Shift to value-based care could leave some patient groups behind

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Delivery reform policies may not account for the health needs of people of color or low-income populations, according to a new report. (CC BY 2.0 by jonrawlinson)

The healthcare industry's shift to value-based care may be leaving some patients behind.

But a task force from Families USA is offering a framework that could ensure patients of color and other underserved populations get a seat at the table in the process.

Sinsi Hernández-Cancio, director of health equity for Families USA and the report's lead author, told FierceHealthcare providers and other stakeholders put a lot of focus on individual patient engagement.  But they struggle to reach out to communities. 


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"Healthcare systems have to get a lot better at identifying and supporting the leaders that already exist in these communities," she said. "We're talking about ensuring that leaders who actually represent and understand these communities are part of the full range of decision-making processes." 

RELATED: Study of Cincinnati hospital finds new reason health systems should be concerned about economic disparities 

The report points to focus areas such as the importance of using quality measurements that promote equity and cultivating a more diverse workforce to help address disparities. 

Hernández-Cancio said that using these focus areas to drive policymaking can ensure delivery-system transformation "centers on the achievement of health equity" and addresses "the multiple barriers to good health and high-quality healthcare" faced by minority communities. 

RELATED: 4 ways hospitals can improve health equity 

 The report also dives into some current programs and analyzes how effectively they address disparities and inequities. 

For example, the Centers for Medicare & Medicaid Services' Hospital Readmission Reduction Program could end up harming safety-net and community providers that treat patients with high unmet social needs. Hernández-Cancio said many of these providers are already struggling financially, and readmission penalties from CMS could exacerbate those problems. 

"One of the things that some of us in the equity world are very concerned about is the great potential for this actually backfiring on some of the communities that are struggling the most," she said. 

However, there are promising programs at the state and local levels. Covered California, the state's Affordable Care Act exchange, requires plans to aggregate data based on gender, race and ethnicity, and Coordinated Care Organizations in Oregon are required to undergo cultural competency training and build plans to address inequities and disparities. 

RELATED: Racial disparities in early deaths among black adults narrowing compared to whites in U.S., study finds 

Hernández-Cancio said there are some uniting factors among the programs the report reviewed positively. Providers trying these projects are more willing to "look beyond the four walls of the hospital or clinic" both in engagement and in investment, she said, and have made addressing the social determinants of health a central priority. 

As the demographics of the country continue to evolve, it will be increasingly crucial to address the unmet needs of people of color and of other underserved groups, Hernández-Cancio said. 

"Ensuring that our healthcare system is able to provide high-quality and affordable care to everyone in the country is not just the right thing to do, but it's also the smart thing to do," she said. "Given how this country has been changing and who our future workforce is, we need to make sure that people of all backgrounds are able to live up to their full potential in order to ensure our nation's prosperity in the future." 

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