CMS is a dedicated partner for distributing health equity throughout America. Dr. LaShawn McIver, Director of CMS Office of Minority Health says that our generations will get benefits from this unwavering commitment to equity. Thus, CMS is driving the structural change for Medicare ACO reporting. So, it has included the all-payer reporting structure in the PFS final rule from CY 2022–2032. Every ACO Medicare has to follow it for 10 years. It has provided a preparatory phase for ramping up to this replacement.
The health equity concept CMS has conveyed to its providers and Medicare ACO organization is different from equality. Instead, it empowers all efforts to address health disparities as a crucial element. However, the ultimate goal is broadening coverage and ameliorating health outcomes.
Before the further delay, let’s have a look at a summary of the PFS Final Rule for Medicare ACO.
PFS Final Rule; An Action-oriented Approach for Health Equity
As we know, the Centre for Medicare and Medicaid Services is a US government body. We value it for its large spread of health insurance coverage for more than 170 million people. Therefore, it supports several programs simultaneously to accomplish its main motives. For example,
- QPP Program,
- Children’s Health Insurance Program (CHIP),
- Health Insurance Marketplaces, etc.
Health equity means giving the highest level of care with fair and just options for the assessment of optimal health for all. So, everything like disability, gender, sexual orientation, language, race, and others comes after equity.
Health Priorities to Address the Health Equity Disparities (2022–2032)
Meanwhile, CMS has a clear realization of coming difficulties in the practical application of equity. So, it has made a strong determination to underpin utmost efforts and show consistency in its actions. It is truly attentive to America’s top five health priorities in PFS final rule for Medicare ACO.
| Priority 1 | Promote Standardized Data Collecting, Reporting, and Analysis |
| Priority 2 | Identifying the Root Determinants of Differences within CMS Programs and Addressing Inequities in Policies and Operations to Narrow Gaps |
| Priority 3 | Boost the workforce’s and health systems’ capacity to lessen disparities in health and access to care |
| Priority 4 | Improved Health Literacy, Culturally Appropriate Services, and Language Access |
| Priority 5 | Optimize Access to All Types of Health Care Services and Coverage |
Compatibility of CMS Framework for Health Equity
The PFS Final Rule provides the complete framework for implementing health equity in Medicare ACO. This framework is an amalgam of sets of instructions and rules followed in the past. It shares a harmonious agreement with Healthy People 2000 Framework. This Healthy People 2000 Framework has played a directional role in the 2023 framework for Medicare ACO. Alongside, CMS has also counted on several other efforts across HHS in a wise manner. By doing so, CMS aims to reduce/eliminate health disparities and implement health equity giving a critical aspect to healthcare.
Likewise, Medicare ACO Framework covers the CMS program areas from Medicaid to CHIP to the CMS innovation center. It equally empowers the underlined goals of these domains by expanding health equity coverage to underserved areas. Thus, this Framework serves to endorse the idea of achieving the maximum degree of health for all people. And the only way of attaining this is by addressing unjustified inequalities and erasing all healthcare disparities.
Moreover, the framework has consistency with Executive Order 13985 on Promoting Racial Equality and Assistance for Underserved Communities. The federal government has used the terminology ‘Underserved Communities’ here. Similarly, PFS finalized Framework also gives considerable attention to the same populations under Medicare ACO. The federal government in the US takes all populations that share a certain trait as underserved communities. In other words, these geographical communities have been systematically deprived of a full opportunity to participate in aspects of economic, social, and civic life. Thus, they have faced health disparities as per the definition of “equity.” Members that are included in underserved communities need access to health equity the most. These members might be:
- Different racial and ethnic populations
- Disabled People
- LGBTQ+ communities
- Rural communities
- Groups of poor people, etc.
Conclusion
Hence, we have the following key takeaways for the PFS finalized framework for Medicare ACO.
- With an improved and more comprehensive 10-year approach, the CMS Framework for Health Equity is a replacement for the earlier Medicare-focused CMS Equity Plan. This plan Improves the Quality of Medicare. Moreover, it seeks to further integrate health equity across all CMS programs, including Medicare, Medicaid, CHIP, and the Health Insurance Marketplaces.
- In addition to this, the revised CMS Framework for Health Equity also emphasizes the role that CMS plays to promote health equity. For this, it assists providers, health plans, federal, state, and local partners, tribal nations, people and families, partners in quality improvement, researchers, policymakers, and other stakeholders equally.
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