LaShawn McIver, M.D., M.P.H., is director of the Centers for Medicare and Medicaid Services’ Office of Minority Health. On April 12, at CMS’ annual conference focused on healthcare quality, she spoke about the deeply rooted connection between equity and quality and how CMS is approaching quality improvement with an equity lens.
McIver joined CMS in August 2020. She previously led government affairs and advocacy efforts at the American Diabetes Association. She began her talk by defining what health equity means to CMS: the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health, regardless of race, ethnicity, disability, sexual orientation, gender identity, socio-economic status, geography, preferred language, or other circumstances.
“We are working to advance health equity by designing, implementing and operationalizing policies and programs that support health for all of the people CMS serves,” she explained. “Equity and quality are not one and the same. However, they are interconnected at the deepest level, and CMS firmly believes that we cannot have true quality without equity.”
CMS weaves quality and equity together in several ways, she said.
“Our Office of Minority Health is leading a data-driven approach to identifying structural barriers and uniting the agency to eliminate them. We are guided by the key considerations put forward by our stakeholders and partners to help align and focus our work,” she said. “Our providers, plans, individuals and community organizations set our priorities and we remain committed to adapting, adjusting and course-correcting to ensure we are meeting the needs of those we serve first and foremost” She also noted that the centers within CMS will work across HHS to tackle such issues as improving maternal health outcomes, advancing behavioral health, and being better prepared for the next pandemic or other health emergency.”
Better data gathering and analysis is one key to the strategy. “We stratify and analyze data by demographic and social risk factors to identify where there are gaps in access, quality and outcomes among and between specific populations. We then are able to use this information to make data-driven decisions to focus resources and interventions to close these gaps and eliminate disparities.”
By strengthening the infrastructure in historically underserved communities, including rural communities, tribal nations, territories and other geographically isolated areas, CMS can ensure these communities and providers and plans serving them have the resources they need to consistently deliver the highest quality care to help individuals achieve optimal outcomes, she said. “This is crucial, both during national health and environmental emergencies and under more stable conditions.”
McIver said CMS will also focus on building capacity of healthcare organizations and the workforce to reduce health and healthcare disparities. “We are paying particular attention to understanding and meeting the needs of providers plans and other organizations who disproportionately serve underserved communities to ensure CMS programs are structured in ways that allow these providers and networks to fully realize the intended benefits of these programs,” she said. “For example, we are considering ways that Accountable Care Organizations and value-based care can encourage participation among underserved and safety net providers, and how we can structure our programs to support providers in identifying and addressing social risk factors and social determinants of health as they provide care.”
Other areas of focus involve advancing language access, health literacy and the provision of culturally tailored services and working to increase all forms of accessibility to healthcare services and coverage so that all individuals with disabilities have improved access to quality health care coverage services and benefits.
We are working to promote broader coverage of services that address health-related social needs, such as nutrition supports, home modifications, wraparound housing supports and other services like home healthcare. These home- and community-based services help individuals age in place comfortably with the care and support they and their families need.
In closing, she said that CMS envisions success as all those served by CMS having achieved their highest level of health and well-being in that disparities in healthcare quality and access have been eliminated. “As we work together to achieve this vision, we are committed to being transparent and accountable,” she said. “We are also committed to our partnerships with our local communities, states, U.S. territories, tribal nations providers, plans, quality improvement partners, social service providers, and the many other entities in our healthcare ecosystem.”