts of interest.

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Expert Point of View: Shonta Chambers, MSW

According to Shonta Chambers, MSW, Executive Vice President of Health Equity Initiatives and Community Engagement, Patient Advocate Foundation, the social determinants of health that hinder people’s ability to access and adhere to cancer care cannot be ignored if health equity is to be achieved.

Shonta Chambers, MSW