EquiCare Toolkit

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). 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 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.

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: 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. 

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: 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.

The Primary Care Collaborative. (n.d.). Home. https://thepcc.org

Abstract: Payment systems generally do not directly encourage or support the reduction of health disparities. In 2013 the Finding Answers: Solving Disparities through Payment and Delivery System Reform program of the Robert Wood Johnson Foundation sought to understand how alternative payment models might intentionally incorporate a disparities-reduction component to promote health equity. A qualitative analysis of forty proposals to the program revealed that applicants generally did not link payment reform tightly to disparities reduction. Most proposed general pay-for-performance, global payment, or shared savings plans, combined with multicomponent system interventions. None of the applicants proposed making any financial payments contingent on having successfully reduced disparities. Most applicants did not address how they would optimize providers’ intrinsic and extrinsic motivation to reduce disparities. A better understanding of how payment and care delivery models might be designed and implemented to reduce health disparities is essential.

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

Abstract – Objective: The aim was to identify healthcare payment and financing reforms to promote health equity and ways that the Agency for Healthcare Research and Quality (AHRQ) may promote those reforms. Data Sources and Study Setting: AHRQ convened a payment and financing workgroup–the authors of this paper–as part of its Health Equity Summit held in July 2022. This workgroup drew from its collective experience with healthcare payment and financing reform, as well as feedback from participants in a session at the Health Equity Summit, to identify the evidence base and promising paths for reforms to promote health equity. Study Design: The payment and financing workgroup developed an outline of reforms to promote health equity, presented the outline to participants in the payment and financing session of the July 2022 AHRQ Health Equity Summit, and integrated feedback from the participants. Data Collection/Extraction Methods: This paper did not require novel data collection; the authors collected the data from the existing evidence base. Principal Findings: The paper outlines root causes of health inequity and corresponding potential reforms in five domains: (1) the differential distribution of resources between healthcare providers serving different communities, (2) scarcity of financing for populations most in need, (3) lack of integration/accountability, (4) patient cost barriers to care, and (5) bias in provider behavior and diagnostic tools. Conclusions: Additional research is necessary to determine whether the proposed reforms are effective in promoting health equity.

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