Value-based models can either narrow or widen disparities. The difference often comes down to what gets measured. This white paper proposes a practical equity measurement framework.
A payment model is only as equitable as the metrics that govern it. If quality scores ignore who is being left behind, even a well-intentioned program can reward systems for avoiding the patients who need the most help.
The risk of unintended harm
Risk adjustment that fails to account for social circumstances can make clinicians who serve disadvantaged communities look like poor performers. Over time, that can pull resources away from exactly the places that need them.
A framework for measuring equity
We propose measuring equity along four dimensions:
- Access: who is able to get care, and how quickly
- Outcomes: whether results differ across groups defined by race, income, geography, and language
- Experience: whether patients feel respected and understood
- Resource allocation: whether payment flows toward, not away from, under-resourced communities
Putting it to use
The paper offers guidance for payers and provider organizations on stratifying existing measures, collecting demographic data responsibly, and tying a portion of payment to closing documented gaps, so equity becomes a measured result rather than an aspiration.