The Trump Administration’s second term has signaled a focus on reducing health care costs and improving health outcomes through strengthening efforts to prevent chronic disease and advancing payment reform. However, the word ‘equity’ has become a political target with the administration actively rolling back existing policies and initiatives designed to identify and reduce health disparities.
As we commemorate Health Care Value Week, it is important to acknowledge that the value-based care (VBC) movement – tying payments for care delivery to the quality and cost of care provided – can only truly work if equity remains at its core. When overlooked, underserved communities will be left behind. Now more than ever, patient and consumer advocates must be engaged when shaping these policies to prioritize access, quality, patient experience, and equity and ensure that payment models meet the diverse needs of patients.
To help in this effort, the National Partnership for Women & Families established the Equity-Centered Payment Reform Learning Collaborative in 2024, bringing together patient advocates for open dialogue to identify common priorities for advancing equity in health care payment reform. Member organizations include American Heart Association, the Center for Medicare Advocacy, Medicare Rights Center, National Health Care for the Homeless Council, and the National Urban League.
Key Takeaways from the Learning Collaborative
Through a series of discussions, the Collaborative identified several themes and actionable recommendations:
Set guardrails against exacerbating inequities or disincentivizing care.
Participants emphasized the importance of addressing unintended consequences in VBC models. Payment models must account for factors like housing and food insecurity that disproportionately affect historically underserved populations. This includes adjusting provider payments based on social risks, ensuring those serving complex populations are not penalized, and discouraging practices like avoiding high-cost patients. Additionally, investments in community-based organizations can help ensure they have the tools to thrive in VBC systems.
Support Low-Resourced Providers.
The Collaborative noted primary care clinicians serving Medicaid beneficiaries often face tight financial margins and limited capacity to participate in VBC due to low reimbursement. Investments in infrastructure, such as hiring staff and upgrading health information technology, are essential to support these providers and ensure equitable participation in VBC models.
Collect Self-Reported Data.
High-quality data, stratified by race, ethnicity, disability, gender identity and other factors, is crucial for identifying and addressing disparities. However, trust must be built through clear communication and transparency to ensure patients feel comfortable sharing demographic information, especially in the current political climate. Despite the CMS Innovation Center’s recent decision to rescind the requirement to collect demographic data following Trump’s executive orders, it will be necessary to collect and analyze demographic and health related social needs (HRSN) data to understand how providers and plans are performing under value-based payment arrangements and what improvements or tweaks are necessary to achieve quality and cost targets.
Prioritize Patient-Centered Outcomes and Experience Data.
The use of patient-reported outcomes and experience data is underutilized. Quality measurement that focuses on what matters most to patients is essential for improving the quality and equity of care.
Close the Knowledge Gap About Payment Reform Opportunities.
Most patients and caregivers are unaware of VBC models, their inclusion in them, and the benefits they provide, which can cause confusion, limit patient engagement, and hinder the ability to take full advantage of benefits provided. Their lack of awareness also limits accountability and patients’ ability to raise or address issues they may experience in new or existing models. Current efforts to improve public communication about VBC and share stories of patients in accountable care organizations are encouraging.
Increase Transparency in Patient Engagement.
Meaningful engagement of patients and caregivers must occur early and consistently in the design of VBC models. Without their input, efforts risk being shaped solely by industry priorities, limiting their effectiveness in addressing equity and person-centered care. Although CMS and other health industry stakeholders have made efforts to strengthen partnerships with consumer and patient groups, the level of engagement is not always clear. Patient advocates are often unaware of the impact of models to effectively hold payers and providers accountable.
Looking Ahead
While federal priorities shift, opportunities to advance health equity through VBC remain. These include strengthening primary care, integrating behavioral health, supporting rural communities and advancing patient safety, experience, and outcomes.
The path to person-centered, equitable care requires intentional, inclusive approaches to payment reform. Instead of dismantling equity initiatives, the administration should continue efforts that further advance health care reform to address concerns most important to patients.
To learn more, read the full issue brief: Patient Advocate Perspectives on Advancing Value-Based, Person-Centered Care.
