Roadmap to reduce disparities needed in value-based care
- Current value-based payment programs fail to consider health equity, leading to little if any reduction in disparities and, in some cases, potentially exacerbating them, a new Health Affairs analysis finds.
- To address this problem, the National Quality Forum developed a four-pronged roadmap to show how performance measures and associated policies can help eliminate disparities and ensure equal care regardless of race, ethnicity or socioeconomic class.
- To illustrate the roadmap, the authors look at how performance measures and value-based payment can help reduce racial disparities in hypertension in African Americans.
Value-based programs are intended to improve quality and outcomes while reducing healthcare costs, but the impact on health disparities gets less attention.
A recent study in the Annals of Internal Medicine found at least one program — Value-Based Payment Modifier (VM) — had little impact on performance measures and could add to healthcare disparities without improving performance if risk-adjustment formulas and incentives are inadequate.
The NQF roadmap has four key components: identifying and prioritizing targets for narrowing heath disparities; implementing evidence-based interventions, investing in development and use of health equity performance measures and rewarding efforts to close the health equity gap.
The authors chose hypertension because African Americans suffer stroke and heart failure at two times the rate of non-Hispanic whites, and standardized measures for hypertension are already used in many payment programs.
Under the roadmap, interventions aimed at reducing disparities in hypertension could be applied anywhere from the patient-family or provider level all the way up to the policy level, the authors note. Programs like the Merit-based Incentive Payments System could incentivize healthcare organizations to implement quality improvement activities that promote health equity.
For example, an organization could measure health equity by the extent it reaches out to its African American population or its financial investment in community groups that focus on healthy behaviors.
The roadmap also recommends tying such performance measures to payment incentives and financial supports.
“Creation of a stronger business case for equity can encourage the leadership of health care organizations to prioritize equity and invest in the data infrastructure necessary for stratifying performance measures,” the authors write. “Ultimately, leaders must truly value reducing health disparities and encourage the payment and care delivery reforms necessary to incentivize, support, and sustain health equity efforts.”