CMS Focus on Health Equity
Equity is a pillar of CMS's Strategic Vision with the goal to incorporate health equity and address health disparities across all programs and in the community. "CMS is working to advance health equity by designing, implementing, and operationalizing policies and programs that support health for all." CMS believes achieving health equity via improving data collection to better measure and analyze disparities across programs and policies will positively impact quality. CMS recently recommitted to ensuring equity in CMS programs with the publication of the CMS Framework for Health Equity 2022-2032.
The CMS Framework for Health Equity 2022-2023 (2022) has five priorities:
Priority 1: Expand the Collection, Reporting, and Analysis of Standardized Data
Priority 2: Assess Causes of Disparities Within CMS Programs, and Address Inequities in Policies and Operations to Close Gaps
Priority 3: Build Capacity of Health Care Organizations and the Workforce to Reduce Health and Health Care Disparities
Priority 4: Advance Language Access, Health Literacy, and the Provision of Culturally Tailored Services
Priority 5: Increase All Forms of Accessibility to Health Care Services and Coverage
Additionally, CMS continuously updated the Meaningful Measures (MM) Framework, now in version 2.0, and its associated CMS Quality Measure Action Plan (QMAP). One goal in MM 2.0, Leverage Quality Measures to Promote Health Equity and Close Gaps in Care, has one objective and four sub-objectives:
- Commit to a patient-centered approach in quality measure and value-based incentive programs to ensure that quality and safety measures address health care equity.
- Expand confidential feedback reports stratified by dual eligibility in all CMS value-based incentive programs, as appropriate.
- Introduce plans to close equity gaps through leveraging the pay-for-performance incentive programs.
- Ensure equity by supporting development of socioeconomic status (SES) measures and stratifying measures and programs by SES or dual eligibility.
- Partner with the CMS Office of Minority Health regarding Health Equity Summary Score (HESS) measures.
Several 2022 CMS proposed rules requested information (comments and suggestions) regarding equity, e.g., Inpatient Prospective Payment System, Outpatient Prospective Payment System, and Physician Fee Schedule. CMS asked how CMS and measured entities can ensure equitable care for all patients regardless of racial/ethnic group, geographic location, and/or income status. Several CMS programs adopted equity-related measures or adjustments beginning with calendar/payment year 2023. For example, the Hospital Inpatient Quality Reporting Program adopted Hospital Commitment to Health Equity, Screening for Social Drivers of Health, and Screen Positive Rate for Social Drivers of Health. The Accountable Care Organization (ACO) Merit-based Incentive Payment System (MIPS) added a health equity adjustment to the ACO MIPS quality performance category score. CMS released guidance to give states greater flexibility to address health disparities and health-related social needs among Medicaid beneficiaries in managed care. In April 2023, in the Part C and Part D final rule, CMS finalized a health equity index reward for the 2027 Star Rating to provide incentives to Part C and D plans to improve care for enrollees with social risk factors. These items are a step toward reducing health care disparities in the U.S.