Over the course of two and half years, with funding from The Donaghue Foundation, we had the opportunity to co-chair a uniquely collaborative effort to develop a research agenda to advance high-value, equitable health care. We were able to share this work at AcademyHealth’s 2024 Annual Research Meeting on a panel that also discussed the National Academies of Science, Engineering, and Medicine (NASEM) report titled Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All and the Health Services Research special issue on Achieving Healthcare Equity in the United States sponsored by the Agency for Healthcare Research and Quality
We began by creating a framework for the research agenda that included a definition of high-value, equitable care and a driver diagram delineating the primary and secondary drivers essential for its achievement. The definition and drivers subsequently guided a broader stakeholder process to develop the research agenda for high-value, equitable care.
Our goal in developing the definition and drivers was to inform a specific set of research questions aimed at identifying what new evidence was necessary to guide decision-making within health systems, as well as the actions of stakeholders who influence the behavior of these systems, such as federal and state policymakers, regulators, health plans, and employers. We found an overlap among the drivers, and many research questions that could be categorized into more than one driver.
We describe this effort as uniquely collaborative for several reasons, starting with our different perspectives and positions within the health care research ecosystem. As a patient advocate and advisor on patient and community engagement (Donna Cryer) and an expert health system researcher (Beth McGlynn), we co-led the initiative’s consensus group which also spanned a wide range of perspectives from policy and research to patients and community to health systems and health plans.
Over the course of several virtual meetings and interim exchanges, we collectively engaged in thoughtful discussions and debates with over 50 stakeholders from various disciplines to ensure the clarity and relevance of our work. It was an enriching experience to collaborate with such a diverse group of experts, each bringing their unique perspectives and insights to the table.
The process took place completely virtually, which meant increased accessibility and easy solicitation of input, idea generation, and prioritization, and involved vulnerable, candid conversations about what health care could and should mean, to whom, for whom, and the ways we can create and measure accountability.
Highlighted below are the definition and primary drivers that emerged. To review the comprehensive research agenda, secondary drivers, and other steps in our process, please see the summary brief.
Definition: High-value, equitable care exists when diverse individuals’ needs and preferences for health care are met in ways that:
- are timely and easily accessible to all and support equal opportunities for health;
- are respectful, collaborative, culturally responsive, and provided without bias or discrimination;
- increase the likelihood of achieving optimal health outcomes for all;
- are affordable for all individuals and society; and
- are supported by evidence.
Five primary drivers for achieving high-value, equitable care:
- A Fair and Just Culture of Whole-Person Health for All
The health care system is aligned to provide holistic care that address patients’ overall health and wellbeing.
- Care That is Accessible to All Patients
All patients are able to receive the care they need.
- Health System Centered Around Primary Care
Primary care serves a key role in providing continuous and coordinated care within the broader health system.
- Adequate Health System Capacity to Deliver Care
Health care organizations have appropriate policies, technologies, staffing and other resources to support patient needs.
- Health System Accountability for Outcomes
Health care organizations are held accountable by policies, payers, communities and patients for health outcomes.
This collective endeavor focused on the intersection of value and equity in health care and the kind of evidence necessary to make progress, moving from describing the problem to more of a focus on testing interventions and scaling effective strategies. We considered the scope in which different aspects of the health system could act, and how to hold actors within those spheres of influence accountable through new risk adjustment approaches that drive value and equity, aligned performance measures, public reporting on progress, and diversified governance of health care systems to include patient and community representatives.
We also observed a recurring theme: the necessity, as well as the challenge, of harmonizing complex systems and entities to pursue a comprehensive approach to achieving better health outcomes for all. As we move forward with AcademyHealth's efforts to disseminate and promote the research agenda, it will be crucial to coordinate our endeavors with similar initiatives aimed at addressing health inequities through collaboration across sectors and disciplines.
We look forward to sharing the agenda more broadly and continuing this journey towards a more inclusive and effective health care system, providing greater clarity for the research community to engage with these questions.