Reducing health care disparities through changes in payment and delivery system

A panel at the upcoming AcademyHealth Annual Research Meeting in New Orleans, LA, will share insights gained by three ongoing interventions aimed at reducing health care disparities. Funded by the Robert Wood Johnson Foundation's Finding Answers program, these interventions are blazing trails in three distinct settings in an attempt to close gaps in care via innovative payment and delivery system changes.

The session, "Solving Disparities through Payment and Delivery System Reform," will be held on Monday, June 26 from 11:15 a.m. to 12:45 p.m. in the Celestin A room of the Hyatt Regency New Orleans.

"We know a lot about what works to reduce disparities, but it takes effort; there is no one-size-fits all solution," said Finding Answers Program Director Marshall Chin, MD, MPH. "It's not surprising that providers who are consumed with a multitude of immediate regulatory, financial, and quality-improvement concerns and a rapidly changing health care sector find it challenging to focus on disparities. But our grantees are demonstrating it can be done."

The Finding Answers grantees are tackling a range of health conditions, from diabetes to dental caries, and focus on different populations-;from rural Oregon families to a diverse, multilingual suburban population, to women giving birth at a busy New York City hospital. Yet each is uncovering insights valuable to payers, providers and policy-makers.

During the panel, program officers and grantees will discuss what they have learned about integrating payment reform and care delivery reform to improve health equity. These include practical lessons in areas such as reorganizing the care team, deciding whom to involve in an intervention and at what stage, and optimal ways to structure payment incentives (who gets them, how much, what for?).

"These grantees have taken bold steps to tie alternative payment models to equity-focused care delivery reform," said RWJF Program Officer Emmy Ganos. "Creating these frameworks is a potentially powerful lever for reducing health disparities, particularly as the health care system is moving away from fee-for-service toward value-based care. We hope that others will be emboldened to design their own interventions with providers and payers and we look forward to an engaging discussion of the possibilities."

The three funded grantees are:

• George Mason University (Fairfax County, VA): Improving screening and disease management for diverse, multilingual patients at safety-net clinics in northern Virginia using team quality improvement incentives.
• Icahn School of Medicine at Mount Sinai (New York, NY): Ensuring postpartum care for Medicaid-covered, high-risk, mostly minority women in a New York City health system through physician incentives and coordinated care.
• University of Washington (rural counties in Oregon): Community-based oral health care for mothers and children in rural Oregon using expanded-practice dental hygienists, global budgeting and a team payment incentive.

The panel will feature:

• Marshall Chin, MD, MPH, Director, RWJF Finding Answers Program
• Emmy Hall Ganos, PhD, RWJF Program Officer
• Peter Milgrom, DDS, Professor, University of Washington; Principal Investigator of University of Washington Grantee Program
• Elizabeth Howell, MD, Professor, Icahn School of Medicine at Mount Sinai; Principal Investigator, Icahn Grantee Program
• Len Nichols, PhD, Professor, George Mason University; Principal Investigator, Finding Answers George Mason Grantee Program