Quality, Disparities, + Equity: How Does Value-Based Care Narrow the Gap? BY A L I K H A N , M D , M P P, FAC P
In 2020, the twin pandemics of COVID-19 and nationwide health disparities cast into sharp relief the persistent challenges of achieving high-quality, clinically excellent care in all parts of American society—particularly in rural and urban communities with high social vulnerability. The COVID-19 pandemic also underscored the limitations of fee-for-service reimbursement in the pursuit of that goal. A careful examination of recent trends in value-based care—and how they spotlight healthcare delivery innovation for the underserved—offers useful context into the vast frontier of what’s possible in American medicine.
QUALITY + EQUITY ARE OFTEN INTERLINKED The challenges facing the U.S. healthcare system are well-documented: We pay more—$4.1 trillion in annual healthcare spend, or 267% more than the average Organization for Economic Cooperation and Development (OECD) nation—for worse quality and outcomes, with American life expectancy two years lower than the OECD average. The experience in traditional American healthcare is miserable, with an average net promoter score of -1.2 for primary care practices nationally and burnout rates for physicians and nurses at critically high levels. Those trends are further concentrated in older adults, who tend to be the sickest, most complex patients; indeed, 96% of Medicare spend in 2020 was linked to chronic disease. Increasingly, older adults are also subject to health-related social needs.1 Financial strain, food insecurity, and poor housing quality are the most common hurdles to overcome, according to a recent Humana analysis of Medicare Advantage enrollees. Nearly 1 in 4 of these enrollees reported multiple social needs.
Source: Kim and Bostwick, “Social Vulnerability and Racial Inequality in COVID-19 Deaths in Chicago.” Health Education and Behavior. May 21, 2020.
36 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS
Spring 2022
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Despite progress in advancing quality and equity in vulnerable communities, the value-based care journey is in its adolescence.”
