Contributor: Navigating Health Equity in 2024: The Evolution of Accountability, Part 2

This article is part 2 of 2. Read the first article here.

Elizabeth Oyekan, PharmD, FCSHP, CPHQ

Accreditations and Regulations

Achieving The Joint Commission (TJC) and CMS new requirements will require developing continuous quality improvement programs with defined goals, interventions, and measures to address these disparities. Accreditation is important for health outcomes because it establishes accountability for health care entities to meet specific standards and benchmarks for quality, safety, and performance. When organizations meet the established standards, there is greater consistency in care, and trust is fostered in the services provided. Several accreditation and certification programs for addressing health disparities include:

• TJC’s Accreditation and Health Equity Certification program for organizations working towards formalizing structures and goals for addressing health disparities. TJC designed flexible and accommodating requirements for leaders to implement a health equity system because they recognize that no single organization has effectively created a structure for optimizing health equity for its patients.
  • TJC’s Accreditation signifies that the accredited health care organization has met or exceeded these standards, indicating a commitment to providing high-quality, safe, and effective patient care. Achieving this accreditation is often seen as a mark of excellence in the health care industry and can enhance an organization’s credibility.¹
  • The Health Equity Certification can assist an organization with improving data collection and analysis of disparities to address gaps, advance collaboration with other organizations, and make health equity a key pillar of the organization’s strategic plan.²
• The National Committee for Quality Assurance’s Health Equity Accreditation and Health Equity Accreditation Plus, have emphasized health equity as a priority among stakeholders such as government agencies and employers choosing to contract with accredited organizations.³ These programs can help reduce disparities, align staff and leadership, and help the organization become recognized for equity.
  • Health Equity Accreditation centers its attention on the fundamental aspects of promoting health equity. This includes creating an internal culture that bolsters the organization's efforts toward health equity, gathering data to facilitate the development of language services and provider networks that meet the cultural and linguistic requirements of individuals, and pinpointing chances to diminish health disparities and enhance health care.
  • Health Equity Accreditation Plus is tailored for organizations that have made significant progress in their pursuit of health equity, emphasizing the collection of data related to community social risk factors and the social needs of patients. Additionally, it entails the establishment of partnerships to bolster community-based organizations and create meaningful avenues for patient and consumer involvement.
• Utilization Review Accreditation Commission stands as the largest independent accreditation organization in the United States and holds a prominent position in accreditation pharmacies. Several types of pharmacy accreditations offered include specialty pharmacy, infusion pharmacy, and health equity accreditation.
  • The Health Equity Accreditation is designed to foster the incorporation of health equity principles, back industry efforts to eradicate health care inequalities, and ensure that vulnerable racial and ethnic groups receive optimal health care.⁴

While this is not an all-inclusive description of relevant accreditation programs, it summarizes some of the most well-known and is provided as a reference for health plans, health systems, pharmaceutical entities, and practitioners, including pharmacists, seeking to navigate these programs and incorporate relevant measures and practices within their services.

Maureen Hennessey, PhD, CPCC, CPHQ

Incorporating SDOH, Health Equity Into Pharmacy, Health Care Practice

Incorporating social determinants of health (SDOH) and health equity practices within systemic practice requires a comprehensive and ongoing effort from health care organizations and all sectors in the health ecosystem to facilitate everyone attaining optimal health outcomes. Here are suggestions for resources and steps health systems, health plans, and pharmacy stakeholders can take to incorporate SDOH and health equity initiatives into pharmacy and other health care practices.

Adopt a health equity framework

Using a health equity framework, such as the American Hospital Association’s Health Equity Roadmap, could also help establish the current baseline and realistic goals for a health system. This particular framework includes a transformational model that provides technical and operational guidelines for improvement supported by a Health Equity Action Library with toolkits for transformation.⁵

Deploy assessment and data tools

To commence health equity implementation, hospitals can utilize assessment and data collection tools provided by CMS to identify groups that are disproportionately affected by health inequities. The collection data may consist of:

• Administrative claims data
• Electronic clinical data
• Standardized patient assessments
• Patient-reported data and surveys

The collection portion of the measures distributed by CMS was intentionally not prescriptive to allow latitude for hospitals to incorporate screening to best meet their organization’s and patients’ needs. The suggested screening tool by CMS, the Accountable Health Communities Health-Related Social Needs Screening Tool, outlines a recommendation of health equity questions for patients to answer.⁶ In general, it would also be beneficial to have quality management software that can help collect and stratify demographic and SDOH needs to follow health equity metrics.

Initiate internal collaborations

Health system pharmacy teams play a pivotal role in addressing SDOH by serving as approachable community members, maintaining regular patient interactions, and championing patient engagement and medication adherence. Their multifaceted involvement contributes significantly to enhancing patient outcomes by managing critical health conditions, such as uncontrolled blood pressure and poorly managed glycemic status, to prevent further health complications. Even so, medication adherence continues to be a substantial factor in readmission rates, as documented in the literature from Cedars-Sinai Medical Center, Duke Health, and Long Beach Memorial Hospital.^7-9

With the incorporation of SDOH and stratification measures, health systems are likely to submit to entities readmission data stratified by race and ethnicity, and performance data on stratified Healthcare Effectiveness Data and Information Set (HEDIS) quality measures, such as Controlling High Blood Pressure and Glycemic Status Assessment. In addition, they may be collecting data to support performance on CMS and HEDIS measures pertinent to SDOH assessment and intervention. This data can help health systems coordinate efforts and design them to align with the measures set by both CMS and TJC standards.

For example, pharmacy teams can collaborate closely with quality and population management teams to formulate comprehensive management strategies aimed at tackling readmission rates impacted by medication nonadherence. In doing so, they have the potential to identify and address health disparities and unmet SDOH needs.

Population health management (PHM) and quality management (QM) teams attesting to CMS’ Health Equity commitment can also stratify key performance indicators by demographic variables, such as race and ethnicity; identify equity gaps; and then display this information on hospital performance dashboards. For instance, if a hospital’s dashboard were to include readmission rates for heart attack and heart failure and demonstrate correlating racial or ethnicity disparities, PHM and QM teams can collaborate to investigate factors likely contributing to the disparities.

Subsequently, this discovery could serve as the foundation for a quality improvement initiative focused on identifying and addressing SDOH led by the pharmacy departments. Specifically, pharmacy departments can enhance performance on CMS’s Equity-Focused measures (SDOH-1 and SDOH-2) by actively collecting SDOH information from patients.

Pharmacists could assist with screening for a sub-population (e.g. readmitted patients with high blood pressure and elevated glycemic status), identifying and addressing unmet SDOH needs creating adherence barriers, and measuring outcomes such as adherence improvement, BP and glycemic metrics, and readmission metrics. Through these efforts, pharmacy initiatives have the potential to align and contribute to the health system’s performance on CMS measures, meet TJC’s NPSG, and elevate performance on health plan measures.

Valerie Nguyen, BS

Consult promising and best practices

In an ever-evolving field where improving quality and care are crucial, examining best practices in health care becomes paramount. The Pharmacy Quality Alliance has documented promising real-world SDOH services for improving the quality and safety of medication use. One of the featured services includes improving medication adherence among patient sub-populations.

For example, SCAN Health Plan analyzed factors such as cholesterol, blood pressure, and diabetes medication adherence quality scores and compared racial and ethnic disparities among the members to implement an initiative for training staff to support medication adherence with home-based medication visits and Spanish-language story photographs. After a year and a half, SCAN Health Plan demonstrated its success by reducing racial and ethnic medication non-adherence by 35% for Black and Hispanic patients.¹⁰

Leverage collaborations with life science companies

An additional source for training, resources, and collaboration to close health disparity gaps may be found within life science manufacturers. A recent survey of health plans and health systems found that 93% of respondents currently have, plan, or are willing to consider collaborations with pharmaceutical manufacturers to assess and refer individuals with SDOH needs. Further, nearly three-quarters of plan respondents and more than half of system respondents were interested in receiving population health resources from manufacturers to support patient engagement and adherence.¹¹

Pharmaceutical manufacturers, payers, and other community stakeholders have collaborated on initiatives to reduce health disparities existing in communities, focusing on conditions such as behavioral health, cancer, heart disease, HIV, kidney care, and prediabetes.¹² Such collaborations can help close gaps by improving access to medications and devices; facilitating adherence and better clinical outcomes; and building goodwill and further collaborations among participants.¹³

Conclusion

Across the health care ecosystem, taking action to eliminate health disparities has become a national priority. Adverse SDOH presents formidable obstacles to accessing and adhering to appropriate care and therapies. Accreditation standards and quality measures are emerging to advance alignment among key stakeholders. Action from all sectors will be vital to reducing longstanding inequities and improving health outcomes among our communities.

References

1. Joint Commission accreditation. The Joint Commission. https://www.jointcommission.org/what-we-offer/accreditation/

2. Health Care Equity Certification. The Joint Commission. https://www.jointcommission.org/what-we-offer/certification/certifications-by-setting/hospital-certifications/health-care-equity-certification/

3. NCQA’s health equity accreditation programs. National Committee for Quality Assurance. Accessed August 8, 2023. https://www.ncqa.org/programs/health-equity-accreditation/

4. Health equity accreditation. Utilization Review Accreditation Commission. https://www.urac.org/accreditation-cert/health-equity-accreditation/

5. The health equity roadmap. AHA Institute for Diversity and Health Equity. Accessed August 31, 2023. https://equity.aha.org/

6. Heilman E. A guide to CMS’s new health equity measure. Medisolv blog. September 2, 2022. Accessed August 29, 2023. https://blog.medisolv.com/articles/a-guide-to-cms-new-health-equity-measure

7. Rosen OZ, Fridman R, Rosen BT, et al. Medication adherence as a predictor of 30-day hospital readmissions. Patient Prefer Adherence. 2017;11:801-810. doi:10.2147/PPA.S125672

8. Pittman T. Medication nonadherence increases health costs, hospital readmissions. Duke Health. November 20, 2018. https://physicians.dukehealth.org/articles/medication-nonadherence-increases-health-costs-hospital-readmissions

9. Bonetti A, Reis W, Mendes A, et al. Impact of pharmacist-led discharge counseling on hospital readmission and emergency department visits: a systematic review and meta-analysis. Journal of Hospital Medicine. 15: 52-59. doi:10.12788/jhm.3182

10. Pharmacy Quality Alliance. Social Determinants of Health Resource Guide. Pharmacy Quality Alliance; 32.2023. Accessed August 30, 2023. https://www.pqaalliance.org/sdoh-resource-guide

11. PRECISIONvalue. Population Health Survey, 2023. Proprietary data on file.

12. Oyekan E, Hennessey M, Galante D, et al. Bringing social determinants of health to life to optimize health outcomes in patients with chronic conditions. Journal of Clinical Pathways. Accessed December 5, 2023. https://www.hmpgloballearningnetwork.com/site/jcp/pharma-insights/bringing-social-determinants-health-life-optimize-health-outcomes-patients

13. Hennessey M. Pharma’s role in addressing social determinants of health. Managed Healthcare Executive^®. November 20, 2019. Accessed December 5, 2023. https://www.managedhealthcareexecutive.com/view/pharmas-role-addressing-social-determinants-health