Making a Business Case for Reducing Racial and Ethnic Disparities in Health Care

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Abstract

Racial and ethnic disparities in health care are an important problem, for affected individuals, caregivers, and society at large. Numerous remedial efforts have been launched, including the Finding Answers program of the Robert Wood Johnson Foundation (RWJF). Reform calls for documenting disparities, developing and disseminating information about effective remedies, and generating supportive business cases for improvement. This brief report focuses the need for business cases, which are harder to build than might at first appear, as shown by a literature scan and interviews with entities working to reduce disparities under RWJF grants.

Introduction

The persistence of racial and ethnic disparities in American health care is an important problem for society, for medical caregivers, and of course for the people disadvantaged.¹ Numerous remedial efforts have been launched, including the Finding Answers program of the Robert Wood Johnson Foundation (RWJF),² along with other public and private initiatives.³ Central components of the disparities-reform agenda are

• documenting the existence of consequential disparities in treatment or results;
• developing and disseminating information about interventions that successfully reduce disparities in care or improve the quality of care for minority patients; and
• generating supportive business cases for improvement.

This brief report focuses upon the third aspect of building the case for change—the need for disparities-policy innovators and researchers to create business cases that support useful interventions across a wide variety of caregivers and health plans. The core idea is that ways are needed to encourage caregivers and related organizations to spend the time, effort, and money needed to make effective improvements. Thus, this report does not address the difficulties in obtaining solid evidence of significant health improvements for disadvantaged populations, which is arguably the central thrust of RWJF's Finding Answers program.⁴ We address the issues and challenges in developing the business case for ongoing implementation of improvements that are found to be effective in improving clinical processes or outcomes.

Our report draws in part upon information and insights developed as we assessed ways to help improve the operations of Finding Answers and its national program office (NPO) at the University of Chicago.⁵ Finding Answers projects address disparities in caring for three chronic conditions—cardiovascular disease, depression, and diabetes—which are rather common, have great impact on patients' lives and on heath care spending, and whose care is believed to feature wide disparities yet relatively clear standards of care.⁶

The goal of this report is to make suggestions about future activities under the Finding Answers program that affect business-case development, as well as to illustrate more general lessons with specifics from early program experience. We seek to lay out the issues involved in establishing a case for wider adoption of promising health care interventions. Developing good business cases is an important aspect of developing the "practical blend of strategies and interventions that work to measurably reduce" disparities [emphasis added], which is the goal of Finding Answers.⁷

(End of excerpt. The entire brief is available in pdf format.)

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