A National Priority Agenda to Advance Health Equity Through System Transformation

Hernandez-Cancio S, Albritton E, Fishman E, Sanchez D
Publication Year: 2018
Patient Need Addressed: Care Coordination/Management, Patient satisfaction/engagement
Population Focus: Dual eligible, Medicaid beneficiaries
Demographic Group: Racial and ethnic minority groups, Rural
Intervention Type: Staff design and care management, Technology/innovation
Type of Literature: Grey


Insights Results

Overview of article

  • This study identified 19 recommendations considered high priority among the 6 domains of action to ensure that the needs and priorities of communities of color, rural communities, and other underserved groups are purposefully addressed in ongoing and future system transformation efforts. These recommendations and domains of action came from task force members who worked together to arrive at a general consensus on the top policy changes for each of the domains necessary to build a truly equitable and transformed health care system
  • The 6 domains of action are: 1) Designing and implementing payment systems that sustain and reward high-quality, equitable healthcare; 2) Supporting safety net and small community providers’ transition to a value-based healthcare system; 3) Building robust and well-resourced community partnerships; 4) Ensuring a transparent and representative evidence base; 5) Implementing equity-focused measurement that accelerates reductions in health inequities; and 6) Growing a diverse healthcare workforce that drives equity and value
  • The Medicare and Medicaid programs should lead the way by directly incentivizing disparity reductions and explicitly including these measures in their quality measure sets. This should be based on the measures laid out in the National Quality Forum’s 2017 report A Roadmap for Promoting Health Equity and Eliminating Disparities: The Four I’s for Health Equity


  • Good examples of the kinds of models and activities that have been shown to be effective in improving the health of communities dealing with health inequities include integrating community health workers and other bridges to community-based resources, creating telehealth programs that expand access and cultural competence, and integrating behavioral health and primary care
  • The barriers to successful entry into value-based payment programs can be high for safety net and small community providers, even as, in many cases, they have a long history of providing care for communities of color and low-income people. Supporting these trusted, culturally centered, providers’ success is critical to advancing health equity

Key takeaways/implications

  • People of color are dramatically underrepresented in the current evidence base that is used to inform healthcare policy and practice. Yet, despite this inherent bias, this evidence is often presented, and usually used, as if it were universally applicable. To build the equitable, high-value, high-quality healthcare system we need, these gaps in the evidence base must be addressed