Pursuing Health Equity
for the Nation
Click to edit CMS BLOG
April 25, 2016
By: Cara V. James, Ph.D., Director of the Office of Minority
Health at the Centers for Medicare & Medicaid Services
Romana Hasnain-Wynia, M.S., Ph.D., Program Director for Addressing
Disparities at the Patient-Centered Outcomes Research Institute (PCORI)
Pursuing Health Equity for
the Nation
‘Accelerating Health Equity for the Nation’ is this year’s theme
for National Minority Health Month, which we mark every April as a time to
focus on efforts to help all Americans achieve the highest level of health they
can. Health equity is a challenging goal given how many factors contribute to
optimal health, but it is a goal we can never stop striving to attain. There
are numerous barriers minorities and other underserved populations face in accessing
the health care and those barriers often lead to disparities in health and
healthcare outcomes. The Centers for Medicare & Medicaid Services Office of
Minority Health and the Patient-Centered Outcomes Research Institute (PCORI)
are two of the organizations established by the ACA working to address these
barriers and accelerate progress toward health equity.
The CMS Office of Minority Health is dedicated to increasing
understanding and awareness of health disparities among CMS beneficiaries and
ensuring that the voices and needs of minority and underserved populations are
included in developing, implementing, and evaluating CMS programs and policies.
It does this through its “USA” framework, which has three interconnected
elements that together will help lead to health equity —increasing Understanding
and awareness of disparities among its beneficiaries; creating and sharing Solutions;
and accelerating the implementation of effective Actions. Key activities
include strengthening CMS data and using it to create initiatives that
organizations can use to reduce disparities, through such specific efforts as
the CMS Equity Plan to Improve Quality in Medicare,
the Mapping Medicare Disparities Tool, and From Coverage to Care.
PCORI’s mandate is to improve the quality and relevance of
evidence available to help a range of healthcare stakeholders—including
patients, caregivers, clinicians, employers, insurers, and policy makers—make
better-informed health decisions. It does this by funding research that
compares two or more approaches to care to determine what works best, for whom,
under which circumstances, based on the outcomes most important to patients.
PCORI’s authorizing legislation directs it to pay particular
attention to health disparities and to include members of minority groups in
research whenever possible. That’s one reason why Addressing Disparities is one
of PCORI’s five National Priorities for Research, which govern how PCORI awards
its research dollars. The Addressing Disparities program now includes a
substantial portfolio of studies designed to determine how to reduce barriers
to effective preventive, diagnostic, or therapeutic care, taking into account
individual and group preferences, to achieve the best outcomes in each
population.
Seeking New Approaches
Both the CMS Office of Minority Health and PCORI also are
concerned with strengthening the healthcare workforce to better serve
vulnerable and underserved patient populations. This includes initiatives
focusing on how to better make use of lay members of healthcare teams—who are
known, for example, as community health workers, patient navigators, and promotores
de salud—as links between patients, communities, and the healthcare system.
CMS Office of Minority Health is working on how to support,
engage, and empower these professionals, while PCORI has funded more than 50
projects that are comparing health outcomes and other aspects of programs that
do and don’t include lay members of healthcare teams. One large study involving 30 primary care
clinics and almost 1,900 patients compares the effectiveness of a clinic-based
standard of care to a collaborative approach that includes community health
workers. It asks whether the collaborative approach improves hypertension
control for racial and ethnic minorities and other groups that experience
disparities in this condition.
Delivering Health Information and Services via Telecommunications
Telehealth is another area that both CMS and PCORI are exploring
as a means to reduce disparities.
PCORI is currently funding 26 projects on telehealth, many of
which focus on underserved populations. One of these studies compares the
effectiveness of a telehealth self-management approach versus traditional
in-person care for African-American and Hispanic/Latino patients with chronic
heart failure. In the telehealth intervention, a care provider contacts the
patient weekly via a video call. The study will measure emergency room use,
quality of life, and other outcomes. Another CMS initiative is looking for ways
to expand the use of telehealth in rural areas, where health care tends to be
less available than elsewhere.
Reducing Disparities in Chronic Disease Treatment and Outcomes
Both the CMS Office of Minority Health and PCORI have a commitment
to reducing disparities in the treatment of a range of illnesses. Among these
is asthma, which is more prevalent and severe among African Americans and
Hispanics/Latinos than among whites, as are a range of disparities in health
outcomes.
At PCORI, there are more than a dozen projects addressing racial
and ethnic disparities in asthma treatment outcomes. These include eight
studies that compare ways to increase patient and clinician adherence to the National Asthma Education and Prevention Program
guidelines. Project teams include patients, clinicians, insurers,
health systems, community clinics and practices, public health departments, and
patient and caregiver advocacy organizations.
Accelerating Health Equity
The CMS Office of Minority
Health and PCORI are just two of many organizations working to move our nation
further along the path to health equity. However, to achieve that goal,
we need more individuals, organizations, and communities to join the effort. We
look forward to working with you to make health equity a reality.this
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