The Role of MIH Teams in Improving Health Equity: Data Collection

Community paramedics know perhaps better than many other health professionals that the social situations people face directly affect their health and health outcomes. Social determinants of health (SDOH) and health equity continue to gain national attention as a way to improve population health. 

The Centers for Medicare and Medicaid Services (CMS) is investigating models that account for SDOH and finding ways to reimburse for addressing these needs. SDOH plays a role in larger efforts at health equity and value-based care. 

CMS’s Health Equity Efforts

The CMS Framework for Health Equity aims to codify efforts to track and document SDOH, as well as efforts that impact those needs. Mobile integrated health (MIH) teams are poised to be key partners for the healthcare ecosystem to document and address SDOH. That also positions MIH for funding opportunities provided by these efforts.  

The framework has five priorities, but we’re going to take a closer look at the first priority – to expand the collection, reporting and analysis of standardized data. 

To understand what change is needed, measure improvements and tie health equity efforts to funding requires accurate, interoperable data collection. Through its Healthy People 2030 initiative, CMS lists five domains for SDOH: economic stability, educational access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. 

What’s Needed to Improve Data Collection

Many social and healthcare needs fall within those domains, and it’s a challenge to standardize what to collect and how to collect it. Healthcare facilities across the industry have disparate electronic health management systems. 

To help standardize the data, CMS has Z codes for SDOH, although they provide a high-level view of SDOH. There’s also some standardization around collecting data on race, ethnicity, language, gender identity, sex, sexual orientation, and disability status.

“Over the past few years, the Z-codes have been fruitful in some regard,” said Shail Sinhasane, Founder of Rainbow Health. “But we still have to standardize the collection process and analyze that data.” 

Analyzing data also means connecting that data to outcomes. Sinhasane pointed out that once a need is documented, there needs to be a process to act on that need and measure the outcome.  

Where MIH Teams Fit

MIH teams are on the front lines of providing care to people in their homes, coordinating care at sobering centers, and connecting people to housing, food or transportation assistance. They are key partners for healthcare systems looking to understand existing social needs and coordinate access to community services as well as healthcare.

With opportunities for payments tied to achieving CMS’s health equity standards, healthcare providers have incentives to partner with MIH teams. And team leaders can leverage those incentives to create more coordinated ecosystems to help patients.

MIH teams can also look at developing standardized methods for collecting data. Sinhasane recommends starting with CMS sociodemographic data, Z codes, and the domains listed in CMS’s health-related social needs screening tool

Next, Sinhasane said there needs to be a streamlined process to share data with others involved in care coordination. 

“Value-based care models means everyone has to pitch in and work together effectively and responsibly,” he said. “Actively measuring SDOHto demonstrate the direct impact on reducing the impacts of SDOH with CMs’s health equity framework means you’re more likely to get a good payment mechanism in place.”

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