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Valuing Diversity: Addressing Health Disparities Challenge Award
The challenges of COVID-19 have brought the crucial work of our nation’s scientists to the forefront and highlighted the need to address racial inequity in health care.
The PhRMA Foundation has established a new Challenge Award focused on finding solutions to racial health disparities. This Challenge Award aims to inspire bold and vital research on how value assessment can better capture evidence regarding diverse populations and drivers of health disparities.
We invite submissions based on bold and fresh ideas to advance methods and processes associated with value assessment (and/or value elements). The PhRMA Foundation seeks papers that describe solutions to the following question:
“How can value assessment methods and processes better account for populations that are typically underrepresented in research and drivers of health disparities?”
Letters of Intent are due December 1, 2020. See “Application Components” for full details.
The historic events of 2020 have brought significant public health and social challenges into stark relief.1 Unquestionably, the COVID-19 pandemic has magnified disparities in health status and health care access, which can be linked to upstream determinants such as a patient’s underlying socioeconomic environment.2-4 Similarly, searing examples of social injustice have magnified an urgent need to improve health equity and invest in diversity and inclusion initiatives across various sectors.
The events of 2020 reflect systemic problems that demand a response from across the health care system. The persistence of serious health disparities and inequities in the U.S. raises the question of whether we have placed adequate value on eliminating them. This includes rethinking our conceptions of value, addressing everyday drivers of health inequities, and increasing representation of diverse populations in research, all of which affect how we make decisions about health care.
Value assessment provides a framework to evaluate and render decisions based on evidence on the outcomes of care relative to the costs. Yet, while research has advanced to study drivers of health disparities – including social determinants of health and structural inequities – there has been almost no overlap with empirical approaches to assess value. Taking health disparities and representation of diverse populations into account in value assessments is of particular importance in the US context, given the trends of rising income inequality5 and diversification of racial-ethnic demographics.6
As highlighted by health outcomes for patients with COVID-19,7 the impact of an intervention on outcomes and costs may differ across patients due to a variety of factors, many of which may relate to broader drivers of health disparities. Inadequately addressing health disparities and diverse representation of populations in value assessments can weaken the ability of value assessment to serve as an effective tool to support decisions around delivery and reimbursement of health care that drive patient-centeredness and health equity.
Recent events reinforce that we cannot understand value in health by examining health status, preferences, and health outcomes in a vacuum. Understanding the differential value of health interventions across populations, including populations that are typically underrepresented in research,8,9 can lead to value-based decisions that account for what matters to all patients, rather than relying on a subset of patients and imputing their values across a diverse population.
Researchers and other stakeholders should seize the opportunity to explore new methods and processes for value assessment to advance health equity. Bold new approaches are needed to better capture evidence regarding diverse experiences and perspectives in measuring the value of health interventions.
Examples may include, but are not limited to:
- Document examples in which available evidence on outcomes and preferences traditionally accounted for in value assessment –including clinical, health-related, and/or economic outcomes may not account for diverse perspectives
- Identify practical avenues through which underrepresented individuals can shape current value assessments
- Evaluate and identify solutions to improve existing value assessment methods and processes) that may inadequately address health disparities and underrepresented populations
- Evaluate ways that value assessment can be effectively directed to, or complemented by, evaluation of interventions to reduce system-level contributors to health disparities
- Identify the impact of systemic barriers (e.g., digital divide, institutionalized racism, workforce practices) on value
- Describe the data, information technology, or novel methods necessary for conducting value assessments of clinical interventions within underrepresented populations
- Examine non-clinical aspects of health care that contribute to disparities and their effects on value
- Evan Hill, Ainara Tiefenthaler, Christiaan Triebert, Drew Jordan, Haley Willis and Robin Stein. How George Floyd was Killed in Police Custody. The New York Times. 31 May 2020. Available at: https://www.nytimes.com/2020/05/31/us/george-floyd-investigation.html (Last accessed 07/25/2020)
- Merlin Chowkwanyun and Adolph L. Reed. Racial Health Disparities and Covid-19 – Caution and Context. NEJM 2020; 383: 201 – 203. DOI: 10.1056/NEJMp2012910. Available at: https://www.nejm.org/doi/full/10.1056/NEJMp2012910 (Last accessed 07/25/2020)
- Daniel S. Goldberg. Structural Stigma, Legal Epidemiology, and COVID-19: The Ethical Imperative to Act Upstream. Kennedy Institute of Ethics Journal. Available at: https://kiej.georgetown.edu/structural-stigma-covid-19-special-issue/. Updated 17 June 2020. (Last accessed 07/25/2020)
- Gehlert S. et al. Targeting Health Disparities: A Model Linking Upstream Determinants to Downstream Interventions. Health Aff (Millwood). 2008; 27(2): 339–349. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2494954/ (Last accessed 07/26/2020)
- Income Inequality. US Census Bureau. Available at: https://www.census.gov/topics/income-poverty/income-inequality.html
- Vespa J, Medina L, Armstrong D.A., Demographic Turning Points for the United States: Population Projections for 2020 to 2060. US Census Bureau. Rev Feb 2020. Available at: https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf
- The COVID Tracking Project. Available at: https://covidtracking.com/
- Recruitment of Underrepresented Study Populations. UCSF Participant Recruitment Clinical and Translational Science Institute. Available at: https://recruit.ucsf.edu/events/recruitment-underrepresented-study-populations
- Including Underrepresented Groups in Research: Challenges and Strategies for Recruitment. Oregon Clinical and Translational Research Institute. Updated August 2020. Available at: https://www.ohsu.edu/sites/default/files/2020-08/Underrepresented%20groups_VD%2008.25.2020.pdf
The PhRMA Foundation is committed to driving real change in health care delivery and recognizes the benefit of shared knowledge. Therefore, the Foundation has established a Value Assessment Research Network to encourage collaboration and dissemination of findings borne out of the program.
Recipients of all PhRMA Foundation awards under the Value Assessment Initiative will become members of the Network and be asked to participate in periodic calls or in-person meetings to discuss and drive advancement in the field.
The PhRMA Foundation will host a public forum in 2021 to highlight activities funded by this program. Awardees must be willing and available to present their winning papers at this forum.
Letter of Intent and Application Considerations
Evaluating the value of health care interventions is challenging. But, when designed well and used appropriately, tools that quantify the value of a health care treatment can inform decision-making for patients, providers and payers. There are several criteria to consider in developing solutions to drive high-quality value assessment.
Bold and Novel Approaches Challenge Awards are designed to push the envelope further on value assessment methods, such as “how value is derived,” “‘what influences value,” and the “who is affected by value assessment.” Challenge Awards should reflect bold and innovative ideas to improve value assessment methods and related designs.
Stakeholder Engagement A vital step to a successful shift toward a value-driven health care system is ongoing engagement with stakeholders. It is particularly important to incorporate patient perspectives and acknowledging that all individuals are future recipients of health care and are driving factors of high-quality value assessment. Recommendations for patient engagement processes are made available by the National Health Council.
Real-World Applicability All funded activities should generate resources, evidence or ideas that can be applied feasibly in the U.S. health care system. Variations in practice patterns or disparities in care (e.g., demographics, socioeconomic status and type of insurance) should also be acknowledged.
Review and Validation Research activities should be subject to systematic ongoing validation to ensure that accurate, truthful and non-misleading and reproducible findings are generated. Results should not be
disseminated until validated through expert review, with input provided by all relevant and qualified stakeholders. The process of review should be well-documented and accompany the dissemination of the results.
Patient-Centered Decision-Making Value assessment tools create opportunities to support patient-centered decision-making if patients and other stakeholders are able to review and customize value information based on that all potential consequences of care should be presented in a transparent and disaggregated form, such as in an “impact inventory table.”(Sanders 2016) Additionally, all criteria should be quantified and included in assessments if possible.
Addressing Uncertainty Tools or frameworks that assess care value should adequately explain and address all sources of uncertainty (e.g., in parameter selection, decision process, measurement) and conduct and present relevant sensitivity and scenario analyses.
Sanders GD, Neumann PJ, Basu A, et al. Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine. JAMA. 2016;316(10):1093- 1103. doi:10.1001/jama.2016.12195.
- Award opportunities are open to all individuals and organizations with a specialization in health economics, outcomes research, clinical sciences, health care evaluation, public health, health equity or related disciplines.
- Eligible applicants should be affiliated with an academic institution in the United States, U.S. patient group or organization focused on improving health equity in the U.S.
- Collaboration across stakeholder groups and fields of discipline is encouraged.
Recipients of Challenge Awards will be honored and asked to present their winning papers at a public forum in 2021. Awards will be given in the following amounts:
- The winner will receive $50,000
- The runner up will receive $25,000
- Third and fourth place will receive $5,000
The PhRMA Foundation will not support evaluations of specific health care interventions.
The award is a one-time award that is payable to an individual, shared among a team or an institution/organization. Award monies may be used as the recipient wishes – there are no restrictions imposed by the PhRMA Foundation. A 1099 will be issued for tax purposes.
“How can value assessment methods and processes better account for populations that are typically underrepresented in research and address drivers of health disparities?”
To apply for the PhRMA Foundation Valuing Health Equity Challenge Award, applicants must submit a letter of intent due December 1, 2020 @ 11:59 PM EST. Those whose submissions are selected will be notified by December 21, 2020 and asked to complete a full application.
To start a Letter of Intent, go to the proposalCENTRAL website at https://proposalcentral.com/. If you are a new user of proposalCENTRAL, follow the “CREATE ONE NOW” link under “Need an Account?” and complete the registration process. If you are already a registered user, login at https://proposalcentral.com/ with your username and password. If you have forgotten your password, click the “Forgot your Password?” link.
Once you are logged in, please click the “Professional Profile” tab at the top and complete steps 1-10 or update with current information including your CV or biosketch.
To start a Letter of Intent, select the “Grant Opportunities” tab and a list of applications will be displayed. Find “PhRMA Foundation” and click the Apply Now link next to the Valuing Health Equity Challenge Award to create your Letter of Intent.
Should you have questions regarding proposalCentral and the application system, please email firstname.lastname@example.org.
Letter of Intent Components
Your Letter of Intent (LOI) is due by December 1, 2020 @ 11:59 PM EST and includes:
- Descriptive title of proposed paper
- Proposed response to challenge question. The response should not exceed 600 words excluding Title and Figures.
- Names of other key personnel and their CV/biosketches (if applicable)
- Affiliated or participating institutions (if applicable)
Those whose submissions are selected will be notified by December 21, 2020 and asked to complete a full application. Full applications are due February 1, 2021 @ 11:59 PM EST.
You will return to proposalCentral to login at https://proposalcentral.com/ with your username and password. If you have forgotten your password, click the “Forgot your Password?” link.
- You may edit your contact information. You will not be able to edit your original LOI submission.
- Please upload your response to the challenge question in a paper suitable for publication, not to exceed 3,000 words excluding Title and Figures. (Note: At this time, we do not know which publication we will target to publicize our award winners.)
Award notification will be by March 1, 2021.
The PhRMA Foundation does not provide written reviews.
To download brochure click HERE. Please contact the PhRMA Foundation at email@example.com, or call 202-572-7756 for more information.