The ongoing effort to transform health care in the United States is an important opportunity to address racial, ethnic, and other health inequities directly and deliberately. A central pillar in delivery system and payment reform is promoting evidence-based care: incentivizing treatments with strong evidence of success and appropriate value, and disincentivizing those that are not supported by a strong evidence base.
The Health Equity Task Force for Delivery and Payment Transformation’s Top 19 Recommendations for 2019 and Beyond.
Financial Support for Safety Net and Small Community Providers to Participate in Delivery System Reform: Medicaid-Based Options for States.
As efforts continue to remedy the failures of our health care system by changing how providers are paid and care delivery is organized, it is imperative that achieving health equity be included in the equation. Unfortunately, health system transformation efforts have largely ignored one of our health care system’s most fundamentally wasteful and unfair problems: persistent racial, ethnic, and geographic health and health care inequities. So instead of leveraging the opportunity of health system transformation to accelerate achieving health equity and better health and health care for all, unintended consequences could actually be making inequities worse.
Community Health Workers in Delivery and Payment Transformation: How New Delivery and Payment Models Can Incentivize and Support the Use of CHWs
The current attention on implementing delivery and payment reforms to improve the quality of care and health outcomes while reducing costs creates an important opportunity for greater integration of CHWs into the health care system and for providing more sustainable financing for CHWs. In this brief, we detail how health system transformation initiatives in Vermont and Oregon align with the value that CHWs provide and how these initiatives can incentivize CHW integration.
There has been an important and ongoing effort over the past decade to address the manifest failures of our health care system by changing payment and provider organization to reward value and not volume. But transformation efforts largely ignore one of our system’s most fundamental problems: persistent, extensive, severe, and costly health and health care inequities based on race, ethnicity, and geography, among other factors.
Lowering the price of prescription drugs remains one of the top health care priorities for consumers.1 But pharmaceutical manufacturers continue to increase prices on lifesaving medications.2 A recent proposal from the Trump Administration seeks to control prescription drug costs in Medicaid by giving states the authority to eliminate people’s access to needed and even lifesaving drugs. This approach fails to address the underlying issue of pharmaceutical manufacturers setting such high prices at the national level.
A Framework for Advancing Health Equity and Value: Policy Options for Reducing Health Inequities by Transforming Healthcare Delivery and Payment Systems
Families USA created the Health Equity Task Force for Delivery and Payment Transformation to bring together state and national health equity thought leaders to catalyze much-needed action to leverage health system transformation for the benefit of those whom the health system is leaving behind. Ensuring that people who are facing the biggest barriers to good health and high-quality health care are served well by the health care system will improve care for everyone.
Medicaid managed care contracting is a promising pathway for securing more sustainable funding for community health workers (CHWs). This issue brief provides examples of contract language that can be used to incentivize or require Medicaid managed care organizations to utilize and fund CHWs and considerations for advocates looking to improve support for CHWs through this pathway.
High and rising prescription drug prices force consumers to skip doses or even avoid filling their prescriptions for life-saving medications altogether. Now is the perfect time for Congress to finally begin to take action by including the bipartisan CREATES Act in the omnibus legislation to fund the government, which must pass Congress by March 23rd.
Efforts to shift to a value-based health care system create an opportunity to improve the quality of care and health outcomes, save money for consumers and the health care system as a whole, and drive reductions in health disparities. But such positive outcomes from payment and delivery reform efforts are not guaranteed. There are some elements of this proposed rule that can help reduce health disparities, but a real commitment to health equity requires additional steps from CMS.