Significant progress stops short of full data, accountability
Barack Obama in 2008 promised to tackle inequality in health care — with data.
He said his administration would "challenge the medical system” by "requiring hospitals and health plans to collect, analyze and report health care quality for disparity populations and holding them accountable for any differences found.”
"Disparity” is the industry shorthand for health differences between groups linked to disadvantage. For example, racial and ethnic minorities are less likely to get preventive care, more likely to face serious illness, and less likely to get quality health care when they do, according to the Health and Human Services Department.
Two signature pieces of legislation, the American Recovery and Reinvestment Act and the Affordable Care Act — better known as the stimulus and Obamacare — include a range of measures to move toward data-based accountability for hospitals.
But progress is less certain for health plans, whose main regulator is not the government but a private nonprofit, the National Committee for Quality Assurance.
"I believe most people working in health policy who are interested in disparities would say so far so good, but we still need see what happens,” said Thomas LaVeist, director of the Hopkins Center for Health Disparities at the Johns Hopkins Bloomberg School of Public Health.
Action under the Recovery Act and Affordable Care Act includes:
• Implementation of electronic medical records, with bonus payments for "meaningful use” that require data collection by race, ethnicity and language proficiency, which LaVeist calls "vital” for holding hospitals accountable.
• Medicare's eventual move to "value-based” reimbursement, which bases payments on quality measures.
• New standards for health data collection. All health surveys sponsored by the Health and Human Services Department now must include standardized information on race, ethnicity, sex, primary language and disability status.
Most provisions to strengthen data collection on health disparities focus on government-funded surveys, not hospitals or health plans. Meanwhile, accountability is enforced primarily through Medicare payments to hospitals. The administration's action plan to reduce health disparities does call for incentives to reduce disparities for health plans participating in new health insurance exchanges, but rules for such exchanges will vary by state and don't include large employer-based plans.
It's clear that Obama has made significant progress on this promise, largely through the health care law and economic stimulus. However, we find the incentive-based approaches fall short of "requiring" hospitals and health plans to collect the data. So we rate this a Compromise.
Email interview with Thomas LaVeist, director of the Hopkins Center for Health Disparities at the Johns Hopkins Bloomberg School of Public Health, Dec. 14, 2012
Health and Human Services Department, "What are Health Disparities?" last modified April 8, 2011
Health and Human Services Department, "HHS Action Plan to Reduce Racial and Ethnic Health Disparities," April 2011
HealthCare.gov, "Health Disparities and the Affordable Care Act," updated Feb. 22, 2012
Health and Human Services Department, National Partnership for Action to End Health Disparities, "Fact Sheet: The HHS Action Plan to Reduce Racial and Ethnic Health Disparities," April 7, 2011
HealthCare.gov, "Improving Data Collection to Reduce Health Disparities," last updated Jan. 23, 2012
Health and Human Services Department, Office of Minority Health, "Reducing Health Disparities with Improved Data Collection: New Refined Data Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status," accessed Dec. 13, 2012
CMS.gov, "Hospital Value-Based Purchasing," updated Oct. 2, 2012
American Medical News, "Hospitals find success in slashing health disparities," March 16, 2012
Kaiser Family Foundation, "Minority Health," accessed Dec. 12, 2012
Kaiser Family Foundation, "Disparities in Health and Health Care: Five Key Questions and Answers,” Dec. 14, 2012
Kaiser Family Foundation, "Putting Men's Health Care Disparities On The Map: Examining Racial and Ethnic Disparities at the State Level," Sept. 27, 2012
Kaiser Family Foundation, "Putting Women's Health Care Disparities On The Map: Examining Racial and Ethnic Disparities at the State Level," June 20, 2009
Health bills include provisions for disparity
The health care reform bill under consideration in the U.S. Senate includes provisions that call for the federal government to collect data on disparity populations.
What's a disparity population? It's any group that tends to get sicker or have worse outcomes than the overall population. It can be defined in terms of race, ethnicity, sex, primary language, and disability status, and it can also apply to rural populations.
The Senate health bill gives the U.S. secretary of Health and Human Services or a designee the authority to develop standards for collecting health data in regards to race, ethnicity, sex, primary language, and disability status, as well as rural populations.
It's not clear from the legislative language whether hospitals and health plans will be explicitly required to collect data and then be held accountable. The legislation does say the secretary should consider "minimizing the administrative burdens of data collection and reporting on States, providers, and health plans." We'll have to wait to see how the new rules develop. For now, we rate this promise In the Works.