July 7, 2022
Transition to Value
  • An analysis conducted by the Center for Medicare and Medicaid Innovation (CMMI) found issues with implicit bias within three major payment models: Kidney Care Choices, Comprehensive Care for Joint Replacement, and Million Hearts Cardiovascular Disease Risk Reduction. CMMI found that while Black Americans were more than three times more likely to have end-stage renal disease, the Kidney Care Choices model’s medical eligibility criteria for beneficiaries may have erroneously excluded Black Americans. The Comprehensive Care for Joint Replacement model calculated a hospital’s target price for their episodes of care based on the blend of the facility’s historical spending and regional averages, but not on social risk factors. Lastly, researchers found that the risk calculator used to predict risk scores for the Million Hearts Model was developed specifically for Black and White populations. Thus, the model underestimated risk in patients in other racial and ethnic groups as well as those with lower socioeconomic status. (Article here)