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Addressing Racial Disparities in Home Health Care – The Role of VBP and Health Equity

Exploring Solutions to Overcome Healthcare Disparities in Home Care for Minorities


December 21, 2023 – Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health.  It remains vital for all individuals, irrespective of their background, have access to appropriate and effective care. Yet, disparities persist, often hidden beneath the surface of healthcare systems and policies. In the home health and home care segment, these disparities have been found in a recent study, raising concerns about equitable access to these essential services. 

In this blog, we will look at the existing gaps in healthcare for minorities, specifically focusing on the challenges faced by Black Medicare patients in accessing home health care that were published in the journal Medical. As we navigate through these findings, we will also examine how value-based payments can help bridge these gaps, ensuring fair and just access to care for all.

Disparities in Home Health Care Referrals for Black Medicare Patients

A recent study published in the journal Medical Care highlighted a concerning trend in the home health care segment. The study published this month found that black Medicare patients are significantly less likely to be referred for home health care compared to their white counterparts. This occurs despite exhibiting similar readiness for discharge from medical facilities. 

The study, which involved data analysis from a multisite study of the implementation of discharge readiness assessments in 31 US hospitals, found that only 22.4% of Black patients were referred to home health care at discharge, compared to 26.7% of White patients. This referral gap occurred even though there were no substantial differences in the clinical readiness of these patients. The implications of these findings are profound, particularly in highlighting the systemic biases that can influence healthcare decision-making and access.

Home health care is important in recovery post-hospitalization, especially for the aging population. It includes services like skilled nursing, therapy, and assistance with daily living activities. Without these services, individuals can face poorer health outcomes, higher rates of hospital readmission, and slower recovery. Unfortunately, the disparity in referral rates points to a broader issue of minority health outcomes being disproportionately affected.

And this isn’t the only study that has shown that patients from racial and ethnic minority groups are less likely to receive home health care. This moves us further from health equity, as inadequate post-hospitalization care can exacerbate existing health conditions and lead to a decline in overall health status. This gap in home health care referrals also highlights the need for more inclusive and equitable healthcare practices and policies that actively work to eliminate racial biases and ensure that all patients have equal access to necessary health services.

Quality Disparities in Home Health Care for Minorities

The challenges for minorities in accessing home health care are compounded by another critical issue. When minorities do receive these services, the quality of care is often lower compared to their white counterparts. 

A study published in Health Affairs provides a concerning insight into this quality gap. It reveals that minority patients are more likely to receive care from lower-rated home health agencies. Black and Hispanic home health patients had a 2.2% and a 2.5% lower adjusted probability of high-quality home health agency use, respectively. This is significant because lower-rated agencies often have fewer resources, leading to challenges in providing high-quality care. For example, they may struggle with staffing shortages, which can result in less frequent or shorter visits for patients. Agencies might also lack the infrastructure or resources necessary for comprehensive training or implementation of best practices, affecting the overall quality of care provided.

The biggest concern about receiving care from lower-quality home health agencies is that it can lead to poorer health outcomes. This includes higher rates of complications, hospital readmissions, and slower recovery rates. These outcomes don’t just impact patients’ health and quality of life but also add to the overall healthcare costs. This is due to the need for additional treatments, rehospitalization or extended care. Other research also shows that patients receiving home health services from high-rated agencies experience fewer adverse outcomes than those receiving services from low-quality agencies. 

This quality gap also reflects and perpetuates broader health disparities experienced by minority populations. According to the Kaiser Family Foundation, disparities in health and healthcare are closely linked with social determinants of health, such as socioeconomic status, environment, and access to resources. Lower-quality home health care can make these underlying issues even worse, leading to a cycle of poor health outcomes and continued health inequities.

Simply put, health equity implies that everyone has a fair and just opportunity to attain their highest level of health. This is not possible when certain groups systematically receive lower-quality care. The issue of minorities receiving lower-quality home health care is a critical concern that needs to be addressed. However, addressing this challenge is not easy. It requires a multifaceted approach, that involves increasing funding and resources for lower-rated agencies, enhancing training and support for home health care providers, and implementing policies that specifically target the reduction of healthcare disparities. By leveraging value-based payments and health equity strategies, as we’ll discuss in the next section, we may be able to reduce these gaps. 

Leveraging Value-Based Payments and Health Equity Strategies in Home Health Care

Utilizing value-based payments (VBP) and health equity strategies may put us on the right path to addressing healthcare disparities for minorities in the home health care industry. These innovative approaches, while impactful, are not easy to implement and will take careful consideration and collaboration among stakeholders.

Value-Based Payments as a Catalyst for Change: Value-based payments shift the focus from quantity of services delivered to quality. They essentially incentivize providers to deliver better health outcomes rather than a higher volume of services. Under these types of models, providers are rewarded for achieving specific health outcomes, which encourages them to develop personalized care plans that address the unique needs of minority patients. VBP models can incentivize providers to invest in preventive care and early intervention strategies, which are particularly crucial for minority populations that might have limited access to healthcare. These proactive approaches can help in managing chronic conditions more effectively and prevent complications, leading to better overall health outcomes for these patients.

Integrating Health Equity into Care at Home: Health equity strategies in home health care can make a big impact. This involves understanding and addressing the specific health needs of minority populations. This means providing culturally competent care, ensuring language access, and considering social determinants of health that impact these communities. By integrating these elements into home health care, providers can offer more tailored and effective services.

Some examples of this include training home health care staff in cultural competency to improve patient-provider communication and trust. This can lead to better adherence to care plans and improved health outcomes. Additionally, considering factors like housing, nutrition, and access to transportation in care planning can address some of the root causes of health disparities and promote health equity by providing whole person care.

Data-Driven Approaches and Community Engagement: Leveraging data is critical in implementing effective value-based payment and health equity strategies. Data can be used to identify health disparities, track progress in addressing these issues, and tailor interventions to the needs of specific populations. This ensures that resources are allocated effectively and that care strategies are based on actual community needs, which is important when working in minority communities that may have specific needs. This is where community engagement comes into the picture. Providers need to collaborate with community organizations and leaders to gain insights into the specific health challenges and needs of minority populations. This collaboration can also help in educating the community about available home health care services and how to access them.

When looking at this holistically, value-based payments and health equity strategies have the potential to transform the home health care industry for minority populations. But it will not come without proper collaboration of all stakeholders. By focusing on quality, personalized care, and addressing the broader social determinants of health, these approaches can help bridge the gap in healthcare disparities, leading to a more equitable and effective healthcare system.

Advocates Perspective

Examining the glaring disparities within the home health care sector for minorities reveals a real problem that requires response. Everyone deserves health equity in all facets of the healthcare system, but right not that isn’t happening. However, the incorporation of value-based payments and health equity strategies presents a promising avenue towards addressing these disparities. By shifting the focus from volume to value and integrating a deep understanding of the unique needs of minority populations, the home health care industry can make significant strides in ensuring equitable, high-quality care. This transformation will not be easy. It requires a concerted effort from all stakeholders and a commitment to understanding and addressing the specific needs of minority patients. The goal is a healthcare system where every individual, regardless of their racial or ethnic background, receives the care they need in a manner that is respectful, effective, and tailored to their unique circumstances.


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About the Author

Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).

His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.

mandy sahhar

About the Co-Author

Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.