Why This Matters
Health care access, quality, and outcomes continue to vary between patients of different demographic backgrounds. It’s therefore important to identify appropriate and effective measures of demographic differences in health system performance, and harness these data to identify interventions and inform others of progress toward closing gaps. However, there is only limited research on whether metrics measure what matters for closing performance gaps, and whether accountability mechanisms exist to ensure these metrics make a meaningful change in health care inequities by patient race, ethnicity, language, and other key factors.
What We Found
The Urban Institute sought to fill these gaps with a research project to document health system stakeholders’ perspectives on the current landscape of health system performance measurement, approaches to identifying and addressing health inequities, and opportunities for improving transparency and accountability to all healthcare system stakeholders. Stakeholders in this study include health services researchers, health system administrators, clinicians, consumers and patients, health policymakers and regulators, insurers, and plan purchasers.
Key informants in this study urged that health system stakeholders frame the effort to improve health system outcomes for all – and particularly for those patients from groups that have historically faced barriers to accessing high-quality care – as efforts to close performance gaps.
Key informants in this study also wrestled with the concept of health system accountability. By accountability, study participants referred to the obligation of health systems, as well as entities that finance and regulate them, to take responsibility for evidence of performance gaps, commit to eliminating them, and be transparent about actions to address them and the outcomes of these actions.
To improve health system performance and eliminate gaps, key informants believed that all stakeholders should be engaged in helping to identify performance metrics, particularly to develop measurement approaches that work best for their specific contexts. Ultimately, however, stakeholders must strive to develop national, standardized, and validated measures of performance gaps that can be consistently applied across different health systems and plans.
Key informants believe performance data should be publicized in ways that key audiences – particularly consumers and payors – can understand, while providing context to avoid misinterpretation. Health care payers and regulators should work to align incentives and benchmarks to support closing of performance gaps. Key informants also saw promise in value-based payment models and other financial incentives that reward progress toward closing gaps, while properly accounting for and supporting efforts to ameliorate social risk factors.
How We Did It
To conduct this study, we interviewed 21 key informants between January and November 2025. Key informants were selected to represent a diverse group of stakeholders in health care, including health system administrators, accreditors, clinicians, health services researchers, consumer advocates, technical assistance providers, and health insurance plans. In addition, we invited interviewees to a virtual group discussion in November 2025; 13 of the key informants agreed to participate in the group discussion.
