VSSL 4 Equity

The health care "value equation" frames value as the product of quality and costs. While this is a helpful framework, it unfortunately fails to directly consider equity.


Unsurprisingly, this dynamic means that value-based payment and delivery programs can create or exacerbate healthcare disparities. As a health care community, we need to do better, identifying and address disparities in our systems of financing, delivering, and making decisions about care. 

VSSL is committed to being part of the solution by prioritizing equity-focused projects in its portfolio of work. As Lab Director, Joshua M. Liao, MD, MSc, notes, “While value-based care initiatives have put heavy emphasis on quality, costs, and patient experience, very few have directly addressed the issue of parity.”

In 2020, Dr. Liao and collaborators embarked on several innovative projects to fill that gap and emphasize equity in healthcare payment, delivery, and decision-making:

Equity in telehealth among Medicaid patients. In collaboration with the Washington State Health Care Authority (HCA), Dr. Liao and VSSL colleague, Dr. Ashok Reddy, MD, MSc, have embarked on a new project to understand telehealth use and its role in healthcare payment and delivery in the Washington state 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, that was prepared by VSSL in collaboration with the HCA. The second, ongoing portion of this work involves large-scale empiric analyses of telehealth use among Medicaid patients. For Drs. Liao and Reddy, high priority questions to address in this work include understanding outcomes and disparities in telehealth use and impact among vulnerable patient groups. 

Equity in vaccination and cancer screening among older adults. Together with colleagues at the hospitals associated with University of Pennsylvania and at several VA sites around the country, Dr. Liao is spearheading a body of work to identify ways to improve vaccination and cancer screening rates among older adults. The team secured two 5-year grants from the NIH to pursue this work, and as Dr. Liao notes, the grants “explicitly focus on testing and tailoring interventions to high-risk groups including racial minorities, ethnic minorities, and socioeconomically vulnerable individuals.” 

Equity in value-based payment reforms. Dr. Liao co-leads a body of work with colleagues at the University of Pennsylvania evaluating how new payment reforms impact healthcare disparities and outcomes. In an NIH-funded project, the team is evaluating how bundled payments for joint replacements—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. 

Dr. Liao shared his desire to continue growing the Lab’s work in the area of equity: “We have a number of grants and analyses in process directly focused on this issue. Through these efforts, and future collaborations across and beyond UW, we’re excited to use our focus on healthcare value to drive progress toward greater healthcare equity.”