Table 3.

Brainstorming Themes Regarding Economics and Policy, as Discussed at the 2017 Starfield Summit

Themes of Starfield Summit Participants' Discussion on Economics and PolicyRepresentative Statements from Group Discussion Reflecting Theme
Health equity research should move from studying disparities and toward implementing solutions.“Individuals and systems are frustrated about collecting health disparity and health equity data without established evidence-based mechanisms with which to act on data.”
“The field of implementation science provides a conceptual framework to take existing knowledge about health disparities and demonstrate interventions that promote health equity.”
“Health equity policies should be driven by attainable patient-oriented outcomes.”
Health equity interventions should balance both individual and community-level risk factors.“Individuals living in the same zip code can have vastly different social determinants of health.”
“Care decisions should be informed by both immediately ascertainable individual medical data and historical community-level public health data.”
“Real-time public health data streams could make social determinants data more relevant and actionable.”
Solutions to address health equity should use a team-based approach.“Individuals from the community, as health workers, have the potential to understand community needs and effectively connect patients with resources.”
“We need to think about expanding the workforce to address SDHs… . Data from HealthLeads shows that one-time passive referrals are much less successful than ongoing coaching.”
“Electronic health records limit data-sharing between systems, but understanding how individuals use various sectors [eg, clinic vs. hospital] is crucial to coordinate care.”
Health care payments should be risk-adjusted for sociologic data.“Enhanced payment models need to incorporate a marker for social complexity and its impact on health outcomes.”
“Centers for Medicaid and Medicare and other private groups are exploring how to operationalize socioeconomic status in healthcare payments.”
“Other countries' [eg, New Zealand, United Kingdom] experiences with social deprivation index-linked payment adjustments could inform US interventions.”
Redistributing payments from health care to the social service sector supports health equity work.“Primary care clinics may not be the ideal location to address social determinants of health, despite the fact that primary care intimately interacts with the social issues that affect peoples' lives.”
“The social services and primary care health system must work in collaboration to gather health equity data and subsequently act upon social determinants.”
“Enhanced payment models for social complexity should pay for appropriate health care and appropriate community-based services.”
Alternative payments for health equity work in primary care should be pursued.“Alternative payment models will increasingly hold health care delivery organizations accountable for social factors outside of the clinical setting, which may produce dangerous disincentives to care for socially disadvantaged patients.”
“Innovative financing mechanisms, such as social impact bonds and benefit corporations, may provide avenues for private-sector investment in health equity.”
“Future ideas should focus on creating public-private partnerships and incentivize these relationships for private companies.”
Primary care should influence political structures that heavily impact health equity.“Globally, there appears to be a threat from government structures to move health systems away from people-centered services.”
“Our system needs leaders who embody the ethics of equity and this may involve addressing political realities.”
“We need to move beyond a profit-driven system to one that is rooted in morality.”
  • SDH, social determinant of health.