Payment Models
As our healthcare system continues to innovate ways to incentivize quality over quantity, we must ensure that health disparities and social determinants are addressed if we are to achieve health equity. Years of research have revealed the link between non-medical factors and poor health outcomes. New payment models must be equipped to address the factors that drive high healthcare costs and poor outcomes. This is particularly true among vulnerable populations, who often live with higher rates of chronic disease and less access to health care services. As shared in our 8-point-call-to-action TRCC highlights policies that would help ensure payment to care providers and non-clinical community- based organizations to reduce costs and advance health equity.
Resources and Information
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Centers for Medicaid and Medicare Services press release: “CMS Issues New Roadmap for States to Address the Social Determinants of Health to Improve Outcomes, Lower Costs, Support State Value-Based Care Strategies”
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The American Academy of Family Physicians article: "Advancing Health Equity: Principles to Address the Social Determinants of Health in Alternative Payment Models"
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Center for Health Care Strategies report: “Leveraging Value-Based Payment Approaches to Promote Health Equity: Key Strategies for Health Care Payers”
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Health Affairs article: “The Case for ACOs: Why Payment Reform Remains Necessary”
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Health Affairs article: “Health Equity Should Be A Key Value In Value-Based Payment And Delivery Reform”
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Kaiser Family Foundation research: “Medicaid Authorities and Options to Address Social Determinants of Health (SDOH)”
John Lewis Equality in Medicare and Medicaid (EMMT) Act
H.R. 3069 - Representative Terri Sewell (D-AL)
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Introduced on 5/2/23
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6 Co-Sponsors as of 6/6/23
S. 1296 - Senator Cory Booker (D-MA)
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Introduced on 4/26/23
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2 Co-Sponsors as of 6/6/23
Description
The bill would:
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Direct the Center for Medicare and Medicaid Innovation (CMMI) to consult with experts on health disparities, such as the Office of Minority Health of the Centers for Medicare & Medicaid Services, the Federal Office of Rural Health Policy, and the Office on Women’s Health, on developing new payment models that focus not only on lowering costs but also advancing health equity and improving access to care.
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Focus on creating and testing new value-based payment models. Currently, it is not mandated to take into account social determinants of health like a patient's environment, education, and economic background during the testing and implementation of new payment models.
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A one page summary on the bill prepared by TRCC staff is available here
Status
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The bills remain under consideration in the House Energy and Commerce and Ways and Means Committees and the Senate Committee on Finance
Additional Information
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Rep. Sewell's office press release: Rep. Sewell and Sen. Booker Introduce Legislation Named for the Late Rep. John Lewis to Advance Health Equity and Access to Care
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Sen. Booker's office press release: Booker Reintroduces Legislation to Promote Health Equity and Access to Care
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TRCC is currently circulating a sign-on letter to support Representative Sewell and Senator Booker regarding this legislation
Contact
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For further information about this issue or other legislation in the ELM, please contact Tom Dorney at tdorney@rootcausecoalition.org or Hannah Miller at hmiller@rootcausecoalition.org