Achieving Health Equity
To improve responsiveness of care for Medicaid and other underserved patients: use time-to-treat data (i.e., data measuring the time between clinician identifying a need for an appointment and the patient having a scheduled appointment) to identify patterns by which care or engagement with Medicaid patients or other groups of underserved patients has not achieved standard practice guidelines; and with this information, create, implement, and monitor an approach for improvement. This approach may include screening for patient barriers to treatment, especially transportation barriers, and providing resources to improve engagement (e.g., state Medicaid non-emergency medical transportation benefit).
Ensure timely treatment of patients from underserved populations, to help them achieve improved health outcomes.
Evidence of eligible clinicians tracking and improving timeliness of care delivered to patients from underserved populations, including those with Medicaid, through analysis and intervention. Include both of the following elements:
1) Analysis of time-to-treat data – Report documenting analysis of trends and inequities in time-to-treat data, disaggregated by beneficiary type (to compare those with and without Medicaid benefits) and by other patient demographics such as race/ethnicity, disability status, sexual orientation, sex, gender identity, or geography. Report should include possible explanations for the trends and inequities identified; AND
2) Implementation Plan and Results – Documentation of plans for activities to address inadequacies in time-to-treat performance, and the outcomes of those activities. Activities may address barriers facing patients (e.g., lack of access to affordable transportation) or barriers presented by the eligible clinician (e.g., appointment availability does not align with needs of those who lack sick leave).
An urban outpatient center is interested in assessing what inequities might exist in their current practice related to access to timely care. First, they analyze time-to-treat data, and look at differences by race/ethnicity, sex, zip code, and beneficiary type. They notice that patients with both Medicare and Medicaid benefits are most likely to miss or arrive late to appointments. They also notice that these patients are located in urban zip codes that have insufficiently accessible public transportation options to the outpatient center. To support these patients, the outpatient center researches Medicaid benefits related to transportation benefits in their state, and builds in EHR prompts for eligible clinicians to provide information about those benefits to all patients with Medicaid and Medicare. The center also institutes a call system that provides the information to Medicaid beneficiaries one week before their scheduled appointment. After several months of implementation, the outpatient center repeats their analysis of time-to-treat data and observes a small but noticeable improvement in timeliness of care for patients with Medicare and Medicaid services.
The standardized screening for transportation barriers, adopted by Centers for Medicare & Medicaid Services, is from the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) tool at: https://www.nachc.org/research-and-data/prapare/