Health Care Equity and Alternative Payment Models (APMs) – Sinsi Hernández-Cancio on the “Spotlight on Action” podcast

| Jan 25, 2023

Recently, our Vice President of Health Justice, Sinsi Hernández-Cancio, was a guest on Health Care Payment Learning & Action Network’s Spotlight on Action podcast. Sinsi is a lawyer, health policy expert and patient advocate. She is also a mom, a person with chronic conditions, a mother to a child with chronic conditions, and a Puerto Rican woman. Her professional expertise and life experiences inform the way she thinks about moving the health care system towards one that effectively cares for every single person in this country – with dignity, excellence and respect.

Sinsi joined Aparna Higgins, host of Spotlight on Action and LAN Senior Advisor and Senior Policy Fellow at the Duke-Margolis Center for Health Policy, HCPLAN, to talk about the role of health equity in the patient experience and how equity can be improved in health care.

Here are some highlights from the episode:

What do we mean when we talk about health equity?

… Health equity is an idea that every single person has the ability to be as healthy as possible, right? Without barriers and especially without structural barriers that are impeding them from being healthy. Now, a chunk of that has to do with the kind of health care they can get, and a lot has to do with things that aren’t about health care, but have everything to do with health like the conditions in their neighborhoods and things like their experiences with racist inequities and structural inequities and income and education and language and a whole bunch of things, right? So, it’s important to understand that the actual clinical care you get is a very important part, but a relatively smaller part compared to everything else that I just mentioned.

How can patients better advocate for themselves?

I think that the first thing is to answer to frame this as not only what individuals can be doing, you know, to make sure that they’re getting the best possible health care and advocating [for] themselves in different health care settings, but that it’s also a family, right? For a lot of us, whether it’s because you’re accompanying a spouse or child or a parent or some elderly relative, health care is not just about the individual. It’s about how the family can [be engaged] in supporting the health of that particular individual. […]

And in fact, patients do better when they have someone else with them in appointments to help them ask the right questions, advocate for them, remind them if they forgot something, take notes if they need to. So that’s the first thing. It’s like, make sure that as a patient you are very clear about who’s like on your team, on your team in terms of family or friends who can be there to support you.

What role can Alternative Payment Models (APMs) and value-based care play in advancing health equity?

So, I believe that the movement away from fee-for-service towards value-based care is essential in achieving equity. I do believe though, that it will only work if we’re being explicit about addressing equity and very, very transparent about the roots of the inequities to reduce the racial and ethnic and other inequities in mind, right?

On how to evaluate how APMs and person-centered care is working and what else is needed to support those programs.

And addressing things that are really affecting people’s health outside of the four walls of a clinic, like the air they breathe and the food they eat and the water they drink. The return on investment needs to be on, like, are people healthier? That’s how you measure. Are people missing less work? Are people missing less school? Like a social return investment is going to be really, really important or else we’re never going to get ourselves out of this kind of like Catch 22 of like, well, we want to improve outcomes, we can only do it by saving money. And that is not a six-month turnaround in most cases, that is not even something that can be measured in the same balance sheet, right? Like, it might be that we need to spend more earlier with middle-aged people in primary care so that Medicare can save money 10 years later.

At the same time, there’s things that are really clear that are going to be needed outside of health care for it to be successful. … there is a bigger picture that needs to happen around infrastructure and the care infrastructure and the data infrastructure that’s needed. And addressing things that are really affecting people’s health outside of the four walls of a clinic, like the air they breathe and the food they eat and the water they drink.

Learn more about how value-based payments and alternative payment models can improve health equity: listen to the full episode, “Improving the Patient Perspective through an Equity Lens,” on HCPLAN’s website.