One of the considerations of Equity programs is the identification of the benchmark or best performing population. The easiest way to identify a group to measure against, and the method that is often used as a result, is to measure against the population served. This leads to health plans and other types of organizations measuring against the highest performing segment of their customer base. Can we see how this may not result in appropriate targeting of improvements or interventions?
Specifically, but not uniquely, in the health care space, the healthiest people served by the health plan may not be high performing against the population as a whole (the broader community). Therefore, in this example, community level statistical analysis should be leveraged wherever possible to improve quality across all the populations served. When determining the cohort distribution, criteria such as Race, Ethnicity, Language, Disability, Sexual Orientation, Gender Identity and Expression, Financial and Employment Opportunity, Quality of Housing, Access to Education, and other Social Determinants can be used in a multi-factor model.
Tiering performance results and then identifying common characteristics may be appropriate; however, it is sometimes appropriate to use geographic groupings that demonstrate similar patterns of access to resources or services. In deciding how to slice the population to apply improvement interventions, a rigorous data analysis strategy should be used.
Once we have our cohorts defined, an analysis of the barriers to full attainment must be undertaken. Whether this is through compilation of research performed by public/private institutions, feedback and survey of a sample of the cohort, or application of evidence based practice specific to the population profile, the interventions should be designed for the different groups differently.
Finally, the interventions or innovations used to improve the outcomes should always be designed to effect the measurement that was used to identify the disparity in the cohort. Many organizations and regulatory bodies dictate improvement goals or minimum performance standards but, in almost every case, improvement of any amount is rewarded. This may only be realized deep within your financials but it will always be met with a positive even if goals are not met.