Vessel for Equity
Changes in health care payment and delivery programs can perpetuate, exacerbate, or create healthcare disparities. One reason is that many new initiatives do not directly consider equity.
For instance, despite the benefits of the shift toward value-based care, the health care "value equation" frames value as the product of quality and costs. It does not consider equity.
The health care community must do better, addressing disparities in systems of financing, delivering, and making decisions about care.
VSSL is committed to being part of the solution as a vessel for equity. The Lab does so by prioritizing equity-focused projects in its portfolio. As Lab Director, Dr. Joshua Liao has noted: “While new health systems initiatives put heavy emphasis on quality, costs, and patient experience, very few directly address equity.”
The Lab is committed filling these gaps through a number of projects that emphasize health equity in health care payment, delivery, and decision-making:
Advancing Health Equity Through Payment. Dr. Liao is a founding member of an initiative that seeks to advance health equity through health care payment. While the initiative is currently in development phase, Dr. Liao and colleagues have signaled several focus areas through an article in the Journal of the American Medical Association as well as a Call to Action.
In several forums, Dr. Liao has also articulated why this type of initiative is needed.
Equity in value-based payment programs. Dr. Liao co-leads a body of work evaluating how value-based payment programs impact healthcare disparities and outcomes. Via two multi-year NIH grants, Dr. Liao and team are evaluating how voluntary and mandatory bundled payments —a payment arrangement that sets a bundled benchmark price for a set of services and then holds providers accountable for the quality and costs of joint replacement surgery episodes—impact outcomes among racial minorities and socioeconomically vulnerable individuals.
Equity in telehealth among Medicaid patients. In collaboration with the Washington State Health Care Authority, Dr. Liao leads a project evaluating telehealth use and its role in healthcare payment and delivery in the Washington Medicaid program.
The first portion of this work culminated in a report, Paying for and Delivering Telehealth in the Covid Era: Early Groundwork in WA Medicaid (June 2020). The second portion of this work has involved large-scale empiric analyses of claims data to assess telehealth use among Medicaid patients, with a report forthcoming.
High priority areas to address include outcomes and disparities in telehealth use and impact among historically marginalized patient groups.
Equity in vaccination and cancer screening among older adults. Together with colleagues at the University of Pennsylvania, Dr. Liao is spearheading a body of work to identify ways to improve vaccination and cancer screening rates among older adults. Dr. Liao and team secured two 5-year grants from the NIH to pursue this work. Both explicitly focus on testing and tailoring interventions to high-risk groups including racial minorities, ethnic minorities, and socioeconomically vulnerable individuals.
Vaccine confidence among historically marginalized groups
Together with collaborators in the departments of Human Centered Design & Engineering and Computer Science & Engineering, Dr. Liao is conducting work that seeks to use co-design and real-world testing to address vaccine confidence among diverse populations. This work has an explicit goal to include and draw insights relevant to historically marginalized groups.
Dr. Joshua Liao discusses policy intention and implementation to advance equity through payment
(IVI Webinar, July 2021)