Health equity has been thrust into the spotlight with providers, regulatory agencies, and payers seeking ways to identify and eliminate disparities in care across race and ethnicity, gender, sexual orientation, socioeconomic status, and other lines. It is a priority further impacted by the emergence of new quality-based care models that go beyond those established under the Patient Protection and Affordable Care Act of 2010.
For example, in January 2023, the Global and Professional Direct Contracting (GPDC) Model will be replaced with the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, a test program designed to address health inequities and improve support for provider-led organizations in risk-based arrangements. It requires participants to address health disparities and support better health outcomes by:
- Reducing avoidable utilization
- Improving quality scores
- Ensuring safe care transitions
This includes the creation of a health equity plan, beneficiary-level risk adjustments, and collection of beneficiary-reported demographic and social determinants of health (SDOH) information that covers race, ethnicity, language, gender identity, and sexual orientation as required by the United States Core Data for Interoperability Version 2 (USCDI v2).
The challenge for many healthcare organizations that want to participate in new reimbursement models focused on achieving care parity is how to expand healthcare leaders’ view of health equity and SDOH to fully grasp the true reach of this vital data. This is necessary because the prevalent view focuses on initiatives related to patient experience and patient relations, which fails to consider how actionable data comes through as a natural occurrence of a patient’s interaction with the health system staff and care team.
Often overlooked is the fact that healthcare organizations’ coding and revenue cycle management (RCM) departments are already aggregating valuable information that can ultimately help identify and better understand inequities in care delivery and inform initiatives to improve health equity across their patient populations.