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Given the wide expansion of value-based payment (VBP) models in the United States, VBP can be a useful tool for reducing health inequities and advancing equity goals. VBP models provide more flexibility to address social drivers of health (SDoH); they provide services and care coordination that are not typically covered but may be particularly important for people experiencing worse outcomes due to socioeconomic status, race, ethnicity, or other factors.
However, some evidence suggests that the uptake of VBP models has lagged in marginalized populations, and that in some circumstances, VBP could exacerbate disparities. Consequently, many VBP models are now adopting a more intentional focus on equity, such as the Oregon Health Authority’s Coordinated Care Organizations 2.0 model and Supporting Health for All through Reinvestment Initiative. But addressing equity through VBP remains a nascent field with diverse approaches in use—with limited evidence on which approaches work or help avoid undesirable outcomes.