Transforming Health Care to Address Value and Equity

Abstract

The US health care system is failing to deliver value and equity. 1 Life expectancy has been declining nationally. 1 Health care costs in the United States are the highest in the world. 1 Medicare alternative payment models have yielded modest reductions in costs but have generally not improved health or equity. 2 Fundamental change is needed beyond redesign of alternative payment models. Health care must embrace equitable improvement in the national Vital Signs initiative, invest in primary care, and collaborate with communities. National Vital SignsNational Vital Signs are core metrics produced by the Institute of Medicine (now, the National Academy of Medicine) for tracking improvements in health, health care costs, engagement of the public in its health, and health care and quality. 1 Examples include the percent of adults who are overweight and obese; use of addictive substances including tobacco, alcohol, and illicit drugs; individual engagement in health-related behavior; effective clinical care; and individual well-being. 1,3 National Vital Signs are metrics that matter. Many are behavioral, social, or physiological metrics that powerfully influence health, health care costs, and health disparities. Thus, these metrics are well-suited to guide and motivate health care toward value and equity.

The COVID-19 Pandemic and Associated Inequities in Acute Myocardial Infarction Treatment and Outcomes

“…Furthermore, direct and indirect outcomes associated with COVID-19 have been more pronounced among people from racially and ethnically minoritized groups. Black and Hispanic individuals experienced a 60% higher cumulative death rate from COVID-19 than White individuals, and individuals from minority groups accounted for 70% of excess deaths indirectly associated with COVID-19 …”

“…Black and Hispanic individuals experienced a 60% higher cumulative death rate from COVID-19 than White individuals, 8 and individuals from minority groups accounted for 70% of excess deaths indirectly associated with COVID-19. 9 , 10 …”

“…Black and Hispanic individuals experienced a 60% higher cumulative death rate from COVID-19 than White individuals, 8 and individuals from minority groups accounted for 70% of excess deaths indirectly associated with COVID-19. 9,10 Understanding the association of COVID-19 with health care outcomes is essential to efforts to limit the number of excess non-COVID-19 deaths, especially for members of historically marginalized groups who have been the most affected by COVID-19. It is possible that excess deaths during the pandemic were predominantly due to delays in care, with patients seeking or receiving care later in their disease course due to care availability or concerns about contracting COVID-19.…”

How Did Orthopaedic Surgeons Perform in the 2018 Centers for Medicaid & Medicare Services Merit-based Incentive Payment System?

“…Until the burden of quality reporting is reduced through the use of fewer, simpler measures and standardized data submission, performance bonuses are unlikely to offset entry costs for many orthopaedic groups [21,30]. As has been the case with previous value-based payment programs [15,18,28,53], the MIPS has also disproportionately penalized physicians treating socioeconomically disadvantaged and more medically complex patients [16,26]. Without an adequate risk-adjustment scheme in place, and as the comorbidity burden of orthopaedic patients continues to rise [36], surgeons may see a corresponding decrease in MIPS performance [46,57].…”