Experts Share Health Equity Advances in Value-Based Care at CMS Conference

During the CMS Health Equity conference, the “Implementing Health Equity Through Value-Based Care for People in Medicare” session featured a series of expert speakers who detailed cutting-edge developments in postacute care and fee-for-service Medicare. They shared their insights on pioneering strategies and new codes designed to meet health-related social needs, highlighting practical approaches that propelled the programs forward.

Cindy Massuda, JD, senior technical advisor, CMS, and Chris Palmer, MPA, shared groundbreaking work on health equity in postacute care. Massuda discussed preliminary results from the Screen Positive for Health-Related Social Needs Indicator and summarized national statistics from the 2023 Health Equity Confidential Feedback Reports for Post-Acute Care.¹ The work aims to address health equity in skilled nursing facilities and through value-based purchasing initiatives. She highlighted the efforts in collecting data on health-related social needs and discussed their work on confidential feedback reports for quality measures, emphasizing the importance of stratifying data to better understand and address disparities. They also utilized analytical approaches to visualize regional differences in health equity measures.

“We really do know the importance of stratifying the data and that screening positive for health-related social need is an important step toward expanding the collection, reporting, and analyzing of our standardized equity-related data across the postacute care settings,” Massuda said in her presentation. “Health literacy...was our most prevalent [health-related social need], followed by social isolation, which is showing a need for future research in that area.”

Palmer, the coordinator for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program2 of the Health Insurance Specialist Company, CMS, provided a detailed overview of the agency's efforts to integrate health equity into the SNF VBP program. Initially established in 2014, the program expanded in 2021 to include up to 10 measures. CMS identified 22 potential approaches to incorporate health equity, ultimately choosing a bonus point approach. The Health Equity Adjustment (HEA) was proposed in April 2023 and finalized for fiscal year 2027 program year implementation. It aims to reward SNFs serving high proportions of residents with dual eligibility status. CMS continues to explore further enhancements to the HEA, showcasing a commitment to refining its approach and extending health equity adjustments to other value-based purchasing programs.

“SNFs that ended up in the top third of performance for each of the 8 measures in the program earn 2 points. That results in there being a potential total of 16 points available if you were in the top third for all 8 measures,” Palmer explained. “The underserved multiplier is the proportion of residents with [dual eligible status] and for the purposes of the HEA SNF must meet a 20% threshold of 4 to get an HEA bonus payment.”

Maya Peterson, MSN, RN, health communication specialist, CMS Center for Clinical Standards and Quality, shared updates on the Physician Fee Schedule (PFS),³ focusing on care management services. She clarified that her talk wasn't about billing advice but about understanding the key elements of care management within the PFS, including payments to physicians and other health practitioners.

Peterson focused on 3 main areas: social determinants of health (SDOH) risk assessment, community health integration, and principal illness navigation (PIN). The SDOH risk assessment, coded as G0136, evaluates patients' social factors during various visits. Community health integration uses personnel like community health workers to address unmet SDOH needs. PIN services, originating from the Cancer Moonshot initiative, support patients with serious conditions that pose high risks and require extensive care, including those with substance use disorders and serious mental illnesses.

"We heard from the peer support community that we didn't get it quite right when it [came] to the activities that they do,” Peterson said about advancing the program. “So we had listed a whole bunch of things that we needed them to be competent in, and they said we have a really special, specific role with patients with serious mental illness and substance use disorder."

Lucy Bertocci, CMS, explained the Medicare Shared Savings Program's (MSSP) Advance Investment Payments (AIP), aimed at helping accountable care organizations (ACOs). MSSP incentivizes coordinated quality care for Medicare patients. ACOs bill Medicare normally, but if they reduce costs and maintain quality, they share the savings with Medicare. Bertocci noted that ACOs struggle with upfront costs, particularly in rural and underserved areas, since they don't receive savings until 6 months after their first performance year.⁴

AIP solves this by offering initial $250,000 payments followed by quarterly payments over 2 years to support infrastructure investment, she explained. If ACOs save money within 5 years, CMS recoups the payments. AIP targets new, low-revenue ACOs, starting them at Level A of MSSP’s basic track with potential to move to higher risk levels. Payments are based on the ACO’s beneficiary population and the Area Deprivation Index (ADI) scores, with higher payments for those with higher ADI scores or low-income beneficiaries. For 2024, 19 ACOs will receive $26.1 million, primarily for staffing, infrastructure, and care for underserved patients. Future participation is ongoing, and Bertocci encouraged interested ACOs to apply.

The session featured innovative approaches in postacute care and Medicare fee-for-service, emphasizing the integration of health equity into programs such as SNF VBP and PFS. The discussions further highlighted the importance of addressing health-related social needs, stratifying data to understand disparities, and supporting ACOs through AIP. Overall, the CMS Health Equity conference provided a comprehensive overview of ongoing efforts to advance health equity and improve care delivery for Medicare beneficiaries.

References

1. Health equity confidential feedback reports for post-acute care. CMS. October 16, 2023. Accessed June 7, 2024. https://www.cms.gov/files/document/pachealthequityconfidentialfeedbackreportwebinarslides10-16-2023.pdf

2. The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program. CMS. Updated June 6, 2024. Accessed June 7, 2024. https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing

3. Health equity dervices in the 2024 Physician Fee Schedule final rule. Medical Learning Network. CMS. January 2024. Accessed June 7, 2024. https://www.cms.gov/files/document/mln9201074-health-equity-services-2024-physician-fee-schedule-final-rule.pdf-0

4. Medicare Shared Savings Program. CMS. Accessed June 7, 2024. https://data.cms.gov/medicare-shared-savings-program