An Equity Lens for Identifying and Addressing Social Needs Within Pediatric Value-Based Care.

Abstract

* Abbreviations: SDOH — : social determinant of health VBC — : value-based care Socioeconomic disparities in health outcomes have proven to be persistent in the United States. For example, the mortality rate for Black infants is twice as high as it is for white infants, and low-income children are more likely to experience developmental delays as compared with their peers.1 Emerging data reveal striking racial and socioeconomic inequities in coronavirus disease 2019 outcomes. Healthy People, the national framework for population health, has identified reduction of health disparities and achievement of health equity as crucial goals. However, despite substantial investments, the nation is no closer to achieving these key societal aims, with alarming evidence of widening health disparities in recent years.2 Over the past decade, the US health care delivery system has undertaken a large-scale transformation aligned with achieving the triple aim (improving quality, reducing costs, and enhancing experience of care).3 Pediatricians have made important investments in quality improvement, medical home certification, primary care redesign, and electronic health record adoption to advance these aims. The financing of pediatric care has also evolved with a rapid movement toward value-based care (VBC), whereby pediatricians receive incentives for lowering costs and improving quality. In 2016, approximately half of pediatricians participated in VBC, and that amount has likely increased in recent years.4 Pediatric VBC programs are often focused on addressing the social determinants of health (SDOHs) that strongly correlate with adverse physical, emotional, and … Address correspondence to Alon Peltz, MD, MBA, MHS, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard University, 401 Park Dr, Suite 401 East, Boston, MA 02215. E-mail: alon_peltz{at}harvardpilgrim.org