The National Quality Forum (NQF) has issued a Roadmap for Promoting Health Equity and Eliminating Disparities. Despite overall improvements in public health and medicine, disparities in health and healthcare persist. Disparities are differences caused by inequities that are linked to social, economic, and/or environmental disadvantages. Achieving health equity requires eliminating disparities in health outcomes by addressing social risk factors that adversely affect excluded or marginalized groups.
Performance measurement is an essential tool for monitoring health disparities and assessing the level to which interventions known to reduce disparities are employed. Measures can help to pinpoint where people with social risk factors do not receive the care they need or receive care that is lower quality. The NQF roadmap lays out four actions, “Four I’s for Health Equity,” to promote health equity and reduce disparities:
- Identify and prioritize reducing health disparities
- Implement evidence-based interventions to reduce disparities
- Invest in the development and use of health equity performance measures
- Incentivize the reduction of health disparities and achievement of health equity
The report describes five domains of health equity performance measures that could be developed and used:
- Adopt and Implement a Culture of Equity. A culture of equity recognizes and prioritizes the elimination of disparities through genuine respect, fairness, cultural competency, the creation of environments where all individuals, particularly those from diverse and/or stigmatized backgrounds, feel safe in addressing difficult topics, e.g., racism, and advocating for public and private policies that advance equity.
- Create Structures that Support a Culture of Equity. These structures include policies and procedures that institutionalize values that promote health equity, commit adequate resources for the reduction of disparities, and enact systematic collection of data to monitor and provide transparency and accountability about the outcomes of individuals with social risk factors. These structures also include continuous learning systems that routinely assess and the needs of individuals with social risk factors, develop culturally tailored interventions to reduce disparities, and evaluate their impact.
- Ensure Equitable Access to Healthcare. Equitable access means that individuals with social risk factors are able to easily get care. It also means care is affordable, convenient, and able to meet the needs of individuals with social risk factors.
- Ensure High-Quality Care within systems that continuously reduces disparities. Performance measures should be routinely stratified to identify disparities in care. In addition, performance measures should be used to create accountability for reducing, and ultimately, eliminating disparities through effective interventions.
- Collaborate and Partner with other organizations or agencies that influence the health of individuals (e.g., neighborhoods, transportation, housing, education, etc.). Collaboration is necessary to address social determinants of health that are not amenable to what doctors, hospitals, and other healthcare providers are trained and licensed to do.
Finally, the report makes the following recommendations:
- Collect social risk factor data.
2. Use and prioritize stratified health equity outcome measures.
3. Prioritize measures in the domains of Equitable Access and Equitable High-Quality Care for accountability purposes.
4. Invest in preventive and primary care for patients with social risk factors.
5. Redesign payment models to support health equity.
6. Link health equity measures to accreditation programs.
7. Support outpatient and inpatient services with additional payment for patients with social risk factors.
8. Ensure organizations disproportionately serving individuals with social risk can compete in value-based purchasing programs.
9. Fund care delivery and payment reform demonstration projects to reduce disparities.
10. Assess economic impact of disparities from multiple perspectives.
The report was funded by the Centers for Medicare and Medicaid Services Office of Minority Health.
NQF also has produced an executive summary of the full report:
NQF also announced a Health Equity Program that will 1) identify disparities and those affected by health inequity, 2) influence performance measurement to promote health equity and reduce disparities, 3) inspire implementation of best practices through innovative approaches, and 4) inform payment, including risk adjustment, stratification, and payment reform:
NQF has received funding from the Aetna Foundation to develop an approach for addressing the social determinants of health, and from The Urban Institute to develop a measurement framework for food insecurity and housing instability, and is seeking additional funding for the Health Equity Program.
NQF’s Standing Committee on Health Equity will continue to meet and provide guidance on the Health Equity Program and related activities.
Ignatius Bau 