As a health equity practitioner, I have spent my career studying and attempting to address the impacts of historical and contemporary systemic discrimination on health outcomes. Yet as I author this piece, the evidence remains overwhelming: health disparities continue to exist and persist amongst Black, Brown, LGBTQIA+, persons with disabilities and other populations that have been socially excluded or faced injustices. They persist within the scope of years of trending evidence, the “awakening” to the realities of health disparities during the COVID-19 pandemic, and even with organizational investment into health equity. They persist.
There are many ways that we describe health care disparities and that begs the question about whether we have made the issue appear too complex, losing sight in the process of the fact this is about people deserving equitable access to quality health care that they can trust. Take, for example, how we often refer to health disparities in different ways, such as the differences between groups as measured by insurance, the levels of access and use of care, and inequity in quality-of-care outcomes. All descriptions are salient, and all drive to the same point: your identity can determine where, how, and what type of care you receive. In other words, we can lose sight of the people as we discuss how to deliver health care and make significant changes when we know it is not working as it should.
High-Value, Equitable Care
The primary purpose of the High-Value, Equitable Care Research Agenda is to generate evidence-based, community driven research that promotes a redesign of our health care system that delivers equity and value to those it serves. This agenda was developed collaboratively: it was inclusive of those that represented community, patient, provider, payor, and system level voices.
The agenda recognizes that high-value, equitable care can only be accomplished 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.
Moreover, the primary and secondary drivers of the agenda detail the crucial nature of system transformation by further defining whole person care, accessibility, a care home, capacity, and accountability.
Key Considerations to Drive Successful Implementation of the Agenda
Before embarking on the adoption of the agenda, it is imperative that the health research community recognize the collective reality of where we are starting. One of the main barriers in advancing a high-value equity strategy is the very nature of inequities. We have inequities not because of one action or actor; they are the culmination of historical and contemporary barriers existing not just within health care but outside of its walls. This means that the health research community must go beyond just the aims of what the health care system can control and create a bigger tent to include improvements in all areas that impact health.
This is not meant to be dissuasive. Rather, it is a tactical reminder. We must move beyond mere adoption of the standing principles and include a focus on measurement, transparency, community engagement, and learning through Plan, Do, Study, Act (PDSA) cycles to drive success.
To reinforce the aim of the agenda, it is important that the above activities are adopted, alongside the following considerations:
- Clear Definitions that Result in Measurable Action: Terms like ‘value’, ‘accountability’, ‘quality’ and ‘incentives’ are not clear enough. It is critical that these terms are defined, measured and reinforced through shared goals, shared vision and tangible steps. The outputs of successes, gaps and failures must also be widely disseminated, so that true learning and improvement can occur.
- Patient and Community Voice: Structured, empowered, reciprocal and continued community and patient feedback will be critical to reinforce high-value and equitable care. It is only the patients that can measure progress of the aim. When adding diverse voices to this paradigm, remember that “identity” is not a one-size fits all concept. There is diversity within communities, cultures, and perceptions. It is important to seek dissenters as well as champions.
- Think Differently and Broaden the Tent: Health care must stop treating certain issues as though they are outside its walls. Many elements, including the social determinants of health, health-care policies (broader public policy as well as health system policies), and engrained structures that impact health are all a part of the health care ecosystem.
The High-Value, Equitable Care agenda promotes the progress needed to create quality health care for all. Collaboration, shared definitions, transparency, and accountability structures will allow for changes in research and interventions that are sustainable, scalable, and integrated across various levels of care. Without this commitment and investment, we will continue to operate in a health care system that leaves too many people behind when it comes to quality care, making them more vulnerable to health disparities.
As required by ACFC Social Media Use Policy (115-604): "The views expressed on this post are mine and do not necessarily reflect the views of AmeriHealth Caritas."
Read the previous blogs in this series: first, second, third, and fourth.