Value Champion

Module 1: High Value Care and Health Equity

Understanding the intersection between “value” and “equity” can inform conversations between value champions, leadership, and stakeholders, as well as inform early project planning activities. 

Overview 

A deep understanding of the concept of “value”  and “equity” within healthcare is needed if a value champion is to be effective in their work. In addition, understanding the intersection between value and health equity is critical because some patient populations may be more vulnerable to harm from overuse. Understanding the intersection between value and health equity will also help value champions avoid unintentionally exacerbating existing health or health care disparities or creating new disparities as during their overuse reduction efforts. Ideally, value champions will not only reduce low value care, but advance health equity at the same time.

Learning Objectives

1. Describe how health care value and health equity are connected and give an example.
2. Describe how the concept of ‘double jeopardy’ might contribute to health inequities in your setting when a low-value service is delivered.
3. Give examples of different types of potential harm that might be experienced by a patient who receives unnecessary care in your clinical setting and why some patients may be more vulnerable to harm.

Reading Assignments

Promoting Health Equity through De-Implementation Research

In this reading, you will find an explanation of how addressing health equity issues in your setting will require a focus on de-implementing low-value services, not just increasing the delivery of high-value care services.

• Citation: Helfrich CD, Hartmann CW, Parikh TJ, Au DH. Promoting Health Equity through De-Implementation Research. Ethn Dis. 2019;29(Suppl 1):93–96. Published 2019 Feb 21. doi:10.18865/ed.29.S1.93

Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments

This reading places the need to take action on de-implementing overused services squarely within the patient safety field. It describes 6 domains of patient harm from the delivery of a low-value care service and examples of each.

• Citation: Korenstein D, Chimonas S, Barrow B, Keyhani S, Troy A, Lipitz-Snyderman A. Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments. JAMA Intern Med. 2018;178(10):1401-1407. doi:10.1001/jamainternmed.2018.3573

Low-Value Medical Services in the Safety-Net Population

This article demonstrates that rates of low-value care delivery are similar for patients with no insurance or Medicaid compared to those with commercial insurance. In addition, when comparing clinicians in settings that provide care to vulnerable populations to those who were not, rates of delivery of low and high-value care were similar.

• Citation: Barnett ML, Linder JA, Clark CR, Sommers BD. Low-Value Medical Services in the Safety-Net Population. JAMA Intern Med. 2017;177(6):829–837. doi:10.1001/jamainternmed.2017.0401

Reducing low-value care among vulnerable populations

This blog post provides a clear rationale for why we need to focus on the delivery of low-value care in vulnerable patient populations, challenges you are likely to run into, and suggestions for how to create effective messages that will resonate with patients and providers.

• Citation: Chien A, Hasnain-Wynia R. Reducing low-value care among vulnerable populations. Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/hblog20190603.800067/full/

Resources

TAO Webinar: What is "Value" and Why Should We Take Action in the Safety Net?

Everyday Equity Lens

This resource describes the concept of an equity lens and provides a list of questions that are useful in applying that lens to decisions, programs and practices.

• Citation: Rachel DeMeester & Roopa Mahadevan. Using data to reduce disparities and improve health care quality: a guide for health care organizations. Advancing Health Equity White Paper.

An Implementation Guide to Reducing Overtreatment of Asymptomatic Bacteriuria

This is one of a series of articles in the JAMA “Less is More” series and provides a case study with practical strategies that can be used to reduce the use of a low-value care service. 

• Citation: Daniel M, Keller S, Mozafarihashjin M, Pahwa A, Soong C. An Implementation Guide to Reducing Overtreatment of Asymptomatic Bacteriuria. JAMA Intern Med. 2018;178(2):271–276. doi:10.1001/jamainternmed.2017.7290