INSIGHTS

Expert Perspective

April 21, 2022

New Payment Models Can Help Solve Persistent Health Equity Challenges

Corey Redding – Executive Director, CareAllies Accountable Care Solutions, LLC

Everyone should be able to access health care when and how they need to, so they can be as healthy as possible. Sadly, people who face economic, geographic, and socially determined disadvantages can struggle to access quality health care and often fail to reach their full health potential.

Health inequities can directly impact a person’s long-term well-being. For example, they can influence how long someone lives, their quality of life, their likelihood of getting or surviving serious diseases, such as cancer, and their access to treatment to quickly respond to escalating health conditions.

Although health disparities are concerning for our entire population, they are especially worrisome for our country’s most frail patients—those who are over 65, who have several chronic conditions, and who are economically disadvantaged. These patients often qualify for both Medicare and Medicaid, and despite participation in both programs, they can’t always get the care they need. This is not necessarily because care is unavailable, but more likely because there are other roadblocks to receiving care that don’t usually fall under the health care organization’s purview—things like transportation to get to an appointment, the required technology to engage in telehealth visits, and balanced meals to improve overall health and support illness recovery. Or perhaps the patient struggles to follow their care plan, and they don’t have anyone to help, so they aren’t able to stay current with preventive health screenings. These issues are amplified when critical information is not shared between the many providers who manage their numerous conditions.

One way that health care providers can address the challenges these frail patients face is to seek creative solutions that involve others outside of the traditional health care setting. For example, health care entities should be connecting with community organizations, such as food banks, public health agencies, and transportation services, which are already working to respond to existing disparities. Health care providers should also ensure they are sharing pertinent data and working together to support an individual’s journey toward better health.

Unfortunately, traditional fee-for-service models do not enable or encourage this kind of creative problem solving or robust care management. However, emerging capitated payment models offer greater flexibility so providers are empowered to make the decisions that best meet patient needs. These models allow providers to balance the clinical and non-clinical interventions that can impact a patient’s health. By engaging with these models, providers can improve the way they support frail patients, so these individuals get the care they require, regardless of their circumstance.

Currently, many of these models are being tested through the Centers for Medicare & Medicaid Services Innovation Center. Now is the time to explore your options to identify which arrangements can help your practice provide more equitable patient care.

CareAllies continues to help simplify the transition to these value-based models so provider organizations can seize opportunities to provide more targeted, person-centric care that moves the needle on health equity and helps expand access to quality health care for all.

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