The CMS Health Equity Conference’s “Achieving Health Equity through Value-Based Care for Medicare Beneficiaries” session featured a series of expert presentations detailing cutting-edge developments in post-acute care and fee-for-service Medicare. Speakers shared insights on pioneering strategies and emerging norms designed to meet health-related societal needs and highlighted practical approaches to moving the program forward.
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Cindy Massuda, J.D., and Chris Palmer, M.D., senior technical advisors at CMS, shared groundbreaking research on health equity in post-acute care. Massuda discussed preliminary results of positive screening indicators for health-related social needs and summarized national statistics from the 2023 Confidential Feedback Report on Health Equity in Post-Acute Care.1 This effort is addressing health equity in skilled nursing facilities and through value-based purchasing initiatives. She highlighted efforts in collecting data on health-related social needs, described work on confidential feedback reporting for quality measurement, and highlighted the importance of stratifying data to better understand and address disparities. They also utilized analytical approaches to visualize regional differences in health equity measurements.
“We really know the importance of stratifying data and screening for health-related social needs is a critical step to expand standardized equity-related data collection, reporting, and analysis across post-acute care settings,” Masouda said in her presentation. “Health literacy is…one of our most common [health-related social need]This was followed by social isolation, indicating that further research is needed in this area.”
Palmer, coordinator of the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program2 The CEO of health insurance company CMS provided a detailed overview of the agency’s efforts to integrate health equity into the SNF VBP program. The program, first established in 2014, expanded in 2021 to include up to 10 measures. CMS identified 22 potential approaches to incorporate health equity and ultimately selected the bonus points approach. The Health Equity Adjustment (HEA) was proposed in April 2023 and finalized for implementation in the program year of fiscal year 2027. It is intended to reward SNFs with a high percentage of residents with dual eligible status. CMS continues to explore further enhancements to the HEA, indicating a commitment to refine the approach and extend the Health Equity Adjustment to other value-based purchasing programs.
“SNFs that rank in the top third on each of the program’s eight indicators earn two points, meaning that if they rank in the top third on all eight indicators, they could potentially earn a total of 16 points,” Palmer explained. “The underserved multiplier is: [dual eligible status] For purposes of the HEA, SNFs must meet the 20% threshold 4 to receive the HEA bonus payment.”
Maya Peterson, MSN, RN, health communications specialist for the CMS Center for Clinical Metrics and Quality, shared the latest updates on the Physician Fee Schedule (PFS).3 The focus was on care management services, and she made it clear that her talk was not about billing advice but about understanding the key elements of care management within PFS, including payment to physicians and other healthcare professionals.
Peterson focused on three main areas: social determinants of health (SDOH) risk assessment, community health integration, and major illness navigation (PIN). SDOH risk assessment, coded as G0136, evaluates patients’ social factors during various visits. Community health integration uses personnel such as community health workers to address unmet SDOH needs. PIN services, which grew out of the Cancer Moonshot initiative, support patients with serious conditions who are at high risk and require extensive care, such as those with substance use disorder and serious mental illness.
“We heard from the peer support community that we didn’t get it right. [came] “We gave them a list of competencies that we needed for the work they do, and they said we have a really special and specific role for people with severe mental illness and substance use disorders,” Peterson said of promoting the program.
Lucy Bertocci of CMS discussed the Medicare Shared Savings Program (MSSP) Advance Investment Payment (AIP), which is intended to support Accountable Care Organizations (ACOs). The MSSP incentivizes the coordination of quality care for Medicare patients. ACOs typically bill Medicare, but if they reduce costs and maintain quality, they share the savings with Medicare. Bertocci noted that ACOs, especially in rural and underserved areas, struggle with upfront costs because they don’t receive savings until six months after their first performance year.Four
The AIP solves this problem by paying $250,000 up front, followed by quarterly payments over two years, to support infrastructure investments, she explained. If the ACO reduces costs within five years, CMS will recoup the payment. The AIP targets new ACOs with low revenues, starting at level A in the MSSP basic track and potentially moving to higher risk levels. Payments are based on the ACO’s beneficiary population and Area Poverty Index (ADI) score, with higher payments for ACOs with higher ADI scores and lower-income beneficiaries. In 2024, 19 ACOs will receive $26.1 million, primarily for staffing, infrastructure, and care of underserved patients. Future participation is ongoing, and Bertocci encourages interested ACOs to apply.
The session highlighted innovative approaches in post-acute care and Medicare fee-for-service and highlighted the importance of incorporating health equity into programs such as SNF VBP and PFS. Additionally, the discussion highlighted the importance of addressing health-related social needs, stratifying data to understand disparities, and supporting ACOs with AIPs. Overall, the CMS Health Equity Conference provided a comprehensive overview of ongoing efforts to advance health equity and improve care delivery to Medicare beneficiaries.
References
1. Confidential Feedback Report on Health Equity for Post-Acute Care. CMS. October 16, 2023. Accessed June 7, 2024. https://www.cms.gov/files/document/pachealthequityconfidentialfeedbackreportwebinarslides10-16-2023.pdf
2. Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program. CMS. Updated June 6, 2024. Accessed June 7, 2024. https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing
3. Health Equity Services in the 2024 Physician Fee Schedule Final Rule. Medical Learning Network. CMS. January 2024. Accessed June 7, 2024. https://www.cms.gov/files/document/mln9201074-health-equity-services-2024-physician-fee-schedule-final-rule.pdf-0
4. Medicare Shared Savings Program. CMS. Accessed June 7, 2024. https://data.cms.gov/medicare-shared-savings-program
