ACO REACH：利用数据覆盖服务不足的人群，解决不平等问题

MILLIMANWHITE PAPER CMS requiresnewREACHACOsto study and address health equity Molly BilzStoddard Davenport,MPHBrent Jensen,FSA,MAAAChris LewisShelley Moss, FSA,MAAAMatthew Smith,FSA,MAAAJill Van Den Bos, ASA, MAAA CMSrequiresREACH ACOsto assess health equity in theiraligned populations and “promote greater equity in the delivery ofhigh-quality services.”5Participants’financialbenchmarkswill beimpacted by the extent to which their aligned population iscomposed of underserved beneficiaries(described below). CMS requires newly formed REACHACOsto submita Health Equity Plan,which providesan opportunitytostudyand address healthinequities.1 The ACO REACH model defines the term “equity”6as defined inExecutive Order 139857: “the consistent and systematic fair, just,and impartial treatment of all individuals, including individualswho belong to underserved communities that have been deniedsuch treatment, such as Black, Latino, and Indigenous andNative American individuals, Asian Americans and PacificIslanders and other individuals of color; members of religiousminorities; lesbian, gay, bisexual, transgender, and queer(LGBTQ+) individuals; individuals with disabilities; individualswho live in rural areas; andindividuals otherwise adverselyaffected by persistent poverty or inequality.” The Centers for Medicare and Medicaid Services (CMS)hascreated a newaccountable care organization(ACO) program,ACO Realizing Equity, Access, and Community Health (REACH).REACH represents an effort to better reflect CMS’s goals ofachieving equitable outcomes through improving quality of careand focusing on patients in underserved communities. Addressing health inequities isone of the key new elements inwhat was previously the Global and Professional DirectContracting (GPDC) model,2and a place where providers mayhavea largelearning curvewith regards to data analysis. Health inequity is closely linked to social determinants of health(SDOH), which Healthy People 2030 defines as “the conditions inthe environments where people are born, live, learn, work, play,worship, and age that affect a wide range of health, functioning,and quality-of-life outcomes and risks.”Onedomain is healthcareaccess and quality. Examples of SDOH are safe housing, accessto transportation, educational attachment, income, food security,language, and literacy.8 In this paper, we provide some background on health equity,itsrole withinREACH, andfocus onguidance on the Health EquityPlanthatREACHACOswill need to develop under the newprogram.We then present two examples of simple health equitydata analyses using claims and other information,with resultspresented by race and area deprivation index. Healthequityand ACO REACH NEW ACO REACH HEALTH EQUITY PROGRAMREQUIREMENTS BACKGROUND ON HEALTH EQUITY While health equity haslongbeen a subject of publication,interest has accelerated in the last 20 years.3More recently,Executive Order 13985, signed by President Biden on January20, 2021, tasked federal programswithassessingandmitigatingracial inequities produced by their policies.4 REACHbuilds on the principles and methodology set forth inthepreviousGPDC model9to reflect the currentadministration’s priorities, incorporate stakeholder feedback,and improve participant experience. REACH’s stated goals include “improving the quality of care forpeople with Medicare through better care coordination, reachingandconnecting healthcare providers and beneficiaries,including those beneficiaries who are underserved.”10 To achieve these goals, CMS has releasedfive newHealth Equitypolicies11(each of which are briefly described further below): The third policy specifies data to be collected to monitor andevaluate the REACH model, including beneficiary demographicsandSDOH data.13 1.Health Equity Plan Requirement2.Health Equity Benchmark Adjustment3.Health Equity Data Collection Requirement4.Nurse Practitioner Services Benefit Enhancement5.Health Equity Questions in Application and Scoring forHealth Equity Experience The fourth policycreateswaivers for nurse practitioners totake on certain responsibilities and provider services withoutphysician supervision14 The fifth policyupdatesCMS’sprogram application developmentand scoringto encourage application of entities with experienceprovidingcare to underserved communities.15 TheHealth Equity Planpolicy(theprimaryfocus ofthispaper)will require ACOs to be proactive in addressing health equity inREACH. The purpose of the plan is for each ACO to identifyunderserved communities within its aligned beneficiarypopulation and implement initiatives to measure and reducehealth disparities for those populations over the course of themodel performance period. Each REACHACOmust identifyhealth disparities, define health equity goals, establish a healthequity strategy, and plan for implementing the health equitystrategy to achieve health equity for underserved communities.12 ACO REACH ProgramHealthEquity Plans GENERAL DESCRIPTION CMS is requiring