Frontiers of Health Services Management - Spring 2014 - (Page 17)

Introduction * tend to suffer more medical errors with greater clinical consequences (Divi et al. 2007; Flores and Ngui 2006; Schyve 2007), * experience longer lengths of hospital stay for the same clinical conditions (Ash and Brandt 2006), * experience higher rates of avoidable hospitalizations and higher 30-day readmission rates for congestive heart failure (Alexander et al. 1999; Jiang et al. 2005; MedPAC 2008; Rathore et al. 2003), Jos e p h R . B e ta nc our t * 17 F E A T U R E The passage of the Patient Protection and Affordable Care Act (ACA) and current efforts in payment reform signal the beginning of a significant transformation for the US healthcare system. A new set of structures is being developed to facilitate increased access to care that is costeffective and high in quality-otherwise known as high-value healthcare. Pursuing high-value healthcare is the ultimate goal, and healthcare leaders across the country are faced with the daunting challenge of succeeding-perhaps just surviving-in this brave new world (Bohmer 2011). In the area of quality, we are not without a basic blueprint, however. Guided by the Institute of Medicine (IOM) report Crossing the Quality Chasm (Corrigan, Donaldson, and Kohn 2001), we have charted a path to deliver care that is safe, efficient, effective, timely, patient centered, and equitable. Significant gains have been made in this effort, particularly in the area of patient safety (Hosford 2008; Romano et al. 2003). However, one key pillar of quality-achieving equity-has remained elusive and has garnered significantly less attention than have the other quality mandates. Equity in healthcare is the principle that quality of care should not vary on the basis of patient characteristics, such as race or ethnicity. This aim emerged from the findings of another IOM report, titled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Smedley, Stith, and Nelson 2003). The report found that even with the same insurance and socioeconomic status and when comorbidities, stage of presentation, and other confounding factors are controlled for, racial or ethnic minorities often receive a lower quality of healthcare than do their white counterparts (see Exhibit 1). The latest National Healthcare Disparities Report, released in 2012, confirms this problem persists today (AHRQ 2012). As we embark on this healthcare transformation, disparities have emerged as the hallmark of low-value healthcare- care that does not meet quality standards, is inefficient, and is usually of high cost. Between 2003 and 2006, the combined direct and indirect cost of health disparities was $1.24 trillion (LaVeist, Gaskin, and Richard 2009). Addressing disparities and achieving equity are the perfect target areas to recoup value, and doing so will pave the way for high-value healthcare. In the end, if we are to be successful in our pursuit of value, we must be prepared to deliver high-quality care to an increasingly diverse population-especially given that racial or ethnic minorities will comprise 48 percent of the 32 million individuals who will be newly insured under the ACA (RWJF 2013)-and other vulnerable patients across all backgrounds. For example, regarding ethnic minorities, research demonstrates that compared to whites, minorities

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Spring 2014

Frontiers of Health Services Management - Spring 2014
Contents
Editorial
Baylor Health Care System’s Journey to Provide Equitable Care
In Pursuit of High-Value Healthcare: The Case for Improving Quality and Acheiving Equity in a Time of Healthcare Transformation
Ending Healthcare Disparities: An Urgent Priority and a Growing Possibility
Expanding the Evidence Base for Health Equity
A Historical Perspective on Disparities as Context for Our Work Ahead

Frontiers of Health Services Management - Spring 2014