"We tested whether new payment mechanisms could be harnessed in health care delivery reform to reduce health and health care disparities. Here’s what we found."

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The Merck Foundation recently launched Bridging the Gap, a pioneering effort to address the social and medical causes of disparities in diabetes care in eight underserved communities across the United States. Its stakeholders are particularly interested in developing sustainable models that address the medical and social needs of vulnerable populations.  

Fostering a culture of equity across the entire Health and Human Services System is not just a lofty strategic goal for Fairfax County, Virginia. It is also something the Community Health Care Network (CHCN) has been actively working to achieve for many years. In the 1980s, the Fairfax County Board of Supervisors became concerned about the difficulties encountered by the County’s low-income and uninsured residents in obtaining health care, and financed a study of the issue.

Today the National Quality Forum (NQF) published an important report entitled A Roadmap for Promoting Health Equity and Eliminating Disparities: The Four I’s for Health Equity. NQF is a not-for-profit, nonpartisan organization comprised of diverse public and private stakeholders who use performance measurement to drive quality improvement.

What do you get when you invite 15 to 20 diverse patients over to dinner to talk about their health care in their native language? Pure magic!

Dentistry, a cottage industry long after changes in medical care delivery systems, is in the throes of consolidation. In the midst of this change is Oregon’s largest provider of Medicaid dental services by clients enrolled. Advantage Dental Services cares for 325,000 Oregon citizens—primarily children and adults in the rural Oregon Health Plan (Medicaid). In business since 1995, Advantage employs 300 general practitioners and specialists in more than 250 individual practices and 41 Advantage-owned clinics across 34 counties.

People who work in safety net clinics deserve an extra dose of respect, for we all know they could earn more money applying their skills in less challenging environments. In Fairfax County, Virginia, these challenges include a low-income uninsured population that speaks 55 languages. 

As a dental hygienist, I used to work in a clinic, helping treat dental disease and educate patients about their oral health. I enjoyed it, but I knew I was only seeing a fraction of the population. Where I work, in rural Oregon, many mothers, children, and pregnant women just don’t get to the dentist until they have developed serious dental problems that damage their overall health. Now, however, we don't wait for those patients to come to us—we go out and find them.

The trend toward value-based care is accelerating, and is more urgent as the climbing costs of care threaten gains in health coverage. As the field is moving toward new ways of paying for value, attention to health care disparities is sorely lacking. Not for lack of need — since the publication of the Institute of Medicine’s Unequal Treatment report, we’ve seen evidence that progress in reducing disparities in care has painfully been slow, or in some cases nonexistent.