Value-based care champions health and justice by focusing on outcomes rather than on units of service. As this type of payment reform expands, implementing the necessary changes to enable it must operate from a frame of equity rather than equality.
Working toward equality means giving different groups the same opportunities, while working towards equity means giving different groups different opportunities according to their needs. Health equity requires recognizing that systems of care are yielding different results for different populations due to underlying systemic differences, so the solutions to improving health and health care need to be different as well.
The commitment to reducing care disparities for populations affected by racism and other systemic disadvantages has grown over the past few years. Yet the successes have been highly variable, and sometimes have even widened disparities. Some payers and policymakers who are shifting to value-based reimbursement remain stuck in an equality mindset, treating all health systems the same rather than recognizing the disparate starting points for this transition. This is significantly curtailing progress toward a truly equitable health care environment.
In a recent JAMA Viewpoint article, Amol Navathe, Pooja Chandrashekar, and Christopher Chen explored ways to make value-based payments work for federally qualified health centers (FQHCs). These are community-based clinics that receive federal funds to care for historically disadvantaged populations. Value-based payments that treat these centers just like any other primary care clinics, without recognizing and addressing the real-world complexities of serving highly challenging patient populations, will not move the needle toward true health equity.
Navathe and co-authors outlined the policy directions that could allow federally qualified health centers to increase health equity through value-based payments by expanding funding for addressing social drivers of health, providing care in the community with a local workforce, and enhancing quality measurement. Realizing these policy goals depends heavily on how they are implemented.