As efforts continue to remedy the failures of our health care system by changing how providers are paid and care delivery is organized, it is imperative that achieving health equity be included in the equation. Unfortunately, health system transformation efforts have largely ignored one of our health care system’s most fundamentally wasteful and unfair problems: persistent racial, ethnic, and geographic health and health care inequities. So instead of leveraging the opportunity of health system transformation to accelerate achieving health equity and better health and health care for all, unintended consequences could actually be making inequities worse.
Recently, Families USA, in collaboration with the Health Equity Task Force for Delivery and Payment Transformation published The Framework for Advancing Health Equity and Value: Policy Options for Reducing Health Inequities by Transforming Healthcare Delivery and Payment Systems. In this paper, we identified six critical domains for action to achieve a high functioning, efficient, high quality, and equitable health care system. One of them was the need to provide additional financial and technical support to enable safety net and small community providers to get up to speed and engage successfully in health system transformation efforts. These providers, who often have a long history of providing culturally centered care to underserved communities in their own language, and are deeply trusted by their patients, are likely to face significant barriers to participate in new payment models and achieve the metrics required to remain financially sustainable. This is an example of how system transformation efforts could end up actually worsening access and quality for communities of color, rural communities, and other underserved groups.
In this report, we focus on what states can do through their Medicaid programs to support these critical providers so that they can eventually succeed in a value-based payment health care world.