In addition to identifying many helpful strategies to reduce disparities, Finding Answers has also highlighted questions about equity for future study. This is particularly relevant as the financial and political structure of the US healthcare system continues to evolve. Questions to consider include:
- Who needs to change? Providers, care teams, and organizations must shoulder more of the burden to elevate the standard of care delivery. Disparities researchers have predominantly focused on the patient as the target for change. Although this work is critical, it is not sufficient.
- What about understudied minority populations? More work should be done in researching disparities in understudied populations such as American Indian and Asian-American subgroups; pediatric and geriatric ethnic subgroups; and lesbian, gay, bisexual, and transgender populations. Adult African-American and Latino populations have been the focus of most disparities intervention research.
- What are the best methods to implement these interventions? Single-strategy interventions are becoming rare since they generally are less effective than multi-strategy changes. Therefore, multi-strategy interventions should be studied further to determine exactly which components provide the most value. Interventions are more effective when they are tailored to the target populations and organizations and tried across a variety of patient populations and settings.
- How can health care organizations and communities best integrate their efforts to reduce disparities? Health care is often a person’s point of entry to support services, yet few people have been trained to integrate the community and the health care system, and thus these two have remained largely separate worlds. However, many Finding Answers projects or demonstrated ways to achieve integration. Twenty-five percent proposed CHWs, and several others proposed unique ways to leverage the strength of social networks via community-based organizations or churches.
“I see a whole new set of questions about what will reduce disparities in this new health care environment where there are stronger financial incentives for improving care for populations of patients and for integrating what happens in the health care system with what happens in the community.”
– Marshall Chin, Principal Investigator, Finding Answers
- How do cost and payment relate to equitable care? As the Affordable Care Act encourages innovation in health care delivery and the marketplace demands value in health care, our healthcare system is primed for research to determine: 1) interventions that are cost-effective and financially feasible, and 2) whether payment schemes can be designed to improve equity and address social drivers of disparities. Additionally, experiments in payment reform and new organizational structures (like Accountable Care Organizations) increase quality and value and should evaluate their impact on racial and ethnic disparities because equity issues have not been a prime consideration for their design, implementation or evaluation.
- Three pilots of a new Finding Answers program, run out of George Mason University, the Icahn School of Medicine, and the University of Washington, have started to explore these questions through demonstration projects that focus on equity within the context of new and emerging payment models. Their projects will inform payers, health care organizations, and providers about new practices for developing and implementing disparities interventions in the context of innovative payment models.
- Potential for Success: Care, Pay Changes Linked to Cutting Disparities explores whether innovative payment models may be the solution to reducing health care disparities.