Alan Weil, Editor in Chief, Health Affairs https://healthaffairs.org, welcomed Chiquita Brooks-LaSure, the new Administrator at CMS https://www.cms.gov, for a one-on-one discussion at the new Health Affairs Policy Spotlight Series virtual event held August 12, 2021 to talk about the progress being made at CMS.
The Administrator began the discussion by emphasizing that the first step needed to improve health inequities is to address the social factors that need to be balanced with policies. In March 2021, CMS released an updated progress report including six health equity priorities for reducing disparities
The report suggests the priorities needed to address health equities are 1) Expand the collection of data, 2) develop and disseminate promising approaches to reduce disparities, 3) Integrate equity solutions across CMS, 4) Increase the ability to help vulnerable populations, 5) Help individuals with limited English Proficiency and people with disabilities, and 6) Increase physical accessibility to healthcare facilities.
The Administrator also wants to focus on improving maternal health. The goal is to deal with the maternal mortality crisis and to make it more affordable for pregnant women to obtain care. Many of the factors contributing to maternal morbidity are preventable and differentially impact women of color. The Administrator suggests that Congress needs to focus on the health crisis related to maternal mortality and morbidity and give a great deal of thought to issues related to health equities.
In discussing value-based payment systems, she pointed out, “Value-based payment systems are important since providers need to provide care based on quality rather than quantity in order for the payment system to move in new directions. The focus needs to be on developing a model that will work for both people and providers to help the underserved since in the end everyone benefits.”
However, in providing mental health services, telehealth is not always a solution for everyone. More discussion is needed on this subject. Some patients and providers are happy with the use of telehealth but also broadband is not always available especially in rural areas which can make it difficult for rural populations to obtain telehealth services.
The Administrator also discussed the complex issues that may occur when people are on both Medicare and Medicaid. Dually eligible individuals in Medicare and Medicaid often referred to as “duals”, are usually both elderly and live on a low income. This population is three times more likely than Medicare-only beneficiaries to report poor health.
As the Administer commented, “Medicare and Medicaid are simply not designed to work together to serve duals. Payment and incentives are not aligned to help a single organization provide high quality care, so effectively managing dually eligible individuals in the U.S has become a key issue.