An Equity Approach in Addressing Health Care Disparity Among Serious Illness Populations

Disparities in access and quality in our health care system create disparate health outcomes and quality of life for millions of Americans. A health equity approach addresses the full range of needs of patients and is responsive to the differences in environment, finances, culture, and health care. Among populations with serious illnesses, health care has not always addressed the needs of communities historically marginalized and presently underresourced.

Healthcare disparities are differences between groups in access to, use of, quality of care, or health care coverage. Though the Affordable Care Act (ACA) increased access to health insurance, many people remain un- or underinsured. Black, Indigenous, People of Color (BIPOC) Americans are more likely to be uninsured. For those living with serious illnesses, the obstacles are even greater. For example, Black and Latinx patients experience less access to high-quality home health care, which can be attributed to the lack of fewer health care providers in the communities where they live. Despite the positive impact shared decision-making can have on patients, Black patients are less likely to use advanced care planning products or have conversations on their health care wishes. The cost of care can create a disproportionate burden on patients and their families.

C-TAC Approach to Address the Problem

Utilizing C-TAC Core Principles to Improve Models of Care. C-TAC's core principles create a framework in which patient-centered and equitable care can be delivered to patients. High-quality care includes an interdisciplinary team that focuses on the medical and nonmedical needs of patients. Addressing nonmedical needs is a responsive approach to the social determinants of health (SDOH) that impact the quality of care that patients receive.

Centering the voices of patients. Meaningful engagement and feedback from the community will improve how health care providers deliver care. Culturally and linguistically responsive health care services have been shown to improve outcomes for patients. Supporting workforce training designed with the patients in mind creates a workforce better adept at meeting patients' medical and nonmedical needs.

Acting on behalf of patients is essential to securing the care they desire. However, those same patients are also their most effective advocates. Providing spaces where patients can share their stories and remark on their challenges better informs strategies for creating solutions.

Equity-informed assessments. Screening for the social needs of patients, in addition to their medical needs, better informs providers on what community supports patients need to have better outcomes.

Eliminating Co-Pays in Advanced Care Planning (ACP) Sessions and other financial obstacles.  A 2020 report by the Office of the Assistant Secretary for Planning and Evaluation on ACP showed that the co-pay associated with ACP sessions is a barrier to shared decision-making conversations. As a result, underserved and under-resourced populations are less inclined to take advantage of these patient-centered conversations.

Accountable Care Organization Realizing Equity, Access, and Community Health (REACH) Model. The ACO REACH Model gives the Centers for Medicare & Medicaid (CMS) an opportunity to test models with an equity focus.  

Value-Based Models that Incentivize a Health Equity Approach in Care. Value-based payment models, especially those designed to be responsive to social determinants of health (SDOH), reduce the financial burden on patients and their families. It also ensures patients receive high-quality care and treatment.

Integrating Community-Based Organizations (CBOs) into Health Care creates an interdisciplinary approach.  CBOs can reduce disparities by filling in the gap between the hospital and home. Health-related social needs, like housing and food insecurity, have been impacted by decades of disparate government action. Community-informed and led care addresses those social needs and improves outcomes, especially for historically marginalized communities.

State Innovation on Medicaid and Palliative Care. Supporting state utilization of federal funds through Medicaid to support community-based organizations providing palliative care.

C-TAC Calls to Action

  • Advocate for Equity-informed assessments. Focusing on social determinants of health (SDOH) key areas defined by AHRQs (social context, economic context, education, physical infrastructure, and healthcare context) is a way existing systems can be reformed to improve health outcomes. Patient assessments that evaluate a patient’s SDOH circumstances make for better referrals and services that augment the care patients receive.
  • Fund information campaigns in underserved communities to increase public awareness of available resources. Using community-based organizations, especially Black, Indigenous, and People of Color (BIPOC) led organizations as trust validators encourage the use of health care services.
  • Expand telehealth services for advance care planning. A permanent expansion of the pandemic-related flexibility under Medicare to allow for reimbursement of phone-based, audio-only ACP services increasing access.
  • Increase funding for the Racial and Ethnic Approaches to Community Health (REACH), which is the only CDC program that funds communities working to reduce racial and ethnic health disparities.