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A National Priority Agenda to Advance Health Equity Through System Transformation

By Eliot Fishman, , Ellen Albritton, Denisse Sanchez,


The Health Equity Task Force for Delivery and Payment Transformation’s Top 19 Recommendations for 2019 and Beyond.

The United States is struggling with an increasingly expensive and inefficient health care system that delivers very uneven outcomes that fuel pervasive health inequities among communities of color, rural communities, and other underserved groups. Efforts underway to improve the cost and quality of health care have centered on transforming our health care system from one that pays for volume to one that rewards value. However, the health system transformation initiatives that have been implemented thus far have failed to significantly reduce health disparities because they have not prioritized solving for equity.

As health system transformation efforts are ongoing, the time is ripe for leaders representing communities that have largely been excluded from health care transformation policy development and decision-making to intervene for the benefit of their communities. Given that for many of these leaders, health system transformation is a relatively new endeavor, Families USA, together with the Health Equity Task Force for Delivery and Payment Transformation, has been working to establish an effective framework for tackling health inequities, develop a menu of policy options and prioritize them, and promote coordinated action in pursuit of health equity. A Framework for Advancing Health Equity and Value: Policy Options for Reducing Health Inequities by Transforming Health Care Delivery and Payment Systems, published earlier this year, was the first step. We identified six policy domains that are the key targets for change and presented 86 different policy options to consider specific to federal policy, state policy, the private sector, and some that could be Executive Summaryimplemented in any of those spheres. These domains are: payment systems, the safety net, and small community providers, community partnerships, the evidence base, measurement, and workforce.

Advancing Health Equity through System Transformation: From a Framework and Policy Options to a Priority Agenda

This national priority agenda is the next step in our collective efforts to ensure that the needs and priorities of communities of color, rural communities, and other underserved groups are purposefully addressed in ongoing and future system transformation efforts. Task force members worked together to arrive at a general consensus on the top policy changes for each of the domains necessary to build a truly equitable and transformed health care system.i We identified 19 recommendations considered high priority among the six domains of action.