Achieving health equity means removing the barriers that prevent people from being healthy – systemic racism, poverty, and lack of access to economic mobility. Inside health centers, we strive for organizational equity, which includes staff that reflect the populations served, and governance that includes anti-racist policies and procedures. We also strive for equity in care delivery, which means patients receive care that is culturally appropriate and based in trust.
Community health centers have been, and will continue to be, vital to achieving health equity in the United States. Over the past few decades, they have served historically marginalized communities and provided comprehensive, culturally competent, integrated care to millions of Americans. Of the 28 million patients that health care centers serve annually, more than 80% are uninsured or publicly insured and more than 90% are from low-income communities. Additionally, health centers provide vital care to patients with chronic health conditions, particularly diabetes and hypertension.
As hyper-local hubs providing consumer driven, comprehensive care, community health centers are crucial in narrowing health disparities. Health centers are building health equity in their approach and delivery of care, and through their governance and operational model, and investments in these centers has consistently resulted in impactful returns. While health centers are most effective in their locus of power, we are hopeful they can be a force for equity in their larger communities. With increased investment in health centers and clear measurement structures to track health equity outcomes, America can get closer to a reality where all citizens have access to quality, comprehensive health care.
Ultimately, we seek a nation where we no longer have disparities in health outcomes by race and ethnicity.
As we continue to fight for a more equitable health care system, Advocates for Community Health (ACH) is committed to the following principles:
Set pay-for-equity goals.
Rationale: Value based care will continue to strongly influence the direction of the health care industry. By formally integrating goals related to health equity, policymakers can ensure that providers are supported and incentivized to deliver high value, equitable care.
Recommendation: The Administration should establish specific pay-for-equity goals, such as incorporating equity measures into all payment models by 2025[1].
Develop, test, and disseminate health equity measurement tools.
Rationale: The U.S. Health Resources and Services Administration (HRSA) collects and reports measures of health disparities. However, they do not yet collect a more holistic measure of equity. ACH members can help to develop this.
Recommendation: Work in partnership with relevant agencies to identify health equity measurements, pilot those measurement processes in ACH member health centers, and deploy comprehensive measurement processes across the health care system.
Integrate health equity into evaluation and payment for health centers.
Rationale: Health centers are national leaders in health equity and should be compensated for the structural and community-led work to achieve it.
Recommendation: Integrate validated health equity measurement into performance metrics for value-based care models. Measurement tools should evolve to acknowledge intersectional identities, and include measurement of the diversity of the health care workforce.
Incentivize the development of federally qualified health centers (FQHCs) as community hubs with formal relationships with community-based organizations (CBOs) most able to address the social determinants of health.
Rationale: Many ACH members have successfully partnered with CBOs during COVID-19; these networks should be supported and sustained.
Recommendation: HRSA should include CBO partnerships as an allowable expense under 330 grant funding. The Medicaid program should clarify that Medicaid MCOs can contract with FQHCs to serve a similar role.
Provide flexible funding to FQHCs to implement programs proven to close health equity gaps.
Rationale: As the organizations closest to the needs of their diverse patient populations, FQHCs have tested and proven interventions that have successfully closed health equity gaps.
Recommendation: Rather than requiring specific programming, HRSA should include a flexible funding stream for innovative programming with the sole goal of achieving more equitable care delivery.
[1] As endorsed in Liao JM, Lavizzo-Mourey RJ, Navathe AS. A National Goal to Advance Health Equity Through Value-Based Payment. JAMA. 2021;325(24):2439–2440. doi:10.1001/jama.2021.8562