"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.  

Healthfirst is a provider of Medicaid Managed Care plans in downstate New York and, in concert with our sponsor hospitals and medical centers in New York City, has been at the forefront of value-based care models since we were founded 25 years ago. As a Medicaid plan provider, people with a variety of complex health needs trust us on their care journey, so we care about health inequities and the impact on our communities.

As the health care system moves towards value-based payment, we need performance measures that can assess and monitor disparities in health and health care. The National Quality Forum’s Health Equity Roadmap provides a structure to reconsider longstanding disparities in the context of value-based payment and emerging care models.

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.

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.