You Can’t Provide Value Without Providing Equity
More than 1,250 people attended the University of Michigan’s Center for Value-Based Insurance Design 2022 Summit last month, where stakeholders from across the country discussed the opportunities and challenges to reducing health care disparities.
During the keynote panel, “Strategies to Reduce Health Care Disparities and Enhance Equity,” Dora Hughes, Chief Medical Officer at the CMS Innovation Center at the Centers for Medicare and Medicaid Services said that pre-pandemic, there were narrowing difference in life expectancies and reductions in disparities, but “the pandemic reversed progress in a number of key ways.” In particular, she said, the pandemic showed there was significant inequity in “who got sick and how well they survived.” Hughes said the CMS Innovation Center recently launched a new health equity initiative that is the subject of a recent Health Affairs article. Equity is also an important component of the CMS Innovation Center’s 2030 vision.
Co-panelist Laurie Zephyrin, Vice President Health System Equity at The Commonwealth Fund elaborated on the issue of equity. In her opinion, COVID “provided insight as to how deep the problems are that we need to solve. We can’t wait. While we wait, people are losing their lives.” The Commonwealth Fund’s recent state-by-state scorecard of racial and ethnic disparities shows that, “health equity doesn’t exist in any state in the US,” according to Zephyrin.
In a recent video, Zephyrin acknowledged that fixing racial inequities is “daunting,” but there are “so many ways we can shape health, including how people pay for health care, how people access health care, and really thinking about how ensuring the health care system provides equitable, quality care.” Zephyrin emphasized the value of data in making a more equitable health care system. “What we measure is what we value and the reality is we can’t improve health care if we aren’t accurately measuring and tracking these inequitable experiences, inequitable treatment, or inequitable outcomes.”
The importance of data was also a topic in the session on “Progress in Measuring and Reducing Low-Value Care” with panelists Washington Health Alliance Executive Director Nancy Giunto, Dr. Rita Redberg from University of California, San Francisco and Editor in Chief of JAMA Internal Medicine, and Erica Socker, Vice President of Health Care, Payor Reform at Arnold Ventures. When asked about current innovations that are using data to improve health care quality, Giunto described the Allliance’s current Low-Back Pain Implementation Collaborative with 29 multi-stakeholder participants working to improve the value of care for all patients with low-back pain in Washington state, supported by Arnold Ventures’ Provider Payment Incentives portfolio.
While important, data isn’t the only factor, according to Giunto. “We pride ourselves on the data, but it’s really about engaging folks in the conversation. We are bringing together health plan leaders, purchasing leaders, providers, and specialists in Washington who know back pain care and the challenges, and we are talking candidly about what’s not working.” Giunto continued, “You have to set the table well and invite the conversation and disallow entrenchment in individual silos so people are working together.”
When it comes to people getting low-value care, Socker acknowledged that an initial test may not be costly, but “the care cascade that happens as a result starts to look pretty large.” Socker says Arnold Ventures is working on a number of initiatives to reduce low-value care, including research, policy development, technical assistance, and increasing adoption of Accountable Care Organizations. In addition, Arnold is looking at high cost specialty areas to enact reforms, such as orthopedics and spinal fusion. One area that has high cost technology is cardiology, Redberg’s specialty. “A lot of what we waste money on is technology and medical devices.” To address that, Redberg is currently working on a project supported by Arnold Ventures to reduce low-value care, “once you identify it, you can work to change the system.”