Value-based care has emerged as an alternative and potential replacement for traditional fee-for-service reimbursement, centering quality and outcomes rather than quantity. That is the theory.

In practice, value-based care has been shown to exacerbate some disparities in the healthcare system by making it harder for those patients with complex conditions, or being impacted by social determinants of health, to access care. Put simply, if some categories of patient are more financially risky than others to treat, providers may find ways to exclude them – unless checks and balances are put in place to help manage risks associated with SDOH and comorbid conditions.

Health policy expert Matt Reiter hosts a discussion featuring Bill Finerfrock from Capitol Associates, and Tom Dorney from The Root Cause Coaltion. Together they discuss the very real danger of widening health disparities resulting from the expansion of value-based care, and the legislative solution proposed by the John Lewis EMMT Act (Equality in Medicare and Medicaid Treatment) which has been reintroduced in 2023 by Rep. Teri Sewell and Sen. Cory Booker.

All organizations advocating for health equity are encouraged to help advance the legislation by writing letters of support (template below) to Matt Reiter [email protected] who will coordinate their forwarding to Representative Sewell and Senator Booker.  

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LETTER OF SUPPORT TEMPLATE 

Dear Representative Sewell & Senator Booker, 

I am writing in support of S.1296/H.R.3069, the John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act of 2023.

The EMMT Act would require the Center for Medicare and Medicaid Innovation (CMMI) to include experts in health disparities and social determinants of health as part of the evaluation and review process for new payment models. If enacted, this bill would also require fairness of these new payment methods for women, high-risk patients, patients from racial or ethnic minorities, or patients from rural communities. Lastly, it directs CMMI to develop and test a payment model that is tailored to addressing social determinants of health.

While quality and cost are important considerations, equal consideration should be given to the impact a proposed model may have on access to care for women, minorities and beneficiaries residing in rural areas. CMMI is under no statutory obligation to account for social determinants of health when considering new payment models. Indeed, the only factors CMMI must consider when determining whether to approve a new payment model are quality and cost.

Because Medicare is the single largest health care payer in the country, and many commercial insurance plans will adopt policies based on Medicare, Congress must ensure that the models approved by CMMI incentivize reductions in minority and rural health disparities and not create barriers to care. We appreciate all that this CMS Administration has done to advance health equity. Passing the EMMT Act will ensure that all new models account for social determinants of health and how the models impact minority and rural populations.

Your leadership on eliminating health disparities for women, minorities and beneficiaries residing in rural areas is deeply appreciated.

I applaud your leadership on this important bill. The EMMT Act will go a long way towards improving access to quality healthcare for Medicare and Medicaid beneficiaries.

On behalf or our organization: 

Sincerely,

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Health Disparities Podcast Episode 143 (c) Movement is Life 2023

One of the recurring themes linked to healthcare in the United States is that where the need is greatest, there you are likely to find the fewest resources needed for resilience to challenges. This is particularly true during a disaster, be it pandemic, hurricane or economic downturn. A year into the COVID pandemic, the St. Bernard safety-net hospital in the South Side of Chicago received an “F” grade on its safety report. Already under disproportionate strain, the management team needed to implement a turnaround.

Deploying the Just Culture model and collaborative change principles, the team fostered adoption of improved practices and documentation, resulting in a “B” rating in 2022, and at the time of publishing this episode in May, 2023, St. Bernard Hospital has now scored an “A” Grade.

For this episode of the podcast, three members of the team that led those changes share their experiences with our host and Movement is Life Chair, Dr. Mary O’Connor. Featuring Orthopedic surgeon Dr. Daria Terrell MD, Medical Director of Clinical Programming and Health Outcomes, and President of Medical Staff; Orthopedic surgeon Dr. Vietta L. Johnson, MD; and Michael Richardson, RN, Chief Clinical, Quality & Patient Safety Officer.

© Movement is Life 2023

Dr. April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, is president of the American Association of Nurse Practitioners® (AANP). She has 30 years of experience in health care and 18 years as an acute care nurse practitioner (NP). Dr. Kapu has committed her career to advancing NP-delivered care and increasing access to NP care across all settings. Currently, she is Associate Dean for Clinical and Community Partnerships, Vanderbilt University School of Nursing, with oversight for several nurse-led community practices.

In todays episode, which is hosted by NP and rural health expert Mary Behrens, FNP, FAANP, we hear about Dr. Kapu's  experiences of meeting NPs across the country during her year of presidency. NP Behrens and Dr. Kapu also discuss some of the reasons why being an NP is now widely considered to be one of the most rewarding careers in healthcare, and explore the importance of building diversity in the profession. This year marks the 102nd birthday of NP founder and advanced practice expert, Dr. Loretta Ford. Dr. Kapu discusses her accomplishments, her commitment to health equity, and the continued mission to make sure healthcare is accessible to everyone, everywhere. 

Copyright: Movement is Life, Inc, 2023 

Carol Redmond Naughton, JD, shares with us some aspects of the proven Purpose Built Communities model, working with local leaders to help them plan, implement, and sustain holistic neighborhood revitalization initiatives that create healthy neighborhoods which include broad, deep, and permanent pathways to prosperity for low-income families. During the discussion she describes the essential role of “community quarterbacks,” and calls upon listeners to look with open eyes and think about the systems that have kept people trapped in poverty, particularly Black and Brown people, and to not blame the victims.

Carol believes that we need to recognize that the systems have been broken for so long that they have “broken the place,” but the people remain unbroken.  So, when we think about building communities of purpose for children with unlimited human potential, we can find ways to create great places with a “cradle to college pipeline,” and we can change the systems to make it easier to create other great places.

With host Dr. Tamara Huff, MD, MBA, Founder and CEO of Vigeo Orthopedics, in Columbus, Georgia, and member of www.movementislifecaucus.com for transcripts of this and other episodes.

Excerpts

The secret sauce is creating a community quarterback organization. You have got to have an organization that isn’t in the service delivery business, but is thinking about how after the residents have created their vision for the community, how do they implement it? Thinking about how to work with public, private and non-profit partners to actually do the housing, to build the education pipeline, and create those health and wellness amenities.

I love Columbia Parc and I am so proud of what the district partners have been able to do since hurricane Katrina. These were three business leaders that really did not know anything about community development at the time, but our mutual connections suggested they to go to see East Lake in Atlanta and learn how it could be the model for the rebuild of New Orleans. We spent two days together and they came home committed to trying to do what nobody had been able to do in New Orleans before.

Our network members really encouraged us to elevate economic vitality within our model. Poverty is expensive, if you don’t live within walking distance of a grocery store you will be paying higher prices at the convenience store, if you don’t have a car you will be paying a driver or paying with time on a two hour bus journey.

My call to action is to look with open eyes, and think about the systems that have kept people trapped in poverty, particularly Black and Brown people, and to not blame the victims. Recognize that the systems have been broken so long that they have broken the place, but the people are not broken, and if we come at it thinking about how we are building communities for children of God with unlimited human potential we can create great places and we can change the systems to make it easier to create other great places.

Dr. Tamara Huff, MD, MBA sits down with Dr. Alisahah Jackson for a discussion about enhancing the health of every community, and they explore the challenges of building healthier communities against a backdrop of declining health infrastructure, particularly in rural communities. They also discuss the reality of the elephant in the room, that racism exists both in terms of attitudes and bias, and in various structural forms, and how building trust is vital to the displacement of bias. 

Dr. Jackson is a proven leader in empowering women to improve their health and the health of their families and communities. She was named the first Chief Community Impact Officer at Atrium Health, where she established strategies for Health Equity and Social Determinants of Health. More recently, she became the System Vice President, Population Health Innovation and Policy, at CommonSpirit Health, and is also CEO of Why Health Matters. Dr. Tamara Huff is a member of Movement is Life Steering Committee & Founder & CEO, Vigeo Orthopedics, LLC.

Excerpts: 

“There are decisions that are being made for us that actually drive health outcomes. Economic, policy and investment decisions. People may live in a food dessert. Or a maternity dessert. We have to start acknowledging that these decisions are happening outside of our own decisions about our health behaviors.” 

“Providers will often label patients as “non-compliant,” and that is a term I encourage everyone to take out of their vocabularies. I simply don’t believe that people wake up in the morning and decide that they want to be unhealthy. Our responsibility as care providers is to identify what the barriers are that people have to achieving great health, and help patients mitigate or eliminate them.”  

“I was a young African American female physician coming into a community that had only seen one other Black female physician, and I really had to build trust. I’m not going to sugar coat it, there were definitely patients who did not want to see me.”

“One of the things I love about Movement is Life is that you are providing resources to help with behavior change. And thank you, Movement is Life, for being an accelerator of these much needed conversations.” 

“What the data tells us, what the research tells us, is that people who have providers who look like them, who can connect with them, tend to have better health outcomes. Movement is Life has been culturally humble enough to say that things like food are very cultural, it’s one of the things that makes a group uniquely different, so their needs are different. Changes in Hispanic culture are going to look different to changes in African American culture, and different from the dominant culture.” 

Dr. Garfield Clunie (NYU Langone) works on the frontline of maternal child health in New York City, where recent policies to standardize treatments are part of efforts to replace outdated race-based decision-making with more equitable care. This insightful conversation, hosted by Dr. Michelle Leak (Mayo Clinic, Florida), covers several discussion areas. Firstly, the importance of the concept of belonging, which Dr. Clunie believes is at least equal to the more commonly referenced trio of DEI. Secondly, addressing the need for patients to receive care from people who look like them, and the challenges in increasing diversity in the healthcare workforce. This includes proactive policies such as resourcing mentorship appropriately so that it is not an additional unrewarded burden to health equity leaders. Dr. Clunie and Dr. Leak also discuss aspects of the Movement is Life annual Caucus experience, and some suggested health equity reads. With host Michelle Leak, DEd, MBA, FACHE, Mayo Clinic, Member, Board of Directors, Movement is Life; and Dr. Garfield Clunie, Associate Professor of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine Vice-Chair, Diversity, Equity and Inclusion, NYU Grossman School of Medicine/NYU Langone Health, & the 123rd President of the National Medical Association. © Movement is Life 2022-2023.

“Diversity is like being asked to attend the party. Inclusion is being asked to dance at the party, equity is having the same space as everyone else in which to dance. But belonging is being involved in the planning of the party and which kind of music is there. So, you are completely immersed with the other participants, and your input is equal to everyone else’s input.”  ~ Dr. Garfield Clunie

“The take home message is that diversity is important in all realms of our life. In business, medicine, in healthcare. And it’s very important to have different lived experiences come to the table, to create solutions that will be beneficial to tall.” ~ Dr. Garfield Clunie

“When it comes to diversity, equity, inclusion, and also belonging, I personally believe that out of all of those belonging is the most important.” ~ Dr. Garfield Clunie

“Many medical students comment on the positive value that diversity brings to their experience in education. When you bring all the dimensions of diversity together, all the benefits that these dimensions bring to an organization, and to patients, is seen in better quality of care, better decision making, and better leadership.” ~ Dr. Michelle Leak

“Not everyone has the same background or pathway, but they have the same perseverance. A holistic review application (to medical school) takes into account and places value on unique experiences and attributes beyond the standardized tests. But once you have a place, you are still going to have to pass the same exams.” ~ Dr. Garfield Clunie

“In maternal and child health, to try and remove bias, we have moved as much as possible towards standardized care. Every patient is an individual, but it’s unfortunate that in medicine we have adopted different thoughts for different races and ethnicities. In New York City we have made a big effort to remove instances where race is used as part of treatment algorithms. I think that using race or ethnicity to determine treatment pathways is absolutely the wrong way to go.” ~ Dr. Garfield Clunie

Episode 137. Following on from a workshop titled “JEDI Journey: This is the Way,” our diverse panel discusses the importance of processes such as integrating the social determinants of health (SDOH) into information systems via Z codes to advance Justice, Equity, Diversity & Inclusion (JEDI) & anti-racism. With episode host Charla Johnson, DNP, and guests Tonya Jagneaux, MD, Holly Pilson, MD, and Daytheon Sturges, PhD.

The group also explores achieving workforce diversity in general and orthopedic surgery specifically, which is the least diverse specialty of all. With current trends it will take 217 years to reach parity in terms of race and gender representation, and the group shares strategies for accelerating the pace. We hear how part of the challenge is getting diverse students into schools, but once this is achieved the environment must be set up for success. Otherwise, tokenism can lead to isolation and burnout. With pointers towards actionable steps and resources, this episode takes DEI up a notch.

© Copyright Movement is Life 2022-2023

Host: Charla Johnson, DNP, RN-BC, ONC

Secretary, Board of Directors, Movement is Life

System Director, Nursing Informatics

Franciscan Missionaries of Our Lady Health System Baton Rouge, LA

Featuring:

Tonya Jagneaux, MD, MSHI, FCCP

Chief Medical Information Officer – OLOL

Associate Professor of Clinical Medicine, Pulmonary/Critical Care, Louisiana State University Health Sciences Center, Baton Rouge Campus

Holly Pilson, MD, FAAOS, FAOA

Associate Professor of Orthopaedic Trauma, Vice Chair of Social Impact, Co-Director of Diversity and Inclusion, Co-Director of Clinical Research, Department of Orthopaedic Surgery and Rehabilitation, Affiliate Faculty of Maya Angelou Center for Health Equity, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine

Daytheon Sturges, PhD, MPAS, PA-C, DFAAPA, CHES®

Assistant Professor of Family Medicine, Vice Chair for JEDI, Associate Program Director for Regional Affairs and Academic Affairs, JEDI, MEDEX Northwest Physician Assistant Program, University of Washington School of Medicine

Producer/Editor/Writer: Rolf Taylor 

Resources: 

USING Z CODES: The Social Determinants of Health (SDOH) Data Journey to Better Outcomes: https://www.cms.gov/files/document/zcodes-infographic.pdf

Advancing excellence in PA education through leadership, scholarship, equity, and inclusion. DEI Toolkit & Best Practices Guide: https://paeaonline.org/diversity-equity-inclusion

Fewer Words, More Action: Cultivating an Anti-Racist Environment Strategies/Solutions (CARES) Framework for Physician Assistant Education. Carl Frizell et al: https://pubmed.ncbi.nlm.nih.gov/34817435/

Excerpts: 

We need to do a rebranding and a paradigm shift, so that we don’t view diversity as a risk, but we view it as a strength, and we view it as beautiful. I use that term because this is not only hard work it is heart work, and there is some emotional exhaustion that comes with that.” ~ Daytheon Sturges PA-C

“It’s voluntary in 2023 then mandatory in 2024 to be screening for social determinants of health for Medicare and Medicaid for reimbursement. So, people really need to understand the importance of this, and it can’t be just another check the box. At Our Lady of the Lake we have a marketing slogan, “we listen, we heal,” – which is perfect alignment with integrating social determinants of health.” ~ Charla Johnson, DNP

“Just like we look at things like A1C, I’d like to see Z codes be reviewed routinely so we ask the questions, have we resolved food insecurity, have we resolved homelessness, and we can report on that and close that loop. And I really appreciate a provider wanting to use Z codes.” ~ Tonya Jagneaux, MD

“From the vantage point of the good, the bad, and the ugly, the good is that the trend for gender and race diversity is that orthopedic surgery has got better. But the bad is that we remain, year after the year, the least gender, race and ethnically diverse specialty in all of medicine, recruitment efforts alone have not reversed that. To get to parity at the present rate would take 217 years.” ~ Holly Pilson, MD

“I liked how you laid it bear that your zip code is more of a social determinant than your genetic code, and speaking of codes, I really like that you introduced the Z codes as well because that introduces a level of accountability. When you document it, you then have to have a plan about it.” ~ Daytheon Sturges PA-C

“We had two great talks from Cara McLellan and Frank McLellan, and I am going to start using that term: The power of the purse. Until you incentivize it, it does not become a priority. When people see a target then they see this is the journey we are taking.” Tonya Jagneaux, MD

“My part of the session was about workforce diversity, particularly in orthopedic surgery, and what better specialty to talk about in terms of workforce diversity than the one that struggles the most with it.” ~ Holly Pilson, MD

“When you fix policy at the system level then you are able to see more results. We need to look at policy with a JEDI lens, so Justice, Equity, Diversity, and Inclusion, but I also add in anti-racism, to become anti-racist we have to center and discuss race. We are looking at our policies using an equity impact tool, and we are looking as possible harm as well as alternative approaches.” ~ Daytheon Sturges PA-C

“One of the quotes I heard recently is “Nothing about us without us,” it takes bringing those stakeholders to the table, working alongside them and with them, to figure out how we get to more equity in this space.”  ~ Holly Pilson, MD

“It’s important that the minority people who are leading these efforts are doing it alongside and with the majority members of our departments and institutions, because it takes both together. “It’s important to equip the champions and provide education. I have my lived experience as a gender and racial ethnic minority, but I’m not a (DEI) expert.” ~ Holly Pilson, MD

“Medical students have consistently said that orthopedics as a specialty is less welcoming. I don’t know if it’s the surgical culture, some the other specialties mentioned as being less welcoming were also surgical.” ~ Holly Pilson, MD

“I like to offer a DEI toolkit that the Physician Assistant Education Association (Diversity and Inclusion Advancement Commission) has developed.  It’s 6 steps of a quality improvement loop.” ~ Daytheon Sturges PA-C

“Target the leadership structure: what is the racial composition? What voices are there? Do you have buy-in? These are the people who are yielding and wielding power. We need to look at admissions and ask how can we kick the door open and look at our applicants holistically, because this is where the gatekeeping is. We will never have a diverse medical workforce if the schools are not admitting these students.” ~ Daytheon Sturges PA-C

People live and work in social communities, where a huge amount of information that drives decision making around health is disseminated person to person by community voices. Our panel of Hispanic health leaders discuss how achieving health equity requires healthcare providers to utilize social influence as a way to improve population health.  

Dr. Adela Valdez describes the concept of community intersectionality, a framework that allows us to better understand the intersecting social and demographic drivers for our communities in order to better meet their needs. Dr. Ramon Jimenez discusses how learning about the intersectionality concept has enabled him to unpack some of his personal experiences and history to better understand his own journey as a Hispanic orthopedic surgeon. Dr. Ilan Shapiro explores the limitations of speaking “medicalish” and the importance of creating culturally appropriate conversations about health within our communities, using tools and language that make health information accessible to everyone, using social and other media. Dr. De Alba Rosales discusses how achieving health equity will require broader approaches that address social, economic, and environmental factors that influence health. This episode is co-hosted by Claudia Zamora, National Hispanic Medical Association, and Dr. Ramon Jimenez, American Association of Latino Orthopedic Surgeons.

All viewpoints are the participants own.

Co-hosts

Claudia H Zamora, MPA

Founder and CEO, Zamora Consulting Group, LLC

Board Member, National Hispanic Medical Association

Washington, DC

Ramon Jimenez, MD, FAAOS

Executive Board, Movement is Life

Treasurer, Board of Directors, Movement is Life

Co-Founder and President, American Association of Latino Orthopaedic Surgeons

Salinas, CA

Guests

Armando De Alba Rosales MD, MPH

Assistant Dean of Diversity, Equity, and Inclusion (DEI) Student Programs

College of Medicine, Faculty Member of Family Medicine at UNMC

University of Nebraska Medical Center

Omaha, Nebraska

Adela Valdez, MD, MBA, FAAFP

Associate Dean, Diversity, Inclusion and Health Equity

Associate Dean of CME at The University of Texas Rio Grande Valley

Professor, Family Medicine

University of Texas Rio Grande Valley School of Medicine

Harlingen, Texas

Ilan Shapiro MD, MBA, FAAP, FACHE

Chief Health Correspondent and Medical Affairs Officer

AltaMed Health Services

Los Angeles, California

© Copyright Movement is Life 2023.

Integrating clinical excellence with health equity at Walgreens, & driving urban innovation at the Lindy Institute. Featuring Dr. Priya Mammen, MD, MPH 

Emergency room physician and public health leader Dr. Priya Mammen, MD, MPH, still misses her acute care patients, but building on her clinical experiences has enabled her to find ways to advance both urban innovation and health equity.

In this interview, recorded at the annual Movement is Life caucus, episode host Dr. Charla Johnson invites Dr. Mammen to talk about her work with the Lindy Institute for Urban Innovation, her role as Senior Medical Director, Office of Clinical Integrity at Walgreens, and as adjunct faculty at the University of Pennsylvania. Dr. Mammen also discusses some of the themes from her presentation at the caucus, Walgreens: Advancing Health Equity with Community Engagement. 

Featuring:  

Dr. Priya Mammen, MD, MPH

Hosted by:  

Dr. Charla Johnson, DNP, RN-BC, ONC

Production:  Rolf Taylor, Project Advocacy

All opinions expressed are the participants own.

Copyright © Movement is Life 2023. 

Selected Excerpts

“It is not only my profound responsibility, but it is a deep, deep honor to take forward the stories and the voices of patients that have taught me for my entire career.” 

“I miss my patients and I miss touching people. There is that tactile component that I did not realize I would miss. Apparently, I am always checking my husband’s pulse!”

“The populations who are marginalized and disenfranchised often get missed if you look at the health system as a whole.” 

“Cities are engines of innovation, a group of people who have chosen or remain in a finite community. We learn how to coexist. Everything we do is intertwined with the rest of the city. Cities can answer their problems if you bring their leaders, their champions, and the voices of all the cities communities together.” 

“Emergency medicine is the only part of the US health system that is user-triggered, and as Prof. McClellan pointed out, the only truly equitable part of the US health system is EMTALA (The Emergency Medical Treatment and Labor Act). What becomes grueling is to try and help in situations where you need to move people beyond the emergency room.”

“The Race Cards” is an interactive resource kit and activity designed for small groups. Working to end racism so that everyone thrives requires some uncomfortable conversations to be facilitated, because too often discussions about race either stay at the surface level or happen only among audiences steeped in knowledge about sociology, history, systemic racism, and privilege. The Race Cards create a safe space for an honest, authentic discussion in a way that is accessible to everyone.

Dr. Kimberly Allen is the inaugural CEO of 904WARD. Her organization evolved the Jacksonville 904 dialing code into a new nonprofit whose mission is to create racial healing and equity through deep conversations and learning, trusting relationships, and collective action. Episode host Sarah Hohman invites Dr. Kimberly Allen and 904 resident Sharon LaSure-Roy to reflect on the practical application of The Race Cards and report on their use in a workshop at the Movement is Life annual caucus.

Link to 904WARD resource page: https://904ward.org/racecards/ 

Copyright © Movement is Life 2023. All opinions expressed are the participants own.