CMS takes steps, offers tools to address disparities in care

October 1, 2019


Within the Centers for Medicare & Medicaid Services, several initiatives are underway that are intended to reduce health disparities in vulnerable populations, including racial and ethnic minorities, sexual and gender minorities, and people with disabilities.


Cara James, director of CMS' Office of Minority Health and co-chair of its Rural Health Council, detailed some of those efforts during a CHA webinar in early August called "Achieving Health Equity Through Increased Understanding, Sustainable Solutions and Collective Action."

"We are working to ensure that all of our CMS beneficiaries have achieved their highest level of health and that disparities in health care access and quality are eliminated," said James, whose office was created as part of the Affordable Care Act.

Under her leadership, CMS developed the "Equity Plan for Improving Quality in Medicare" and its Rural Health Strategy — both firsts for the agency. The initiatives are meant to help people understand their coverage and connect to care as well as to improve the quality of demographic and health outcomes data captured by CMS.

The data collected so far shows some clear disparities, James said.

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For example, a study of Medicare Advantage beneficiaries found those who are Asian or Pacific Islanders received better care than white beneficiaries in over 40 percent of measures of clinical care while Hispanic beneficiaries got worse care than whites on 15 of 35 measures of patient experience and clinical care.

"We're seeing improvements in a number of the measures that are being tracked, but when you look at the disparities, we largely are not seeing progress in reducing those gaps," she said.

To tackle those disparities, James said, her office has focused on improving its understanding of the people getting the care and how that care is being delivered.

The office in recent years developed a tool to map disparities in health services received by Medicare beneficiaries. It uses various fee-for-service data from across the nation on a number of conditions and looks at prevalence rates as well as hospitalizations, readmissions, outcomes and cost. The tool can drill down to the county level and compare data for various population groups and such categories as race or ethnicity, age and gender.

The information gleaned is being used to identify disparities and the best means to address them, James said.

On rural health care, James' office partnered with the Centers for Disease Control and Prevention for analysis of what she said are very diverse communities with race-based differences in health outcomes and in age distribution. Rural communities tend to have a higher percentage of seniors than the country as a whole. The analysis showed that 24 percent of rural residents are 65 or older, but only 9 percent of Hispanics in the rural U.S. are age 65 or older.

"We very frequently talk about some of the health issues that rural communities face, but we often neglect to reflect on the diversity that's within rural communities and understand that they are not homogenous communities," James said.

To help address the needs and disparities that it has identified among nonurban beneficiaries, the CMS rural health strategy intends to improve access to health care in part by advancing telehealth and telemedicine.

One of the resources developed as part of the strategy is a Disparities Impact Statement designed to help organizations identify, prioritize, and act on health disparities. Technical advice to fill out those statements can be requested by email from [email protected]. The entire strategy is detailed at

To improve overall care, the equity plan developed by the Office of Minority Health calls for expanding the collection and analysis of data and evaluating the impacts of disparities, among other things. The office also started an initiative for beneficiaries called From Coverage to Care. That initiative includes a number of resources, such as an enrollment tool kit and a guide called "5 Ways to Make the Most of Your Coverage." The resources are online at

CMS also is working on establishing a standardized way for care providers to assess the social determinants of patients' health, James said, in hopes of figuring out the relationship between such factors as transportation and social isolation and health outcomes.

The goal is to implement a sustainable action plan to end disparities and achieve health equity. "This to me is the critical work we do," James said.


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