In a recent blog we shared reflections on our health equity journey and identified health system transformation (HST) as the next frontier of health care advocacy. Promoting health equity is an organizational priority at Community Catalyst and one of the fundamental pillars of our HST policy agenda outlined in our initial blog post in this series. While we believe a health equity lens must be a part of all of our work, bringing that focus to HST deserves special attention because of both the opportunity and the risk. On the one hand, changing how we finance and deliver care creates a golden opportunity to tackle disparities in health care and health. On the other hand, if those efforts don’t focus on addressing health equity, health disparities are likely to persist or widen as system reform unfolds.  

When we use the term “health equity,” we’re speaking of a society in which everyone has a fair opportunity to achieve their full health potential. Advocates need to be particularly sensitive to potential harms to people with greater — or different — health care needs as some new policies may have differential impacts on different populations. For instance, some policies may lower costs for some while raising them for others, or they may have a negative health impact on some but not on others. In our work to promote health equity, Community Catalyst is exploring the following areas:

1. Risk-Adjustment

As providers are increasingly placed at risk for the cost of care, risk-adjustment becomes critical to ensure that there is not an incentive to avoid or under-treat sicker or harder to treat populations. While the need to adjust payment based on clinical factors is widely accepted, we have begun looking into risk-adjustment based on population health measures such as socioeconomic status (SES) that also address non-clinical factors that impact cost and health outcomes. People in lower socioeconomic brackets tend to face greater challenges maintaining their health and are more likely to require expensive interventions or have adverse outcomes. Without SES risk-adjustment, providers who serve lower SES patients have a significant amount of unaccounted risk and fewer resources to provide care because of unfairly designed incentive payments. Conversely, providers giving an identical level of care to higher SES patients will show better results and receive an unfair advantage in payments.

2. Health Data Collection

Health data collection policies that do not stratify data by race, ethnicity, primary language, and gender identity and sexual orientation lack the detail and information providers, patients, advocates and the public need to understand and address health disparities. Inadequate health data can mask unique patient and population needs and undermine effective interventions. Consumer advocates, such as the Data Equity Legislative Coalition in Oregon, are building support for strategies that improve data collection policies, and Community Catalyst is working to collect and share those strategies with advocates and policymakers across the country

3. Community-Based Providers

As the health system evolves to serve individuals with a variety of physical, behavioral, social and economic needs, we need to ensure that the health care workforce is also evolving to ensure that individuals receive appropriate, culturally competent care. We believe that expanding the role of Community Health Workers  within multidisciplinary care teams and as part of population health interventions can facilitate the effective provision of services and make quality health more accessible and equitable. 

4. Cultural Competence and Implicit Bias

Community Catalyst is examining proactive approaches at the policy, delivery system and individual levels for improving cultural competence and reducing implicit bias in health care delivery. Community Catalyst has been promoting networks with culturally and linguistically competent providers and urging emerging alternative payment models to ensure that individuals are guaranteed a choice of providers who speak and understand their culture and language. In recent years, substantial attention has been paid to the possibility that implicit bias among health professionals contributes to health disparities. Community Catalyst is exploring the role implicit bias plays in perpetuating health disparities in treatment outcomes and opportunities to incorporate quality metrics that can assess implicit bias in health care and create incentives and support systems to reward providers who undergo implicit bias trainings.

5. Population Health

We identified poor population health as a principle driver of poor value in our health care system. In an effort to address this driver, population health is prioritized in our HST agenda, and we are working to promote programs and policies that aim to redirect resources to address major population health determinants beyond the delivery of medical care, such as education, the built environment and housing.

As we move forward in this new era of health care reform, these health equity priorities are meant to guide consumers and their advocates towards a path that will transform how we pay for and deliver care to the most vulnerable populations. In the coming week and months, we will drill down on each of the areas highlighted above and examine the best ways to achieve the promise of better care, better value and better health.