Pritzker School of Medicine, University of Chicago, Chicago, IL, United States.
Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, United States.
Front Public Health. 2023 Mar 9;11:1104843. doi: 10.3389/fpubh.2023.1104843. eCollection 2023.
Reducing health inequities in marginalized populations, including people with Medicaid insurance, requires care transformation to address medical and social needs that is supported and incentivized by tailored payment methods. Collaboration across health care stakeholders is essential to overcome health system fragmentation and implement sustainable reform in the United States (U.S.). This paper explores how multi-stakeholder teams operationalized the Roadmap to Advance Health Equity model during early stages of their journey to (a) build cultures of equity and (b) integrate health equity into care transformation and payment reform initiatives.
Advancing Health Equity: Leading Care, Payment, and Systems Transformation is a national program in the U.S. funded by the Robert Wood Johnson Foundation that brings together multi-stakeholder teams to design and implement initiatives to advance health equity. Each team consisted of representatives from state Medicaid agencies, Medicaid managed care organizations, and health care delivery organizations in seven U.S. states. Between June and September 2021, semi-structured interviews were conducted with representatives ( = 23) from all seven teams about experiences implementing the Roadmap to Advance Health Equity model with technical assistance from Advancing Health Equity.
Facilitators of building cultures of equity included (1) build upon preexisting intra-organizational cultures of equity, (2) recruit and promote diverse staff and build an inclusive culture, and (3) train staff on health equity and anti-racism. Teams faced challenges building inter-organizational cultures of equity. Facilitators of identifying a health equity focus area and its root causes included (1) use data to identify a health equity focus and (2) overcome stakeholder assumptions about inequities. Facilitators of implementing care transformation and payment reform included (1) partner with Medicaid members and individual providers and (2) support and incentivize equitable care and outcomes with payment. Facilitators of sustainability planning included (1) identify evidence of improved health equity focus and (2) maintain relationships among stakeholders. Teams faced challenges determining the role of the state Medicaid agency.
Multi-stakeholder teams shared practical strategies for implementing the Roadmap to Advance Health Equity that can inform future efforts to build intra- and inter-organizational cultures of equity and integrate health equity into care delivery and payment systems.
减少边缘化人群（包括拥有医疗补助保险的人群）的健康不平等现象，需要通过关注医疗和社会需求的医疗服务转型来实现，这需要通过定制支付方式提供支持和激励。医疗保健利益相关者之间的合作对于克服美国卫生系统碎片化和实施可持续改革至关重要。本文探讨了多利益攸关方团队在推进卫生公平路线图模型的早期阶段如何运作，以实现以下目标：(a) 建立公平文化，(b) 将卫生公平纳入医疗服务转型和支付改革计划。
推进卫生公平：领导医疗、支付和系统转型是美国一个由罗伯特伍德约翰逊基金会资助的全国性项目，该项目汇集了多利益攸关方团队，设计和实施各项举措，以推进卫生公平。每个团队都由来自美国七个州的州医疗补助机构、医疗补助管理式医疗组织和医疗服务提供组织的代表组成。2021 年 6 月至 9 月期间，对来自所有七个团队的代表（=23 人）进行了半结构化访谈，了解他们在接受推进卫生公平计划的技术援助下实施推进卫生公平路线图模型的经验。
建立公平文化的促进因素包括：(1) 利用组织内现有的公平文化，(2) 招聘和提升多元化员工并建立包容性文化，(3) 对员工进行公平和反种族主义培训。团队在建立组织间公平文化方面面临挑战。确定卫生公平重点领域及其根本原因的促进因素包括：(1) 使用数据确定卫生公平重点，(2) 克服利益相关者对不平等的假设。实施医疗服务转型和支付改革的促进因素包括：(1) 与医疗补助成员和个体提供者合作，(2) 通过支付支持和激励公平的医疗和结果。可持续性规划的促进因素包括：(1) 确定改善卫生公平重点的证据，(2) 保持利益相关者之间的关系。团队在确定州医疗补助机构的作用方面面临挑战。
多利益攸关方团队分享了实施推进卫生公平路线图的实用策略，这可以为未来建立组织内和组织间公平文化以及将卫生公平纳入医疗服务和支付系统提供信息。
