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Supporting Health Equity Through Payment: A Call To Action

"Payment is a powerful motivator. In the US, clinicians are paid more for providing more services, regardless of how they affect patients’ health. This dynamic has fueled an inefficient system in which care is often unaffordable and produces disappointing outcomes for many Americans."


This is the impetus behind a new call to action organized by VSSL Director, Dr. Joshua Liao, and colleagues Drs. Risa Lavizzo-Mourey and Amol Navathe.


The three penned an article earlier this summer in the Journal of the American Medical Association, calling for a national goal to advance health equity through value-based payment. In their piece, Drs. Liao, Lavizzo-Mourey, and Navathe note that policymakers have spent a decade shifting financial incentives toward “value-based payment” that emphasizes better health outcomes and cost-conscious care and address misalignment between the payment and health; but that while this approach has created a major cultural shift and care delivery redesign, it has done little to address health care disparities – one of the most critical problems in the US health care system.


The new Open Letter extends these points, calling on the health care community to achieve the goal of supporting health equity through payment. The Letter is based on several beliefs:

  • We cannot make meaningful progress without tackling these issues and realigning payment around equity.

  • Intention precedes implementation, so we cannot meaningfully address disparities so long as they are tacitly accepted as unintended consequences of how we pay for care. We need to set a new, explicit intention to pay for health care in ways that help eradicate inequity.

  • Payment changes should address differences in how a clinician or organization treats different types of patients as well as differences between clinicians or organizations, which may be influenced by broader social and structural factors.

  • No changes occur in a vacuum, and efforts to advance health equity in payment should utilize beneficial parts of existing data, technology, infrastructure whenever possible.


How can the health care community achieve the goal of using paying to improve equity? Drs. Liao, Lavizzo-Mourey, and Navathe highlight several steps:

  • Convene a multi-stakeholder coalition

  • Formally incorporate equity into the concept of value-based payment

  • Create an implementation roadmap

  • Set bold, longitudinal goals

  • Conduct evaluations

The Letter ends with an important caveat:

Of course, this work will require great effort, and no payment approach is immune to unintended consequences. Reimbursement is also just one among many areas where changes are needed to address inequity. But payment is a powerful motivator, and intentional changes can harness it into a powerful solution to inequity. The health care community should undertake this work without delay.

Read and consider signing onto the letter here.