The historic events of 2020 – from the COVID-19 pandemic to a nation-wide reckoning with systemic racism – has brought renewed focus to the health care and access disparities prevalent in our society. These searing examples of social injustice have reinforced the urgent need to improve health equity and invest in diversity and inclusion initiatives across various sectors of America’s health care system.
Value assessment provides a framework to evaluate and render decisions based on evidence of the outcomes of care relative to the costs. But it is becoming increasingly clear that we cannot fully understand value in health by examining health status, preferences, and health outcomes in a vacuum. While research has advanced to study drivers of health disparities – including social determinants of health and structural inequities – this area of study has had limited overlap with empirical approaches to assess value.
The persistence of serious health disparities and inequities in the U.S. – which have been further magnified by the pandemic and can be directly linked to upstream determinants, such as a patient’s underlying socioeconomic environment – raises the question of whether we have placed adequate focus on eliminating them. Answering this crucial question will require the value assessment community to rethink our conceptions of value, more acutely identify and address everyday drivers of health inequities and increase representation of diverse populations in research – all of which affect how we make decisions about health care.
The PhRMA Foundation’s Approach
For the past several years, the Pharmaceutical Researchers and Manufacturers of America (PhRMA) Foundation has made it a priority to support research that promotes the development of advanced value-assessment methods to empower decision makers with better tools to assess high- and low-value care in the U.S. health system. Through the Value Assessment Initiative, the Foundation funds new research and innovative efforts to assess the value of medicines and health care services, improve patient outcomes and reduce inefficiency. Currently, the initiative supports four academic Centers of Excellence and annual funding opportunities via our Challenge and Research awards programs that support the work of individual researchers who make contributions to this important area of scholarship.
But the value assessment community must do more to take health disparities and representation of diverse populations into account, especially given the trends of rising income inequality and diversification of racial-ethnic demographics.
To meet this need, the Foundation launched a new addition to our annual challenge award program: Valuing Diversity: Addressing Health Disparities. This program aims to solicit research proposals that evaluate how the value assessment field can better serve diverse populations and address the drivers of health disparities. We’re asking candidates to submit papers which advance solutions to the following research question:
How can value assessment methods and processes better account for populations that are typically underrepresented in research and drivers of health disparities?
Understanding the differential value of health interventions across populations, including populations that are typically underrepresented in research, can lead to value-based decisions that account for what matters to all patients across cultural and life experience spectrums, rather than relying on a subset of patients and imputing their values within a diverse population.
As highlighted by health outcomes for patients with COVID-19, 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 promote patient-centeredness and health equity.
The PhRMA Foundation believes that the research community can lead the effort to advance solutions to health inequities by seizing the opportunity to explore new methods and processes for value assessment that that are inclusive of all patient communities. Bold new approaches are needed to better capture evidence regarding diverse experiences and perspectives in measuring the value of health interventions.
Members of the value assessment research community who are interested in applying for the new challenge award should review the award brochure for more information, application instructions, and a list of example topics. Initial letters of intent are due by December 1st, 2020. Please visit www.phrmafoundation.org or call 202-572-7756 for more information.