Efforts to improve the overall quality of healthcare have done little to reduce disparities in access to care. But the National Quality Forum has developed a plan to target equity more explicitly in performance-based payment systems.
A research article published in Health Affairs notes that, until recently, the quality metrics employed by major payment programs, including the Centers for Medicare & Medicaid’s Merit-Based Incentive Payment System, have not measured equity when evaluating providers’ performance. “Decades of experience have demonstrated that a general ‘rising tide lifts all boats’ philosophy of quality improvement will not eliminate disparities,” write lead author, Andrew C. Anderson,a RWJF health policy research scholar at the University of Maryland, College Park, and a senior director at the NQF in the District of Columbia, and his coauthors.
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Building on that logical foundation, the NQF sees a need to create stronger incentives to reduce disparities in care. The group recommends tying equity-related performance measures to the bottom line via a four-step road map:
- Identify disparities and sort them by priority. To make the most efficient use of resources, the authors recommend prioritizing opportunities where existing interventions can move the needle relatively quickly by targeting large disparities and relatively simple implementations.
- Rely on evidence-based interventions. The lack of progress on reducing disparities does not mean proven interventions do not exist. The road map encourages policymakers to look across all levels of health systems to see where interventions have the best chance to improve outcomes.
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- Develop better performance measures for healthcare equity. In addition to identifying new disparities, the article points out that performance measurement also has value in the establishment of best practices. That means investment in partnerships and collaborations both inside and outside of traditional healthcare practices in order to ferret out the causes of disparities in incidence and treatment, and then to ensure the effectiveness of coordinated efforts to reduce those disparities.
- Provide incentives for providers that reduce healthcare disparities. Value-based payment models provide an immediate opportunity to use equity as a quality endpoint. The authors point out that such incentives could also lead providers to develop new interventions.