Cara James, Ph.D., is the director of the Office of Minority Health (OMH) at the Centers for Medicare & Medicaid Services (CMS) where she leads CMS’s efforts to meet the unique needs of minority and underserved populations. In this capacity, she provides leadership, vision and direction to address the Department of Health and Human Services' and the CMS Strategic Plan's goals and objectives related to improving minority health and eliminating health disparities. Prior to joining CMS, James was the director of the Disparities Policy Project and the director of the Barbara Jordan Health Policy Scholars Program at the Henry J. Kaiser Family Foundation. James received both her doctorate in health policy and bachelor’s degree in psychology from Harvard University.
Q: How have the priorities of the CMS Office of Minority Health evolved over the last year?
The CMS OMH remains very focused on achieving health equity for minority beneficiaries and is still working to support the agency’s priorities, such as empowering patients and providers. In particular, CMS Administrator Seema Verma has elevated our focus on rural health, and we are working closely with her to bring a rural health lens to all CMS programs and policies.
Q: April is National Minority Health Month, and this year’s theme is "Partnering for Health Equity.” Can you talk about what that means, as well as the difference between equity and equality?
Within CMS OMH, our vision is to have all CMS beneficiaries achieve their highest level of health, which is the definition of health equity. That means instead of giving everyone the same thing, we give people what they need, which may differ from one person to the next.
Q: How is the OMH addressing disparities in health care for rural communities? What’s different about closing those gaps in care compared to disparities in urban areas?
While CMS OMH’s vision encompasses all CMS beneficiaries, our office has four priority populations, which includes individuals living in underserved areas such as rural communities. Rural communities often have worse health outcomes and less access to care, and tend to be less diverse than their urban counterparts. It is also worth noting that not all rural communities are the same, nor are the challenges they face. To date, much of the research on rural health disparities focuses on disparities between rural and urban communities, with fewer studies examining disparities within rural communities. In our work, we focus not only on urban–rural differences, but also on racial and ethnic disparities within rural communities.
I serve as one of the co-chairs to the CMS Rural Health Council. This council is working to resolve some rural-specific issues, develop a better understanding of the impact of CMS policies on rural providers and beneficiaries, and support implementation of the CMS Rural Health Strategy. The recently released strategy will promote policies that make health care in rural America accessible, affordable, accountable and—ultimately—more equitable.
Q: What new tools and resources are available for QIN-QIOs and other health care stakeholders who want to help address health disparities?
Over the past year, we have developed a number of new resources. As part of our work around chronic care management, we created resources for both patients and providers. We also added several new pieces to our From Coverage to Care initiative, including A Roadmap to Behavioral Health—a guide on how to use mental health and substance use disorder services.
We expanded our Building an Organizational Response to Health Disparities portfolio as well to include A Guide to Developing a Language Access Plan and Providing Language Services to Diverse Populations: Lessons from the Field. In addition, recognizing that all organizations are at different points in their health equity journey, we launched our Health Equity Technical Assistance program that provides individualized technical assistance to organizations seeking to eliminate health disparities.
These resources are available on the CMS OMH website.
Q: Tell us about your experience presenting the first-ever Health Equity Awards at the 2018 CMS Quality Conference. When will the next awards program be announced?
We were very excited to have health equity featured so prominently at this year’s CMS Quality Conference. In addition to having health equity highlighted throughout the conference sessions, we were able to present our inaugural Health Equity Awards. Our goal was to identify awardees who were able to demonstrate, with data, that they were reducing disparities between two groups.
We received a number of applications for this award, and we had a panel of individuals from across the agency rigorously review each one. We had not initially planned to have two awardees, but as we narrowed our selection, we saw the opportunity to acknowledge an organization that has been doing this work for a long time, as well as an organization that had made remarkable strides in short order. In terms of our next awards program, this is definitely something we want to maintain and continue, but we do not have a specific time frame right now, so I will just say: stay tuned!
Q: Is there anything else you’d like QIO News readers to know?
We would like everyone to know that we are here to help them on their health equity journey, and they can contact us via our health equity technical assistance email address healthequityTA@cms.hhs.gov. As we saw from our health equity awards, progress is possible, but we need to be intentional about our focus and make sure we mind the “gap.”