Think Tank Unveils Strategy for Improving Health Care for Uninsured, Low-Income Americans

A new set of strategies could dramatically improve how the U.S. health care system serves vulnerable populations, Americans who are uninsured, low-income, or members of racial and ethnic minority groups.

According to the new report released today by the Commonwealth Fund Commission on a High Performance Health System, Ensuring Equity: A Post-Reform Framework to Achieve High Performance Health Care for Vulnerable Populations, closing the health care divide will require a three-pronged policy framework. This kind of organization will help to ensure adequate access to health care and financial protection, strengthen the health care system’s ability to serve vulnerable populations, and supports coordination between the traditional health care system and the resources outside of the health care system that vulnerable groups rely upon.

The report highlights the significant divide between vulnerable populations and their more secure counterparts in rates of receiving recommended screening and preventive care. It also underscored disparities in control of chronic diseases and hospital admissions for conditions that may be preventable with good primary care and community health outreach. For example:

• Just four of 10 low-income adults receive all recommended screening and preventive care, compared with six of 10 higher-income adults.
• Nearly three of 10 (29%) uninsured adults diagnosed with diabetes do not have it well controlled, twice the rate of the insured (15%).
• Black adults are hospitalized for heart failure at rates (959 per 100,000) more than twice the rate for Hispanic adults (466 per 100,000) and nearly three times the rate for white adults (349 per 100,000).

“Our current economic situation has increased the number and proportion of people who are vulnerable, leaving even more families at risk of suffering from our health care system’s inequities,” commission chair David Blumenthal, MD, said in a statement. “The recommendations in this report can encourage policymakers to focus on the unique issues facing these populations and work toward creating a high performance health system for all,” said Blumenthal, a professor of medicine and professor of health care policy at Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School.

The 17-member commission laid out a policy framework that builds on Affordable Care Act reforms to create a more equitable health care system. Highlights of the framework include:

• Create enough willing providers for Medicaid beneficiaries.
• Stabilize health insurance coverage.
• Limit out-of-pocket health care costs.
• Ensure the financial stability of the safety net while stimulating higher performance.
• Promote greater clinical integration in safety-net care systems.
• Focus on comprehensive, coordinated, team-based primary care for all providers serving vulnerable populations.
• Foster an infrastructure of community-based support services.
• Align efforts between the health care delivery system and public health services.

SourceCommonwealth Fund Commission on a High Performance Health System Releases Strategy for Improving Health Care for Uninsured, Low-Income, and Minorities in the U.S. [Commonwealth Fund]