Developing health equity measures

Socially at-risk individuals receive lower-quality health care and experience worse health outcomes than more advantaged individuals. One way to address this in the Medicare population is to use Medicare’s value-based purchasing (VBP) programs, quality reporting efforts, and confidential reports as tools to drive improvements in quality. In particular, including health equity measurement approaches in VBP programs and quality reporting could motivate providers to focus on reducing disparities and to prioritize particular areas for quality improvement. It could also encourage providers to improve health equity through service enhancements, patient engagement activities, and adoption of best practices. In this project, RAND Corporation researchers identified existing health equity measurement approaches that might fit with Medicare’s VBP programs, quality reporting efforts, and confidential reports. The project had two objectives: (1) identify health equity measurement approaches, and (2) decide which of these approaches merit consideration for inclusion in Medicare’s VBP programs, quality reporting efforts, and confidential reports. This report describes the methods and findings of the project and delineates potential first steps for the U.S. Department of Health and Human Services to consider as it continues to evaluate the prospect of incorporating health equity measures and domains in Medicare’s VBP and reporting programs. This research was funded by the Office of the Assistant Secretary for Evaluation and Planning in the U.S. Department of Health and Human Services and carried out within the Payment, Cost, and Coverage Program in RAND Health Care. RAND Health Care, a division of the RAND Corporation, promotes healthier societies by improving health care systems in the United States and other countries. We do this by providing health care decisionmakers, practitioners, and consumers with actionable, rigorous, objective evidence to support their most complex decisions. (author introduction)