Pursuing Health Equity for the Nation
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)
‘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.