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Community engagement, investment and quality indicators were highlighted as potential solutions to address health inequities affecting marginalized communities across the country.

Systemic health and social factors have a significant impact on the quality of and access to health care in the United States, and race, zip code and data are just some of several variables raising equity concerns for underserved communities across the country, according to participants discussions on Wednesday. panel discussion at AHIP 2022.

Opening the session on Taking Action for Health Equity, Dora Hughes, Chief Medical Officer of the CMS Center for Healthcare and Care Innovation (CMMI), noted that two key challenges remain at the forefront of health inequalities: structural factors hindering the provision of medical care. access (eg lack of health care providers and insurance) and inequities in the quality of health care that have historically affected minorities.

Racial and residential segregation in the United States has caused factors such as educational attainment, income, and zip code to have a disproportionate impact on health outcomes, including maternal morbidity and cancer.

“Even for those who do not face access barriers, there are still differences in the quality of service. We still have blacks, Hispanics and other people of color who are not getting the recommended care,” Hughes said.

Lack of data for underserved communities has been cited as a major factor limiting effective discussions with payers, service providers and health plans. Joni S. Khaldun, MD, MD, FACEP, vice president and chief health equity officer, CVS Health, says a deliberate approach to closing care gaps starts with policies, programs and processes.

“Any quality metric, you have to look at it by race, ethnicity, disability status, sexual orientation, gender identity… As a payer, looking at pre-clearance, usage management and appeal processes, you have to look at it from an equity lens.” Khaldun added.

These gaps in data collection have become a hot issue for CMMI. Hughes acknowledged that, looking back at the first 10 years of their respective models, the demographics of the beneficiaries served were unknown and the majority of these patients were white and had a higher income. Efforts in recent years have shifted priorities to accommodate the diversity of the Medicare and Medicaid population.

“The key to this is getting social care providers, federal health centers, rural clinics, health care providers who can really improve research and get their population involved so that they, too, benefit from the work that we are trying to do…when the model is complete and there will be assessed, how do we focus on sustainability?” Hughes asked. “We have learned a lot from our alternative payment models, and in many cases the lessons we have learned have not been more widely adopted by the value-based community.”

The widespread adoption of value-based care systems is still subject to cost and investment, especially for new entrants who are unable to take the risk. In shaping policies and infrastructure that will advance health equity, Marshall H. Chin, MD, MD, Richard Parrillo, Family Professor of Health Ethics at the University of Chicago School of Medicine and Co-Chair of the CMS Health Care Payment Learning and Action Network Advisory Group Health Equity has identified 3 priorities, led by pay reform, that can support and drive the transformation of health care.

“Money is a powerful driver of what we do in healthcare. So, again, pay reform modules support and encourage these health care transformations for health equity. The second is looking at the social determinants of health at the individual level in different patients, and then creatively partnering with various community-based organizations that recognize social determinants,” Chin said.

“If you do not solve the problem of cultural justice, you are at a dead end, because you need a buyer, a solution at the forefront.”

Khaldun’s advice to improve the infrastructure for health equity became more introspective as he encouraged organizations to ask questions that challenge their influence.

“How does this policy, program, process affect historically marginalized communities? If you ask this question frankly, you will see places where you can probably improve,” she said. “And then the second question is: Have I included these historically marginalized communities in how I decide my politics?”

When she served as director and public health officer for the Detroit Department of Health, which has the highest infant mortality rate in the country, community outreach efforts made her aware of the lack of public transportation, which was affecting residents’ access to healthcare. After partnering with Lyft in 2019, Detroit saw its lowest infant mortality rate in over 100 years.

“Metrics, data, community engagement – ​​you can see these differences coming together…Equality is not just a program, it is built into what you do,” she concluded.

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