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Health Equity Implementation

Overview
We are a pioneer and leader in the new paradigm of Health Equity Implementation, applying health inequities, social determinants of health and community-based real world data to health equity implementation science and its linkage to Health Equity Interventions for improving diabetes and other chronic disease management programs.  

Health Equity Interventions recognize that:

  • Health risks include economic, social conditions, environmental and other risk factors that influence individual and group differences in health and health outcomes 
  • Health disparities are differences in health closely linked to social, economic or environmental factors 
  • Health disparities are differences in healthcare quality that are not due to clinical factors 

Our Health Equity Implementation Aims

  • Strengthen the science of community engagement in addressing health inequities in socially disadvantaged communities 
  • Address the need for improved trans-disciplinary and intervention research methods and approaches that respond effectively to health inequities 

Our Health Equity Implementation Goals

  • Establish sustainable and scalable programs that improve health behaviors and health outcomes in communities burdened by health inequities 
  • Accelerate the translation of research findings to such communities by designing effective and culturally-tailored interventions
  • Enhance community capacity by supporting equal community participation in research for which the community directly will benefit

Health Equity Implementation Components
Our practice of Health Equity Intervention encompasses community collaboration, tightly aligned with health equity implementation science and its measurement framework, domains and community measures, together with linkages to the Standard Of Care.  

Evidence Base
Our operationalization of community measures is supported by not only Health Equity Implementation Science, but also:  behavioral science (behavioral economics, decision-making, consumer behavior, social psychology, etc.); complex-care high-touch clinical trials; peer-reviewed and gray literature; conceptual measurement models; existing and new person-centered and other SDOH measures; other credible evidence.  

Health Equity Interventions
Health Equity Implementation includes existing, new and improved interventions and measures based on real-world evidence and their linkage to the Standard Of Care for disease management.  Our approach to interventions integrates and manages Enhanced Care Management (ECM), Complex Care Management (CCM) and Population Health.  While both ECM and CCM focus on managing complex patient needs, ECM is a specific tier within the broader CCM and Population Health frameworks.  ECM is a more intensive and personalized approach specifically designed for the highest-need individuals within a population.  CCM is a broader term encompassing care coordination for patients with multiple chronic conditions.  Population Health looks at the overall health of a larger group and aims to implement preventative measures across the entire population, not just high-risk individuals. 

Technology Transfer
Our Health Equity Interventions, designed to be replicable and scalable, include technology transfers, applications and social media elements.  Such interventions embrace not only health self-management skills, but also education, training and utilization of workplace and technical skills such as fundamentals, new health equity AI road mapping, engagement and data management.

Technical Assistance

Our provision of Technical Assistance encompasses modifying, purchasing and/or developing the infrastructure and IT systems to meet the system requirements supporting integration and interoperability with commercial and government healthcare payor systems.

Tailored Cooperative Staffing

Tailored coop staffing includes recruitment, training and placement programs customized to client needs.  Such staffing includes client needs assessment, design of job descriptions, on-the-job training with cooperative experience with the client and placement with the client.

Overhead Transfers

Clients can optimize workflows by transferring to us staff, facilities and equipment requirements.

Cooperative Community-Based Research And Development

We use a collaborate approach to community-based participatory research (CBPR) to involve engaging community members, researchers and organizational representatives as equal partners to enhance understanding of a given problem, create change and ideally improve health challenges.  CBPR involves co-creating the research agenda and priorities and promotes mutual understanding across partners, through the following key steps:  Community Entry; Health Problem Identification; Study Design; Participants Recruitment and Retention; Data Collection; Data Analysis and Reporting; and Report Dissemination.  Through an iterative process, CBPR establishes valuable relationships with communities and diverse partners through sharing resources, decision-making, results and knowledge throughout the research process.  CBPR uses community dialogue to build trust, bridge socio-cultural differences between partners and brings multiple perspectives in examining an issue.

Value-Based Arrangements

Value-based care ties the amount health care providers earn for their services to the results they deliver for their patients, such as the quality, equity and cost of care.  Through financial and non-financial incentives, value-based care programs aim to hold providers more accountable for improving patient outcomes while also giving them greater flexibility to deliver the right care at the right time.

Value-based care programs also can enable providers to transform the way they deliver care, by promoting collaboration across care teams and encouraging providers to spend more time on services that wouldn’t normally be covered under fee-for-service, such as counseling or screening for social needs.  

Health Equity Interventions support the delivery of the Standard Of Care in alignment with value-based care, where there the patient needs are identified and met during the phases of care and are further aligned with appropriate health plan parameters, together with contract design and administration.  Such alignment is supported by health equity implementation science.  

The goals in value-based arrangements typically aim to improve measures of quality, equity and cost.  

  • Quality: The National Academy of Medicine described a framework for quality in healthcare.  The components of the framework include:  (1) effectiveness (care is based on evidence and is designed to get results); (2) efficiency (providers don’t use resources that are not needed); (3) equity (care does not vary in quality based on personal characteristics such as race, gender and income); (4) patient centeredness (each patient’s values, preferences and needs are respected); (5) safety (treatment does not cause harm); and timeliness (treatment is available without long delays)
  • Equity:  Efforts to improve health equity aim to reverse practices and policies that have made it difficult for historically marginalized groups, especially people of color, to access and receive high-quality care.  As a result of such inequities, these individuals have had poorer health outcomes.  Value-based programs that prioritize equity outcomes, such as requiring care providers to measure and reduce health disparities by race and ethnicity provide financial and non-financial incentives to assure that high-quality care is accessible for communities of color, low-income populations and more.  Measures of health care equity may include, for example, the collection of demographic data and the development of a plan to ensure equitable care is provided.
  • Cost:  Health care providers may earn more or avoid penalties if they reduce or maintain costs.  So, if providers can reduce unnecessary use of high-cost forms of care, like emergency department visits and inpatient admissions, providers may share some of the savings they produce.

Our value-based contract modeling defines contract parameters and project performance based on current and prospective contract terms.  Actuarial modeling supports the staging of the contract lifecycle — design, negotiation, activation, patient and provider measurement, provider and contract performance reporting, settlement, optimization and other elements.

Value-Based Contract Modeling – Representative Components

TARGET POPULATION
• Inclusions; exclusions
GOALS
• Quality improvement
• Cost-savings without diminishing quality
• Cost-savings and quality improvement
COVERED SERVICES
• Define: (1) the specific services in the VBA; (2) VBA-specific billing codes ([a] included in the payment; [b] excluded from the payment); (2) the types of providers that may submit claims for the services included in the payment; (3) what triggers the payment; (4) the time period covered by the payment; (5) etc.
DATA & REPORTING RESPONSIBILITIES
• Responsibilities: (1) of the VBA Entity to furnish data and reports to help providers manage their clinical and financial responsibilities and risk (adjustment for no-risk option); (2) of providers to submit quality and encounter data; (3) etc.
PATIENT ATTRIBUTION
• Defined process for attributing patients; whether attribution will be prospective or retrospective; whether attribution will be to a single provider or multiple providers; clear algorithm for determining patient assignment

PERFORMANCE MEASURES & BENCHMARKS
• Measures selected: equity & SDOH outcomes; shared-goals, conditions and services; capacity to collect/share data
• Performance benchmarks or thresholds
• How provider performance of benchmarks will be calculated, including relative weight or importance of specific measures
PERFORMANCE PERIOD; PHASE-IN; OPERATIONALIZATION
• Performance period (distinguished from the Term)
• Define: (1) phase-in/ramp-up period prior to starting the performance period; (2) sub-periods for specific episodes where treatment of episodes is included; (3) etc.
PROVIDER PARTICIPATION
• Define: (1) requirements providers must meet to participate in the VBA; (2) requirements for risk mitigation where the is a downside risk; (3) etc.
RISK ADJUSTMENT
• Where the no-risk option is not elected: (1) components of the VBA that are subject to risk adjustment; (2) methodology for adjusting risk when risk adjustment is applied; (3) etc.

Excerpt from “Overcoming the cost of healthcare transformation through partnerships,” August 2022, a collaborative effort by Emily Clark, Jack Gordon, Neil Rao, Drew Ungerman and Liz Wol, representing views from McKinsey’s Healthcare Practice.

Healthcare Transformation – Partnering; Collaborations; Alliances

Healthcare transformation can occur through partnerships and other strategic business combinations.  Evaluating, structuring and operationalizing a business combination requires significant effort encompassing five carefully sequenced discussion topics between parties.

  • Identify the strategy and scope of the partnership (value proposition to parties and stakeholders, core value drivers, any requirements or deal breakers)
  • Develop a business plan (translating value drivers to the following:  a financial model (or business case) including funds flow and required investments; a high-level operating model considering  potential risks and mitigation strategies)
  • Align on the appropriate structure to enable strategy, beginning with a range of potential options and identifying “minimum viable structure,” ideal structures and clear exist options
  • Develop the governance model and roles and responsibilities for each party, including detailed governance mechanisms and day-to-day leadership
  • Build an operating plan, detailing key processes and the resources or assets required for the partnership to succeed.

IT Platform Acquisition Finance

The finance of IT acquisition can be arranged, by leveraging the data management requirements for value-based arrangements.