Achieving health equity demands a systemic transformation of the healthcare system. Policies and practices must be examined through an equity lens to detect and address disparate impacts.
A critical area in need of reform is healthcare payment. To advance health equity in primary care, substantial changes are necessary in payment models and investment levels. Specifically, transitioning from fee-for-service paradigms to value-based arrangements is crucial for establishing primary care as a more equitable service.
Health equity efforts also entail intentional actions to eliminate access barriers and allocate resources based on need. To this end, integrated care plays a crucial role in improving access to behavioral health services, fostering engagement in care, and reducing stigma. This is particularly critical for marginalized populations, where integration serves as a key strategy for addressing health disparities stemming from factors such as race, ethnicity, sexual and gender diversity, and geographic location.
Psychologists assume pivotal roles in advocating for these systemic changes and others to ensure the integration of health equity into healthcare systems. Serving as educators, consultants, and policy influencers, psychologists champion and lead system transformations, dismantling inequities, and embedding health equity into the fabric of healthcare organizations.
This post offers a curated collection of articles, toolkits, white papers, and/or other resources related to policy and advocacy strategies for fostering health equity.
Addressing Healthcare Finance Disparities
Articles
DeMeester, R. H., Xu, L. J., Nocon, R. S., Cook, S. C., Ducas, A. M., & Chin, M. H. (2017). Solving disparities through payment and delivery system reform: A program to achieve health equity. Health Affairs, 36(6). https://doi.org/10.1377/hlthaff.2016.0979
Eschliman, B. H., Pham, H. H., Navathe, A. S., Dale, K. M., & Harris, J. (2023). The role of payment and financing in achieving health equity. Health Services Research, 58(Suppl 3), 311-317. https://doi.org/10.1111/1475-6773.14219
Publicly Available Resources
Center for Health Care Strategies. (2024, May). Building a health equity focus into value-based payment design: Approaches for Medicaid payers. https://www.chcs.org/media/Building-a-Health-Equity-Focus-into-Value-Based-Payment-Design-Approaches-for-Medicaid-Payers.pdf
Overview: This brief from the Center for Health Care Strategies provides actionable guidance for integrating health equity into Medicaid program and policy design through value-based payment (VBP) models. These models shift health care payments from fee-for-service systems that reward volume to approaches that incentivize high-value care. As Medicaid payers increasingly prioritize health equity in payment reforms, reducing health disparities demands collaboration across the health care sector. The brief outlines key strategies, including engaging communities in model design, embedding equity into payment requirements, creating performance-based incentives, leveraging data strategies, accounting for social risk factors, and offering technical assistance. It empowers payers, providers, and stakeholders to advance health equity, improve health outcomes, and manage costs within Medicaid.
Center for Health Care Strategies. (2024, May). Developing primary care population-based payment models in Medicaid: A primer for states. https://www.chcs.org/media/Developing-Primary-Care-Population-Based-Payment-Models-in-Medicaid-A-Primer-For-States.pdf
Overview: This toolkit offers state Medicaid programs practical guidance for designing and implementing primary care population-based payment (PBP) models to enhance primary care and promote health equity. PBP models provide upfront, prospective payments based on the number of patients served, rather than the volume of services performed, shifting away from fee-for-service systems to enable flexible, tailored care and effective population health management. By linking payments to both quality and cost, these models foster financial stability, improved health outcomes, and reduced disparities. Developed with support from the Commonwealth Fund and Arnold Ventures, the toolkit outlines critical design elements, including model goals, scope, payment structure, patient attribution, rate setting, and care delivery standards. It underscores the importance of stakeholder collaboration, addressing barriers faced by primary care providers, and aligning with other payers and models to build equitable, sustainable systems that benefit Medicaid patients.
National Academies of Sciences, Engineering, and Medicine. 2024. Response to the Centers for Medicare & Medicaid Services CY 2025 advanced primary care hybrid payment request for information. Washington, DC: The National Academies Press. https://doi.org/10.17226/27985
Overview: On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on policy changes for Medicare payments under the physician fee schedule, and other Medicare Part B issues, effective on or after January 1, 2025. The announcement included a description of the proposed advanced primary care management (APCM) services and a request for information (RFI) regarding the proposed changes to CMS’ advanced primary care hybrid payment. This report responds to select questions from both the APCM section of the proposed rule and the RFI.
The Primary Care Collaborative. (n.d.). Home. https://thepcc.org
Overview: The Primary Care Collaborative (PCC) is the leading national, nonpartisan, multi-stakeholder organization dedicated to improving the health and wellbeing of all Americans by advancing primary care. PCC brings together diverse stakeholders to champion innovative payment models and care delivery policies that foster the expansion of team-based, whole-person primary care. Through its advocacy and collaboration, PCC drives the adoption of sustainable payment systems that support health equity and high-quality care. The organization also provides free online training and resources to empower primary care professionals and stakeholders to address critical topics in advancing health equity.
Healthcare Access
Articles
Berge, J. M., Trump, L., Trudeau, S., Utržan, D. S., Mandrich, M., Slattengren, A., Nissly, T., Miller, L., Baird, M., Coleman, E., & Wootten, M. (2017). Integrated care clinic: Creating enhanced clinical pathways for integrated behavioral health care in a family medicine residency clinic serving a low income, minority population. Families, Systems, & Health, 35(3), 283–294. https://doi.org/10.1037/fsh0000285
Bogucki, O. E., Mattson, A. B., Leasure, W. B., Berg, S. L., Mulholland, H. L., & Sawchuk, C. N. (2021c). Adaptations of an integrated behavioral health program during COVID-19. Cognitive and Behavioral Practice, 28(4), 481–491. https://doi.org/10.1016/j.cbpra.2021.01.006 or https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983459/pdf/main.pdf
Farber, E. W., Ali, M. K., Van Sickle, K. S., & Kaslow, N. J. (2017). Psychology in patient-centered medical homes: Reducing health disparities and promoting health equity. American Psychologist, 72(1), 28–41. https://doi.org/10.1037/a0040358
Hodgkinson, S., Godoy, L., Beers, L. S., & Lewin, A. (2017). Improving mental health access for low-income children and families in the primary care setting. Pediatrics, 139(1), e20151175. https://doi.org/10.1542/peds.2015-1175 or https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192088/pdf/PEDS_20151175.pdf
Joseph, H. L., Zhang, L. F., Best, C., Bancroft, C., James, M., Kapoor, S., Drescher, C. F., & Davis, C. L. (2024). Child mental health treatment access and retention in integrated primary care and traditional outpatient services. Journal of Pediatric Psychology, 49(10), 689-699. https://doi.org/10.1093/jpepsy/jsae057
Ogbeide, S. A., Landoll, R. R., Nielsen, M. K., & Kanzler, K. E. (2018). To go or not go: Patient preference in seeking specialty mental health versus behavioral consultation within the primary care behavioral health consultation model. Families, Systems & Health, 36(4), 513–517. https://doi.org/10.1037/fsh0000374
Possemato, K., Johnson, E. M., Beehler, G. P., Shepardson, R. L., King, P., Vair, C. L., Funderburk, J. S., Maisto, S. A., & Wray, L. O. (2018). Patient outcomes associated with primary care behavioral health services: A systematic review. General Hospital Psychiatry, 53, 1–11. https://doi.org/10.1016/j.genhosppsych.2018.04.002
Scafe, M. J., Mapes, A. R., Guzman, L., E., & Bridges, A. J. (2021). Rural versus urban primary care patients’ behavioral health needs and service utilization. Journal of Rural Mental Health, 45(4), 268-280. https://doi.org/10.1037/rmh0000178
Walter, H. J., Vernacchio, L., Correa, E. T., Bromberg, J., Goodman, E., Barton, J., Young, G. J., DeMaso, D. R., & Focht, G. (2021). Five-phase replication of behavioral health integration in pediatric primary care. Pediatrics, 148(2), e2020001073. https://doi.org/10.1542/peds.2020-001073. https://doi.org/10.1542/peds.2020-001073 or https://publications.aap.org/pediatrics/article/148/2/e2020001073/179806/Five-Phase-Replication-of-Behavioral-Health?autologincheck=redirected
Publicly Available Resources
Kona, M., Clark, J., &Walsh-Alker, E. (2023). Improving access to primary care for underserved populations: A review of findings from five case studies and recommendations. Milbank Memorial Fund. Retrieved from https://www.milbank.org/publications/improving-access-to-primary-care-for-underserved-populations-a-review-of-findings-from-five-case-studies-and-recommendations
Overview: This report discusses how expanding the number of non-physician clinicians and other medical staff on a team can improve access to primary care for underserved populations, particularly in the face of a primary care provider shortage.
Becoming a Policy Influencer
Articles
Alexander, A. A., & Allo, H. (2021). Building a climate for advocacy training in professional psychology. The Counseling Psychologist, 49(7), 1070-1089. https://doi.org/10.1177/00110000211027973
Cohen, K. R., Lee, C. M., & McIlwraith, R. (2012). The psychology of advocacy and the advocacy of psychology. Canadian Psychology/Psychologie canadienne, 53(3), 151-158. https://doi.org/10.1037/a0027823 or https://www.apa.org>pubs>journals>features>cap-53-3-151.pdf
Publicly Available Resources
American Psychological Association. (2015). Legislative issues and advocacy training tools. https://www.apa.org/apags/resources/advocacy/toolkit?tab=2
Overview: The toolkit highlights legislative issues impacting students, the psychology profession, and recipients of psychological services. It provides strategies for enhancing psychologists’ advocacy skills and competencies while promoting broader psychopolitical literacy.
American Psychological Association, Services, Inc. (n.d.). Psychologist’s guide to advocacy. https://www.apaservices.org/advocacy/get-involved/guide
Overview: This site offers resources to help you understand the policy process, engage effectively with elected officials, and conduct successful advocacy meetings. It also provides direct access to the APA Services advocacy team for personalized guidance via email.
Powell, W., Adames, H.Y., Lewis, J.A., Mosley, D.V., Chavez-Duenas, N., Anderson, R., & Neville, H. (2021, February). Breath, eyes, memory: Transforming health systems and advancing public health policies for radical healing. UConn Health Disparities Institute. http://h.uconn.edu/hdi
Overview: This report outlines five guiding principles for transforming health systems entrenched in racism into models that promote radical healing and equity for all. It emphasizes the need to confront unaddressed racial trauma, reimagine health systems and policies with intentionality, and prioritize justice and atonement to achieve meaningful progress toward health equity.
