Challenges and strategies for evaluating racial equity in health initiatives

Challenges and strategies for evaluating racial equity in health initiatives [PDF]

Speakers: Nancy Chiles Shaffer (Centers for Medicare and Medicaid Services Innovation Center (CMMI)), Sarah Lewis (CMMI), Bisma Sayed (Office of Health Policy, Department of Health and Human Services), Jessica McNeely (CMMI)

Though most Center for Medicare and Medicaid Innovation's (CMMI's) models have not targeted underserved populations, some have, and others offer opportunities for evaluations to investigate health equity related outcomes. Evaluations of models that aim to improve the health care of underserved populations and utilize health-related social needs screening offer baseline information about the state of equity in healthcare and lessons learned that can apply to developing future interventions. The majority of CMMI's underserved program enrollees receive Medicaid, the public health insurance program for low income children and adults. Models generally enroll Black beneficiaries in proportions similar to proportions in the populations served, though other disadvantaged racial and ethnic groups are more difficult to identify and measure. Models considered in this presentation utilize health-related social needs screening to identify beneficiary needs beyond clinical care with the intent of providing relevant resources to address or mitigate those needs. Qualitative evaluations of lived experiences provide detailed insights regarding challenges faced by low-income and racial minority populations. This session included a 25 minute presentation synthesizing health equity evaluation findings in CMMI models that enroll underserved populations and screen for health-related social needs, highlighting challenges and opportunities across sectors. Rigorous evaluations utilized a range of valid and appropriate qualitative and quantitative methods (e.g. focus groups, PhotoVoice, difference-in-differences analyses). Understanding equity-related gaps can provide a foundation for improving future models of care, addressing social care more effectively, and identifying opportunities and challenges for future research relating to social care. The presentation also included a 25 minute discussion to encourage dialogue on and examination of the strategies and challenges for evaluating racial health equity in health initiatives.

Learning Objectives

1. Identify the current state of racial health equity analyses in CMMI evaluations, included who our models have reached and what racial/ethnic groups are currently represented.

2. Assess the main outcomes and any observed differences across racial/ethnic groups.

3. Identify and interrogate the strategies and challenges for evaluating racial health equity in health initiatives.