Sustainable Health Equity Only Possible Through Evidence-Based Approaches, According to Study

Health equity can only be achieved when leaders and policy makers are passionate about reducing health disparities and adamantly encourage care delivery reforms that incentivize and support health equity efforts, according to a study in Health Affairs.

Current healthcare payment and quality programs, such as the Hospital Value-Based Purchasing Program and the Merit-based Incentive Payment System, do not evaluate equal access to care, which can derail the program’s mission to include minorities in their funding. In addition, these programs are designed to target the general American population, disregarding the barriers of health that specific communities face. Some payment initiatives, like the Massachusetts Medicaid program, attempt to use financial incentives to decrease disparities, however, this failed due to the lack of ethnic diversity in the health system.

The National Quality Forum (NQF) organized a multi-stakeholder group to develop a road map to navigate around barriers of health to create the most accessible healthcare possible. NQF experts included 4 elements necessary to achieve health equity: identify and prioritize areas to reduce health disparities; implement evidence-based interventions to reduce disparities; invest in the development and use of health equity performance measures; and incentivize the reduction of health disparities and achievement of health equity. The article used hypertension as an example condition that causes morbidity and premature mortality affecting a large population of African Americans to display the 4 elements in action.

The first step in reducing disparities is to identify the disparities at large. Organizations, insurers, and policy makers must prioritize reducing the identified disparities to implement future policies. Regarding hypertension, one must research the prevalence of the condition, the size of the disparity, the strength of the evidence for reduction strategies, and the feasibility of improvement. More than 40% of African Americans have high blood pressure, hypertension, or both, and they are twice as likely to develop stroke or heart failure, according to the American Heart Association. In the past, hypertension was able to be controlled among 81% of African American patients at the Philadelphia Veterans Affairs Medical Center through monthly counseling and drug changes.

The second action would be to adopt the model used by the healthcare providers in Philadelphia, and then modify it again to better fit the needs of the specific population being addressed. Other organizations like Morehouse School of Medicine and Health & Technology Vector Inc created similar programs that incorporated healthy eating, daily exercise, and managing blood pressure. Stakeholders of the program must continue to invest and collaborate among each other, create a culture of equity, create structures that enable equity, measure the affordability of medication, while ensuring the highest quality care.

Throughout this model of reducing disparities, stakeholders may need to develop new incentives to sustain the improvement of health equity. These can include rewards for improving outcomes or attaining absolute thresholds of performance. This evidence-based approach is the only effective way to decrease barriers of health.

“As demonstrated in the hypertension example, this 4-part strategy can and should be part of our quality efforts,” the authors concluded. “Equity will not be achieved unless it is woven into the fabric of quality and payment in our health care system.”

References

Anderson AC, O'Rourke E, Chin MH, Ponce NA, Bernheim, SM, Burstin H. Promoting health equity and eliminating disparities through performance measurement and payment [published online March 5, 2018]. Health Aff (Millwood). 2018;37(3). doi: 10.1377/hlthaff.2017.1301