Blog

As Minority Health Month comes to a close, we should spotlight the enduring inequities affecting minority populations in our health care system. Glaring inequities persist among historically marginalized populations that demand transformative action. These inequities are more than numbers; they represent real-life consequences of historic underinvestment, adverse social drivers of health, implicit and explicit biases, and inequitable care delivery. Historical distrust of the health care system within minority communities stems from past injustices and complicates reform.

My Story

I often reflect on my own troubling health care experience as a young Black girl. In middle school, I was prescribed medication for an eye infection containing amoxicillin – a cousin to penicillin to which I am allergic. This allergy was noted on my chart, but my physician did not check to ensure I was not allergic to any of the ingredients. As the patient, I did not know or think to check the ingredients of the medication as my parents and I entrusted my pediatrician to provide adequate care. His shortcomings led to a week of treating the allergic reaction outside of the eye infection.

This is not a unique narrative and could happen to anyone regardless of race, however, communities of color often face disproportionately negative health care outcomes. I may never know why my physician made this error, the potential reasons are endless. Did my physician lack the time or resources to thoroughly review my chart during a busy day of appointments? Was there a breakdown in communication within the care team? Did he not have an adequate data infrastructure to collect and share information about my health? Or did he simply not care? The importance of health care providers being attentive to patients’ needs and histories, especially in diverse and underserved communities, cannot be overstated. More than 70% of U.S. adults feel the health care system is failing to meet their needs and among Black Americans, younger women are the most likely to say they’ve had negative experiences with health care providers. This is where health system transformation (HST) can step in to work towards creating a system that is focused on providing high-quality care for all.

Payment Reform & Health Equity

The way that physicians and health care organizations are paid to deliver care, greatly impacts whether and how health care systems use their resources to improve care for their patients. Unfortunately, the predominant payment system in health care today does not adequately support or incentivize clinicians and health care organizations to meet the health needs of historically marginalized communities.

HST represents a fundamental shift in care delivery and payment models to a value-based payment (VBP) system that holds health care providers accountable for the cost and quality of care. VBP can also be a useful tool for improving health outcomes and advancing equity. It can provide physicians and health care organizations the resources and flexibility needed to provide preventive, culturally-responsive, personalized care, especially for those that care for people with high unmet medical, behavioral, and social needs. This could look like incentivizing comprehensive team-based care, partnering with community health workers or peer support specialists, addressing food or housing insecurity, developing a treatment plan with the patient, or providing care navigation services to help patients follow through with referrals. To learn more about the transformative potential of value-based care, visit CMS’ new Value-Based Care Spotlight page.

Challenges & Opportunities

There are many obstacles blocking HST implementation, such as data infrastructure, collection and disaggregation challenges, regulatory and legislative hurdles, workforce shortages and lack of diversity, affordability and access barriers, structural racism and implicit biases that contribute to inequitable care. Overcoming these barriers requires a concerted effort and policy advocacy. Through health system transformation, policymakers, health care leaders, and advocates can build a more equitable health care system. The success of health system transformation will depend on partnering with patients and communities and centering the priorities that matter most to them. This is why I’m dedicated to advocating for and educating others on policies that center patient-centered care and equity in our health care system. Let’s join forces and prioritize health system transformation to ensure a healthier future for all.