CMS Innovation Center's Latest Moves: Embedding Equity Into Value-Based Care

“We can't achieve this vision, and we can't transform the health system into one that's more equitable without partnering with all parts of the health system,” Purva Rawal, PhD, said.
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During a recent CMS Health Equity Conference session, health care professionals and policy makers gathered to discuss groundbreaking approaches to health equity and value-based care. The panel, part of a series of discussions led by CMS’s Innovation Center, highlighted efforts to embed equity into health care models, enhance patient outcomes, and reduce costs.

Setting the Stage for Health Equity and Value-Based Care

Purva Rawal, PhD, chief strategy officer of the CMS Innovation Center, moderated the first half of the session, in which Katy Tapp, LMSW, vice president of clinical operations, Commonwealth ACO; Misty Chicchirichi, RN, MSN, senior quality programs manager, Shenandoah Oncology; and Unini Odama, MD, MPH, MBE, vice president of medical affairs, infection prevention and management, health equity, DaVita Kidney Care, focused on innovative strategies for health equity and value-based care. The second half provided insights from CMS team members on how these approaches are being integrated into the Medicare program and beyond.

Introduction to the CMS Innovation Center

Rawal took the stage to outline the CMS Innovation Center’s mission: Established under the Affordable Care Act, the Center tests new payment and care delivery models aimed at shifting from fee-for-service to value-based care. She emphasized the Center's commitment to equity, describing it as integral to the vision of achieving high-quality, affordable, and person-centered care.

Strategic Objectives:

1. Driving accountable care: ensuring beneficiaries have continuous relationships with providers accountable for their care
2. Advancing health equity: embedding equity into all models and addressing health-related social needs
3. Supporting innovation: providing data, regulatory, and payment flexibility to foster person-centered and integrated care
4. Addressing affordability: tackling drug pricing and access to reduce healthcare costs
5. Partnering for system transformation: collaborating across the health system to achieve equitable outcomes

Health Equity Focus

Diving deeper into CMS health equity initiatives, the session detailed the systematic integration of equity into all aspects of their models:

• Screening for health-related social needs: requiring new and redesigned models to screen and address social needs, with a focus on community resource connections
• Adjusting payments for social risk: testing payment adjustments based on social risk to support providers in underserved communities
• Developing health equity plans: helping model participants identify and address disparities in their service areas

Value-Based Care in Practice

Tapp, of Commonwealth ACO, described the challenges and successes of integrating health equity data collection into their practice, emphasizing the importance of incentives provided by CMS to support these efforts. Commonwealth ACO has worked to include social determinants of health (SDOH) data in their reporting, using tools like the North Carolina SDOH screening assessment during annual wellness visits to identify and address patients' social needs.

Chicchirichi, from Shenandoah Oncology, an Enhancing Oncology Model (EOM) participant, highlighted the proactive approach to addressing SDOH in cancer care. With a high prevalence of food insecurity and rural isolation in their service area, Shenandoah Oncology employed patient navigators to identify and address nonclinical needs, such as financial, housing, and transportation support. They utilized the "Find Help" platform to connect patients to local resources and ensure access to nutritious food, which is crucial for improving chemotherapy outcomes.

Odama shared the strategy implemented at DaVita Kidney Care, for addressing disparities in kidney care. DaVita’s approach involves deeply understanding patient needs and barriers through direct feedback. She also explained that DaVita’s value-based care model facilitates a holistic view of health that extends beyond just treating kidney disease. They focus on social care, patient autonomy, and culturally appropriate support to improve home dialysis and kidney transplantation outcomes.

"Value-based care in the model that we have gives us that opportunity to really be humble and to really be accountable, find out which is within our purview, and how we begin to collaborate and cross lanes. Historically, in the renal world, or taking care of kidney disease, we normally just operate in silos, but the value-based care model gives us the opportunity to really have these multidisciplinary crosslane interactions that help us to bring the true value to our patients,” Odama said. “And then, of course, to remain person centric as opposed to just chasing the metric. Because the problem is that once we chase a metric, that metric becomes what leads us instead of the value to the patient.”

Key Takeaways and Future Directions

The importance of community engagement, personalized care, and multidisciplinary collaboration in addressing health equity was underscored by each panelist. They called for continuous adaptation and learning from patient feedback to refine and improve care models.

Rawal emphasized that health equity is not a separate endeavor but an integral part of creating value in health care. She encouraged continued partnership and innovation to transform the health care system into one that is truly equitable for all.

“We can't achieve this vision and we can't transform the health system into one that's more equitable without partnering with all parts of the health system,” Rawal said.