Provisions in the Affordable Care Act (ACA) address a challenge many across the nation are trying to tackle – advancing health equity by improving the health status of and quality of care for racial and ethnic minorities. A recent report issued by the National Academy for State Health Policy (NASHP) highlights eight states that participated in a health equity learning collaborative and have pursued a number of strategies to address health equity through ACA implementation. In addition to addressing health equity through activities that improve insurance coverage and access for minorities, states have also been capitalizing on efforts to ensure delivery system reform initiatives advance health equity.

Racial and ethnic minorities are burdened with poorer health status, poorer health outcomes, and lower quality of health care. The ACA has introduced several broad-based delivery reform initiatives that will help advance health equity.

1. One in four Americans has multiple chronic conditions, and within that population racial and ethnic minorities are disproportionately burdened by chronic disease and illness. Health homes are an option for states to help improve care coordination for people with multiple chronic conditions and mental illness. The ACA offers an incentive of federal matching funds to states that create health homes.

2. The Center for Medicare and Medicaid Innovation (Innovation Center) provides states with another avenue to address disparities. The Innovation Center was established to test innovative care payment and delivery models that have the potential to reduce costs while preserving or enhancing the quality of care. The Innovation Center has launched a number of initiatives that will advance health equity and reduce health disparities.

3. Accountable Care Organizations (ACOs) can also benefit racial and ethnic minority populations. ACOs, also known as the Medicare Shared Savings Program (MSSP), promote care coordination and incentivizes providers to deliver care that promotes cost-savings. To be considered patient-centered, an ACO must incorporate “a process for evaluating the health needs of the ACO’s assigned population, including consideration of diversity in its patient populations, and a plan to address the needs of its population”.

4. Racial and ethnic minority populations are more likely to suffer from preventable hospital readmissions. In a new program under Medicare, called the Hospital Readmissions Reduction Program, payments to hospitals will be reduced if an excessive number of patients are readmitted. This will become effective in October 2012.

The good news – state agencies are energized around delivery system reform and its implications for advancing health equity. The great news – this provides a perfect opportunity for state advocates and community-based organizations to partner with states on these efforts. So, how can consumer advocates partner with states to advanced health equity in delivery system reforms?

– Find out if your state is pursuing any of the delivery system options.

– Bring the consumer voice to the table. In New Mexico, the Department of Health instituted Turn the Curve – a new series of planning meetings that enabled marginalized members of the community to voice their opinions about their most critical health needs and strategies to address them. Health Action New Mexico, a state consumer advocacy organization, along with other health advocacy organizations and community members attended these meetings and expressed their concerns about proposed delivery system reforms that would affect racial and ethnic minorities, such as New Mexico’s Native American population.

– Build strategic alliances. Engage key policymakers and health officials, such as:

  1. State legislators and their staff
  2. State Medicaid agencies
  3. Local health agencies
  4. State Offices on Minority Health
In Minnesota, the health-related agencies have been committed to investing in increasing the validity and use of race/ethnicity/language (REL) data to understand, assess, and improve quality of care for racial and ethnic minorities. Health consumer advocates, such as Minnesota’s Alliance for Racial and Cultural Health Equity (ARCHé) worked with legislators to pass a bill that would call for improved health data collection practices that include information about race, ethnicity, and language. ARCHé has continued to work closely with state agencies, hospitals, clinics, and other community organizations to develop a report of recommendations for standardized REL data collection.

In Ohio, advocates at UHCAN Ohio have been working with the Ohio Commission on Minority Health and other partners, to advocate for robust data collection in major delivery reform initiatives. They are also working with one of the leading Medicaid managed care plans, CareSource, to hire community health workers and place them in community health centers as a way to engage at-risk patients in improving their health. Community health centers serve a high percentage of minority populations.

Consumer engagement is crucial for the success of all models of health care delivery, and meaningful implementation of delivery system reforms that will affect racial and ethnic minorities will require consumers from these populations to be at the table. Racial and ethnic minorities have expertise regarding how delivery systems should be set up to meet their needs and should be recognized by states as valuable partners.

– Angela Jenkins, State Advocacy Manager & Leena Sharma, State Advocacy Manager