Bottom line, chosen from the paper
The health care industry cannot ignore true instances of poor quality, but it also should not worsen health care for at-risk populations. To address this tension, value-based payment models should adopt a disparities-sensitive frame shift to integrate measures of equity into hospitals’ financial calculus, incentivizing hospitals to tackle the disparities challenge without losing sight of quality. Achieving this frame shift requires us to continue determining which metrics matter most when addressing disparities in health care delivery and outcomes, both to improve risk adjustment and to establish which measures are actionable. To avoid underpaying hospitals that disproportionately serve socially at-risk patients, we should assess how risk adjustments would perform if they accounted for factors like socioeconomic position, social relationships, and community context, which the National Academy of Medicine has identified as key domains affecting health care outcomes.(1)
(1)National Academies of Sciences, Engineering, and Medicine. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: National Academies Pr; 2016.
Implications for value improvement
Inequity lowers value
The term value has significantly different meanings in the USA and in countries committed to universal health coverage. In 2008 an influential article was published from Harvard Business School with the key definition given below:
“Value in any field must be defined around the customer, not the supplier… the proper objective is the value of health care delivery, or the patient health outcomes relative to the total cost (inputs) of attaining those outcomes.”