Payers have spent a decade transitioning toward value-based care plans in an effort to improve outcomes and costs for members. But plans that advance quality over quantity have done little to address health inequities, according to Josh Liao, MD, an associate professor of medicine at the University of Washington in Seattle.
Dr. Liao spoke at the National Committee for Quality Assurance's Quality Talks conference April 21. He discussed how health disparities have become "unintended consequences" during the move to value-based care and an issue that should be addressed before payment changes are made, not after. The challenge, according to Dr. Liao, is that value-based payment models don't necessarily account for social determinants of health, leading to worse outcomes for marginalized populations.
"If you look at the official definition, that widely accepted idea of value, you won't find a direct consideration of equity in it. So we're left with that opportunity to reexamine that issue," Dr. Liao said. "The good news is that I think that progress is possible."
Five recommended steps to better align value-based care with health equity:
1. Set an explicit intention to prioritize equity in value-based payments.
Intention should always precede implementation when it comes to value, quality and population health. A clear output of your new payment model from the start should be equity.
2. Make sure the right voices are part of the discussion.
When developing value-based care models, payers should determine the local problems and solutions. Patients, caregivers, community organizations, payers, providers, clinicians and purchasers should all be included in the process through coalitions and committees.
3. Incorporate equity into the definition of value.
The definition of value should include equity. Improvements in care cannot come at the expense of disadvantaged groups.
4. Set bold, longitudinal goals.
It's one thing to prioritize equity, but setting concrete goals is better.
"Going back nearly a decade ago, when policymakers were first grappling with how do we move payment from volume-based to value-based payment, they set those goals. They said by this year, we want our goal (which is bold in my opinion) to set this much — this percentage of payments tied to value- and quality-based payments. And in this year we'd like this much, and in this year we'd like this much. I believe that in our different ways and in our different organizations, we can do that with equity," Dr. Liao said.
5. Collect better data and conduct better evaluations.
The healthcare system needs to collect better equity data and design better measures that can find the gaps in outcomes. Advancing health equity should also be paired with better evaluations of new payment models and how they affect disparities, and then refined.