Advancing High-Value, Equitable Health Care: Insights and Future Directions

Understanding key priorities and challenges is crucial for delivering high-value, equitable care (HVEC) amid ongoing healthcare disruptions and transformations. A recent webinar by AcademyHealth, continuing their HVEC Opportunity Award funded by the Foundation, brought together researchers, health system leaders, policymakers, healthcare professionals, patients, and community leaders to explore the future of health services research.

The webinar presented a comprehensive research agenda focused on advancing high-value, equitable healthcare, defined as timely, accessible, respectful, culturally responsive, affordable, and evidence-supported. Attendees were guided through the process for crafting the research agenda, including its guiding framework, parameters for developing the supporting literature review, and key results.

Development of the guiding framework was led by a consensus group co-chaired by Donna Cryer, JD, Founder, President, and CEO of the Global Liver Institute and Elizabeth McGlynn, PhD, Senior Vice President for Research & Quality Measurement, Executive Director of the Kaiser Permanente (KP) Center for Effectiveness & Safety Research (CESR). High-value, equitable care is defined as timely, accessible, respectful, culturally responsive, affordable, and evidence-supported care. Critical issues addressed included language for diverse populations, expanding healthcare expectations, accountability, incentive structures, and leadership roles.

The methodology for the literature review, conducted by a team of researchers led by Kevin Fiscella, MD, MPH, Professor of Family Medicine (tenured), Public Health Sciences and Community Health at the University of Rochester, involved clarifying research questions, developing search algorithms, using Covidence software for data screening, and creating heat maps for evidence and gap analysis. The review included 95 studies that examined interventions as well as barriers and facilitators to implementation and equity, focusing on conditions like cancer, cardiovascular diseases (CVD), diabetes, and mental health, with race and ethnicity being major disparity categories. The webinar identified gaps in healthcare accountability, access, cultural competency, capacity, and primary care to guide future research and grant programs.

The webinar highlighted current gaps in healthcare delivery to inform the Donaghue Foundation’s grant offerings: lack of healthcare systems accountable to community needs, aligning performance measures to improve equity and value, developing representative governance in healthcare systems, addressing barriers to digital health access and mental healthcare needs, improving patient trust through cultural competency training, and enhancing insurance coverage and affordability.

The gaps identified in the webinar will help inform the Donaghue Foundation’s grant offerings, focusing on priority areas to foster research that addresses pressing healthcare challenges and improves health outcomes for all. Key gaps include the lack of healthcare systems accountable to community needs, aligning performance measures to improve equity and value, and developing representative governance in healthcare systems. Furthermore, critical areas highlighted were addressing barriers to digital health access and mental healthcare needs, improving patient trust through cultural competency training, and enhancing insurance coverage and affordability.

Their approach to achieving high-value, equitable care emphasizes the need for universal health insurance and addresses diverse needs related to disability, geography, language, culture, health literacy, and the digital divide, while also expanding covered services to include social needs. Policies and payment models should foster continuous relationships that address whole-person needs and promote innovation in care providers, including community health workers. The research agenda also advocates for new healthcare workforce training approaches to ensure a stable, resilient, prepared, and diverse workforce, with a focus on retention strategies and advancement opportunities.

In terms of research infrastructure, the focus is on developing payment and policy structures that incentivize health systems to conduct research, evaluating delivery models for different populations, and creating accountability for equitable engagement of patient and community involvement in research. Public reporting on progress, diversified governance including patient and community representatives, and aligned performance measures are essential for improving quality, value, and equity from both patient/family and societal perspectives.

The HVEC’s collaborative efforts underscore the importance of a united approach to advancing high-value, equitable healthcare. Moving forward, the Foundation remains committed to supporting research and fostering partnerships that drive meaningful change in the healthcare landscape.