As director of the Data and Policy Analytics Group (DPAG) at the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health (OMH), Meagan Khau helps lead research that informs policies to reduce health disparities and improve quality of care in older adults and people with disabilities. At DPAG, Khau also assists in developing and implementing support for cross-component and cross-agency collaborations to enhance data collection, analysis and reporting demographics and characteristics associated with health disparities.
Prior to joining CMS OMH, Khau was deputy director of the Division of Pharmacy in the Center for Medicaid and CHIP Services. She received her Master of Health Administration from the University of Southern California and bachelor’s in sociology from the University of California, Irvine.
Q: As we celebrate the 29thanniversary of the Americans with Disabilities Act (ADA) on July 26, can you talk about how it contributes to our July issue theme of senior independence?
According to the Centers for Disease Control and Prevention, two out of five adults over the age of 65 have some type of disability.
Since the passage of the ADA on July 26, 1990, we have seen progress in removing barriers to health care for people with disabilities. The ADA is a civil rights law that prohibits discrimination against and guarantees equal opportunity and rights to individuals with disabilities in all public spaces and areas of public life, including jobs, schools, transportation, government services, telecommunications. However, research suggests that many health care providers may not be fully aware of their legal obligations to patients with disabilities.
Changes to the physical environment to increase accessibility can improve quality of life and care for older adults, as well as for others. For example, curb cuts or automatic doors benefit a wide range of people, from individuals who use wheelchairs or walkers or have limited strength, to parents pushing children in strollers.
The CMS OMH is working to increase awareness among health care providers about the importance of physical accessibility in delivering safe, high-quality care to all — including seniors.
Q: With the ADA’s anniversary this month, what are you doing in terms of observance and outreach?
July has always been a time to celebrate and to reflect on our progress. This involves educating people about different types of disabilities and providing our beneficiaries and providers the means to allow people with disabilities to live healthy, independent lives.
As an example of that, CMS OMH will soon release some new resources to provide information on improved accessibility. Getting the Care You Need: A Guide for People with Disabilities, will help people make the most of their interactions with health care providers and include a checklist for medical appointments. Modernizing Health Care to Improve Physical Accessibility: A Compendium of Resourceshas guidance on how to assess and increase physical accessibility of medical services for individuals with disabilities, and tips and training materials for reducing barriers and improving quality of care.
Q: Can you talk about ADA’s impact on CMS beneficiaries and their families? How has it changed or affected issues like health care disparities, quality of care, care transitions, access to care and/or patient wellbeing?
We anticipate that as beneficiaries with disabilities become more aware of their rights under the ADA, they will advocate for themselves and speak up about their need. Everyone’s needs are different, and we want providers to encourage open conversations between individuals with disabilities and those who provide the care for them. Those of us who work on the program side must also increase our awareness as we develop policies, guidance and resources to support this population.
For example, the CMS Equity Plan for Medicare includes a focus on sensory and physical disabilities. Language and communication barriers are associated with decreased quality of care and clinical outcomes, longer hospital stays and higher rates of readmission.We also focus on understanding, increasing and promoting physical accessibility of health care facilities.
Additionally, many organizations are recognizing the needs of people with disabilities and are working to improve access to care. For example, at the 2019 CMS Quality Conference, CMS presented the 2019 CMS Health Equity Award to recognize exceptional commitment to health equity for underserved populations. One of the winners is Centene Corporation, which announced in 2018 that it would partner with the National Council on Independent Living to increase the accessibility of provider medical offices and services. As a result of these efforts, more than 36,000 of Centene’s members now have improved access to their provider’s office.
Q: What about impact on providers — what effects has ADA had in that sense?
One example would be that not only must providers ensure physical access for people with disabilities, the federal laws prohibit providers from refusing to serve or make a beneficiary wait longer just because the beneficiary has a disability requiring help with things like interpreting or reading. Providers also cannot refuse or charge extra fees to provide braille, large print or sign language interpreters when necessary.
If a Medicare beneficiary with a disability feels that they did not get a fair treatment during their doctor’s visit because of their disability, then they may file a complaint with the Department of Health and Human Services’ Office for Civil Rights.
Q: Anything else you think is important to know or you would like to share?
I would like to encourage the QIO Newsreaders to make use of the resources mentioned above, as well as others like this CMS OMH Mapping Medicare Disparities Tool to identify areas of disparities between beneficiary subgroups, including various disability data. We also encourage readers to subscribe to listserv, check our website for new resources and email us at HealthEquityTA@cms.hhs.gov with any questions.