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Language Services Blog June 18, 2024

The Role of Language Services and Value-Based Payments in Advancing Health Equity

In healthcare, there’s been continued movement toward value-based care (VBC) and value-based payment (VBP) models aimed at reducing costs and improving outcomes. But despite this decades-long focus on incentivizing high-quality care, significant health disparities persist – especially for underserved populations.

In this blog post, we’ll take a closer look at the relationship between value-based care and health equity, and explain the role language services can play in improving outcomes for populations with limited English proficiency (LEP).

The Problem: High Healthcare Costs and Poor Outcomes

The United States has a serious healthcare spending problem. According to data from the Organization for Economic Co-operation and Development (OECD), an astonishing 17.8% of our nation’s GDP was spent on healthcare expenses in 2021. That’s nearly double the national average (9.6%) of every other high-income country in the world.[1]

What’s worse: This high level of spending doesn’t translate to better health outcomes. In fact, the opposite is true. Americans have the lowest life expectancy at birth, the highest rate of people with multiple chronic conditions, and an obesity rate nearly twice the OECD average.

For decades, many have rightly identified the healthcare industry’s fee-for-service model, which incentivizes the quantity of care provided, as a reason for the skyrocketing cost of care. To help address the growing cost of care and poor clinical outcomes, more U.S. healthcare organizations have been shifting to a value-based care model – one that incentivizes both payers and providers for the outcomes they achieve.

Under a value-based care model, work toward better outcomes is guided by the “triple-aim”[2]: Improving the patient experience of care (including quality and satisfaction); reducing the total cost of care; and improving the health of entire populations. This is reinforced by value-based payments, in which payers compensate providers based on the cost and quality of care delivered.

In 2010, the Affordable Care Act (ACA) signed many value-based care guidelines into law. And Medicare, the nation’s largest healthcare payer, began implementing more innovative payment and care delivery models to incentivize better care and wiser healthcare spending.[3]

A decade later, these efforts have helped make progress toward advancing value-based care. But they haven’t fixed the problems of high costs and poor outcomes – especially among our nation’s most vulnerable and underserved populations.

Value-Based Care Still Hasn’t Solved the Health Equity Problem

While improving the health of entire populations is one element of the triple-aim of value-based care, there’s clear evidence that health disparities persist – especially among vulnerable and underserved populations.

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A population that still experiences significant health disparities includes people with limited English proficiency (LEP). Consider these statistics, assembled by the Centers for Medicare & Medicaid Services (CMS)[4], which are particularly relevant to healthcare payers:

  • Since 2010, the percentage of people with LEP who were uninsured decreased from 46% to 29%. But they are still three times more likely to be uninsured than people who primarily speak English.
  • People with LEP are more likely to be uninsured across all racial and ethnic groups.
  • LEP patients experience additional healthcare challenges including low health literacy, having fewer support services, and difficulty communicating with healthcare providers.
  • Lack of support for people with LEP can directly impact health outcomes – including higher hospital admissions, higher medical costs, and lower access to care.

For its part, CMS has acknowledged the health equity issues that have emerged while implementing value-based care and value-based payment models. The result is a growing focus on how to advance health equity in underserved communities – such as the nation’s growing LEP population.

One proposed solution is the ACO Realizing Equity, Access, and Community Health (ACO REACH) Model, which requires all participating ACOs to have a plan to meet the needs of people with Traditional Medicare in underserved communities and make measurable changes to address health disparities. For payers, ACO REACH also includes an innovative payment approach to better support care delivery and coordination for people in underserved communities.

The Solution: A Renewed Focus on Health Equity in Value-Based Payment Models

Given the inherent issues with health equity and value-based care, how can payer organizations move the needle on health equity? By rethinking their approach to value-based payment design models to address the underlying causes of health inequalities.

“Despite VBP’s potential to promote equity, models were historically not designed to do so, and as a result, unintentionally harmed patients and providers,” explains Celli Horstman, senior research associate, delivery system reform for The Commonwealth Fund.[5]According to Horstman, early value-based payment designs actually discouraged participation from providers that practice in underserved communities – such as communities with large LEP populations – because the payments did not account for the health disparities that already existed.

Moving forward, payer organizations can help advance health equity efforts by incentivizing efforts to promote health equity – such as the use of professional certified medical interpreters when interacting with LEP patients.

For payers looking to advance health equity through value-based payment strategies, the Center for Health Care Strategies recommends the following strategies:[6]

  1. Articulate the equity goal.
  2. Assess the current payment and care delivery environment.
  3. Select the performance measures that reflect the equity goal and support the care delivery transformation.
  4. Set performance targets that explicitly support the necessary care transformations.
  5. Design the payment approach.
  6. Address operational issues and other considerations faced by health plans and providers.

 

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Advancing Health Equity for LEP Members

To ensure a more equitable healthcare experience for LEP members, payer organizations must first address the underlying problem: Language barriers. This can be accomplished, in part, by promoting health equity through your organization’s language access plan.

As the healthcare industry’s only dedicated healthcare interpretation service, AMN Healthcare Language Services can help your organization develop a strategy to improve health equity for LEP populations. To learn more, get in touch with a member of our team today.

Sources

[1] Gunja MZ, Gumas ED, Williams II RD. U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes. The Commonwealth Fund. Published January 31, 2023. https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022

[2] Improvement Area: Triple Aim and Population Health | Institute for Healthcare Improvement. www.ihi.org. Published 2023. https://www.ihi.org/improvement-areas/triple-aim-population-health

[3] Jacobs D, Fowler E, Fleisher L, Seshamani M. The Medicare Value-Based Care Strategy: Alignment, Growth, And Equity. Health Affairs Forefront. Published online July 21, 2022. doi:https://doi.org/10.1377/forefront.20220719.558038

[4] Centers for Medicare & Medicaid Services. Improving Care for People with Limited English Proficiency. Published 2023. https://www.cms.gov/files/document/cms-2023-omh-lep-infographic.pdf

[5] Horstman C. Promoting Health Equity by Changing How We Pay for Care. www.commonwealthfund.org. Published August 15, 2023. https://www.commonwealthfund.org/blog/2023/promoting-health-equity-changing-how-we-pay-care

[6] 1.Patel S. Leveraging Value-Based Payment Approaches to Promote Health Equity: Key Strategies for Health Care Payers. https://www.chcs.org/media/Leveraging-Value-Based-Payment-Approaches-to-Promote-Health-Equity-Key-Strategies-for-Health-Care-Payers_Final.pdf

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