In our recently released white paper, ‘The Future of Health Care Delivery is in Risk-based Payment,’ we addressed some essential realities regarding the current state of health care in the United States. We noted that most health care professionals and consumers agree that health care in the United States is overburdened, under-resourced, and sometimes broken. The results of a fractured system are evident as we are experiencing unprecedented levels of physician burnout, high levels of nurse and clinical team turnover, and nationwide provider shortages. We also asserted the significance of transitioning from traditional fee-for-service methodologies to outcomes-driven services based on holistic, patient-centered care.
Today, our health care system is unduly burdened by the increasing demands of health inequities. Whether the disparities are based on race, ethnicity, educational factors, or any number of social determinants, health inequities cost the United States $320 billion annually, and the costs are predicted to rise.
The Centers for Medicare & Medicaid Services (CMS) are tackling rising healthcare costs and health disparities by promoting participation in Accountable Care Organizations (ACOs). ACOs incentivize providers to enhance care coordination for underserved populations and reduce health inequities. CMS is advancing this approach by integrating health equity into all its value-based payment models.
Recently, CMS has revised quality scoring for Medicare Shared Savings Program (MSSP) ACOs to account for patient demographics and underserved communities. Another strategic solution is the ACO Realizing Equity, Access, and Community Health (REACH) model, which incorporates health equity requirements. This model systematically collects and risk-stratifies essential demographic and social determinants of health data for all Medicare beneficiaries in the program.
With an emphasis on population health management and preventive care, ACOs are transforming care for underserved populations. Below are three ways this transformation is progressing.
Data-driven approaches are familiar in our data-fueled society. However, specifically designed technology has enabled providers and clinical teams to optimize population health management tools and analytics to better understand their patient populations based on individual and regional risk factors and health needs. By identifying high-risk individuals or communities, providers can intervene to address unmet needs, prevent adverse health outcomes, and reduce disparities.
In an age when few clinics and hospitals have been immune to the challenges of understaffed operations, coordinated care across multiple specialties is essential—not only for optimizing quality patient care but also for improving efficiencies. ACOs effectively integrate entire clinical teams representing a variety of specialties, including primary care physicians, specialists, nurses, social workers, and other health care professionals. These teams collaborate and communicate to effectively address the diverse needs of underserved populations.
Patient-centered care requires that providers preventative care practices based on outcomes rather than fees or the number of services. Implementing preventive care by committing to annual wellness visits, screenings, and conversations about social determinants of health, including health literacy, results in a deeper understanding of patients' unique needs and leads to customized care plans to address the root causes of health disparities.
In a post-pandemic era, when providers are being asked to do more with fewer resources, improving health care outcomes may appear daunting. ACO participation has demonstrated that providers, whether based in rural or urban areas and those treating underserved demographics, can benefit from population health management and holistic value-based pay models that more effectively identify and solve health inequities while maintaining autonomy and regional practices.
Reducing health disparities is paramount to improving patient care outcomes and helping to reduce or maintain the escalating costs of U.S. health care. Download our white paper to learn more about how ACO participation can help improve outcomes for underserved patients.
https://www2.deloitte.com/us/en/insights/industry/health-care/economic-cost-of-health-disparities.html
cms.gov/files/document/cms-framework-health-equity-2022.pdf