What Should Antiracist Payment Reform Look Like?

Abstract

Racism reduces eligibility for health insurance and access to high-quality care for people of color in the United States, and current payment structures exacerbate the resultant de facto racial segregation. Payers and health plans do not adequately support and incentivize clinicians and health care delivery organizations to meet the health needs of minoritized communities. This article describes foundational work needed to create an antiracist culture of equity; the Roadmap to Advance Health Equity; and specific, actionable antiracist payment reform strategies, including increasing access to and the scope of health insurance coverage, antiracism accountability in managed-care contracts, support for the safety-net system, strengthened nonprofit hospital tax status requirements, and payment incentives to advance health equity. Antiracist payment reforms have great potential to desegregate health care systems and to ensure that everyone has a fair opportunity to receive good health services and optimize their health.

Advancing health equity through partnerships of state Medicaid agencies, Medicaid managed care organizations, and health care delivery organizations

“…For example, upfront payments for equity- promoting infrastructure and services such as information systems with medical and social needs data, community health workers, and outreach teams for preventative services; incentive payments for reducing inequities; and risk-adjusting payment for social risk could all help advance health equity ( 7 , 32 – 34 ). In addition, it is important to apply specific health equity and anti-racist approaches to these payment methods ( 35 ).…”

Investing in Child Health Through Alternative Payment Models: Lessons From North Carolina Integrated Care for Kids

“…MMCOs were not able to meet these needs or provide meaningful incentive rates. To address these concerns, federal or state agencies could provide infrastructure payments, particularly to smaller practices (Singletary & Chin, 2023). These practices may have lower revenues and inadequate data and quality improvement infrastructure needed to participate in value-based payment programs (Singletary & Chin, 2023).…”

“…To address these concerns, federal or state agencies could provide infrastructure payments, particularly to smaller practices (Singletary & Chin, 2023). These practices may have lower revenues and inadequate data and quality improvement infrastructure needed to participate in value-based payment programs (Singletary & Chin, 2023). Risk adjustment for social factors may also help ensure that clinicians are not penalized for serving patients with greater social need, although operationalizing social risk adjustment without unintended consequences remains controversial (Crook et al, 2021; Singletary & Chin, 2023).…”