Tracy Yang, MD, MPhil was most recently a resident physician at New York Presbyterian Morgan Stanley Children's Hospital in New York, NY. During medical school, Dr. Yang conducted research with the goal of developing a family-level cardiovascular risk-reduction intervention among low-income African American parents and their adolescent children. She aspires to work as a practicing physician in an underserved urban hospital context while also running a non-profit or community-based organization that focuses on the social aspects of providing care. She is a member of Alpha Omega Alpha Honor Medical Society, and is the recipient of a Harry S. Truman Scholarship as well as a Rhodes Scholarship. Dr. Yang received a Master of Philosophy in Medical Anthropology from Oxford University in 2013, and her medical degree from Johns Hopkins University School of Medicine in 2018.
Tracy Yang, MD, MPhil, MPH
Pediatric Hospital Medicine Fellow, Boston Children’s Hospital, Boston, MA
Development of a Health Equity Incentive Program: Pediatric Considerations
Background: Several state Medicaid programs as well as private insurers are beginning to incorporate equity into their policies and models for population health. These efforts include reforming delivery systems and health care payment models to hold the health care system accountable for the effects of structural racism on measures related to health equity.
MassHealth, Massachusetts’ Medicaid and Children’s Health Insurance Program, provides comprehensive, affordable health care coverage for over two million MA residents, including 40% of all MA children. MassHealth is developing a strategy in its 2023-2027 1115 waiver to collect standardized social risk factor data (such as race, ethnicity, language, etc.) to stratify Accountable Care Organization (ACO) and Acute Hospital performance reporting and outcomes. These data will be used to introduce incentives for reducing identified disparities among member organizations. The purpose of this project is to inform the development of the health equity incentive program, specifically through analysis of existing pediatric data reported to or collected by MassHealth to guide recommendations about future data stratification for incentives to decrease health disparities.
Objectives:
- Make recommendations on measure stratifications based on literature review for the upcoming health equity incentive program, specifically regarding age, race, and ethnicity
- Perform data analysis of a subset of existing MassHealth ACO quality measures to understand:
- Pediatric vs. adult differences in measure outcomes
- Differences in pediatric outcomes by ACO
- Make recommendations based on the above analysis for the upcoming health equity incentive program, specifically regarding age, race, and ethnicity stratifications by measure
- Contribute to the design of a component of the health equity incentive program (specifically, language data collection during member enrollment)
Methods:
- Attended MassHealth internal and external meetings to understand context and development of health equity incentive program
- Performed literature review to make recommendations for short-term and waiver period data collection and stratification
- Performed data analysis stratifying outcomes for selected quality measures by age
- Contributed to health equity incentive program proposal development through presentations to MassHealth about health equity summary score methodology, the existing state of language data collection, and recommendations for the next waiver period
Results: Based on literature review, short-term recommendations were made as well as suggestions for the 2023-2027 waiver period. We recommended more specific age stratifications for several measures to capture differences between early childhood, adolescence, and early adulthood. We also made recommendations on race and ethnicity stratifications based on disparities found in the literature.
There were differences in pediatric and adult performance across the measures included in this analysis. Limited data were available for existing measures by age, and there were also limited race and ethnicity data to analyze quality measures. Overall, pediatric performance was better than adults for follow-up after ED visit and hospitalization for mental illness. Pediatric performance was worse for both initiation and engagement with alcohol/other drug abuse. Pediatric rates of follow-up after hospitalization for mental illness varied by ACO, particularly for 7-day follow-up.
Future Directions:
- MassHealth should routinely stratify health equity measures by age and adjust age ranges where applicable; aggregate performance including both adult and pediatric populations may mask important disparities by age group
- MassHealth should routinely stratify health equity measures by race and ethnicity as a proxy for the effects of structural racism on disparate health outcomes. Race and ethnicity stratifications should be informed by existing research and in collaboration with experts such as those participating in the Quality Measurement Alignment Taskforce’s Technical Advisory Group
- MassHealth should design incentives with the goal of specifically improving health disparities among children and families, particularly those belonging to historically marginalized groups. For example, measures that evaluate outcomes in sectors outside of healthcare (kindergarten readiness, food insecurity, chronic school absence) will help incentivize current and new work in addressing the upstream social determinants of health.
Preceptor: Clara Filice, MD MPH MHS, Associate Medical Director for Payment & Care Delivery Innovation
