The Rising and Setting of Health Equity

Use of the term “health equity” gained momentum with the widespread adoption of value-based care principles in the early 2000s, though recognition of disparities in US health care is much older. The Institute of Medicine’s landmark report, Crossing the Quality Chasm, which became the foundation of the Triple Aim and modern concepts of health care quality and value, states, “The aim of equity is to secure these benefits [of the health system] for all the people of the United States.” Under that definition, equity in health care is a simple principle that most everyone agrees with. In fact, the Centers for Medicare & Medicaid Services (CMS) has recently stated that it has a goal of “ensuring exceptional care for all enrollees.”

Recent and longstanding research has provided evidence that the quality of health care that individuals receive in the US varies greatly by demographics, including socioeconomic status, education, rurality, age, gender, sexual orientation, race, and ethnicity. The more researchers look for health care disparities, the more disparities they find in life expectancy, hospital readmissions, surgery results, and other vital outcomes. A quick PubMed search of articles with the terms “health equity” and “cancer” reached an all-time high in 2024, yielding disparities discovered for cancer incidence, screening, and treatment outcomes.

The nation’s ability to recognize health inequities improved as it deployed value-based payment models, measured quality of care, and exchanged data to instill accountability. This evolution, combined with the dual, paradigm-shifting lenses of COVID and public examples of lingering society biases, such as within the justice system, spurred action to address health equity as a national priority.

Payers and health systems began to develop the technological infrastructure necessary to collect, track, and stratify health equity data in a meaningful way, and programs were developed to tackle the underlying issues head-on. By 2023, the Triple Aim had metamorphosed into the Quintuple Aim, with health equity as a prominent node. By the end of 2024, the nation’s ability to identify health care disparities and react to them was never stronger, despite the persistent, substantial need for improvement.

In 2025, federal programs and policies changed course to remove or replace all references to health equity or related concepts of social determinants of health (SDOH). A few examples include:

• CMS eliminated the Health Equity Index (HEI) reward factor in Part C and D Star Ratings (first applying a cosmetic name change and then removing the reward altogether).
• CMS stopped accepting health equity plans as part of the Enhancing Oncology Model (EOM), which were formerly required for program participants.
• Quality measures addressing health equity and social determinants of health (such as Hospital Commitment to Health Equity and Screening for Social Drivers of Health) were removed from major CMS hospital programs. The removal was attributed to a cost-benefit analysis that considered the measures not worth the cost.
• Previous commitments to explore race and ethnicity stratification and reporting for Federal Employee Health Benefits (FEHB) plans to support reporting in the Plan Performance Assessment program were removed from non-public guidance updates.
• Several race- and SDOH-focused improvement activities in the CMS Merit-based Incentive Payment System (MIPS), which physicians could undertake in their practices to meet program requirements, were removed from the list of options.
• CMS removed a health equity adjustment to quality benchmarks for accountable care organizations (ACOs) and changed “health equity” to “population” in documentation describing the adjustment for previous years.
• CMS renamed the AHEAD model from “Advancing All-Payer Health Equity Approaches and Development” to “Achieving Health Efficiency through Accountable Design” and significantly redesigned the program.

These changes represented an impactful reversal of focus and progress on health equity in value-based care, but they were not isolated changes; they occurred in the context of a broader elimination of health equity initiatives. For example:

• The United States Department of Health and Human Services (HHS) Office of Minority Health, whose mission was specifically “to improve the health of racial and ethnic minority populations and American Indians and Alaska Natives and eliminate health disparities,” announced a major reorganization and job cuts plan. 
• Other organizations that assisted in accruing national data on health of vulnerable populations will be shut down or restructured.
• Research related to health equity and SDOH are at risk of defunding or cancellation.
• CMS rescinded CMS Informational Bulletins (CIBs) and continues to defund Medicaid initiatives addressing health-related social needs.

In the private sector, some commercial and nonprofit organizations are still prioritizing and supporting health equity initiatives, while some are making language changes to de-emphasize equity in tandem with the policy changes. Importantly, the National Committee for Quality Assurance (NCQA), a leading measure developer and accreditation organization, has not dropped its push for race and ethnicity stratification of quality measure results. Aspects of health equity remain.

The stated rationales for why federal policies and programs have changed, and whether those rationales have any merit, are the subjects of an ongoing and fiery debate. Regardless of the reasons, these changes are sure to have a long-term impact on health equity in the US. The country’s focus on fixing health disparities has been slowed dramatically. Health providers and payers may find ways to advance health equity without mentioning the term “equity,” but if addressing inequities is truly the aim, it will be difficult to prove progress without an infrastructure for measuring disparities.

A hard lesson learned from the COVID era was that health disparities hide in plain sight as long as they remain unexamined. If health equity data are not intentionally measured, analyzed, and addressed with focused attention, then there will be no way to know whether care is truly being improved for all Americans.

About David Sloan, PhD

David Sloan, PhD, is an independent consultant and expert in health policy and strategy. Over his career, he has specialized in advising on topics connected to value-based payment, quality measurement, diagnostic coding, and market segmentation. Prior to transitioning to health care, he conducted doctoral and post-doctoral research in systems neuroscience.

About Tom Valuck, MD, JD

Tom Valuck, MD, JD, is the editor of Quality Outlook. He formerly led the Value-Based Care discipline for the Market Access team at Real Chemistry. He used research and strategic advisory services to help clients improve health and health care by assessing, responding to, and shaping the value landscape.

Tom is a thought leader on health care system transformation, focused on achieving better health and health care outcomes at a lower cost. His work includes facilitating the exploration of next-generation measurement and accountability models for health care delivery systems. He also helps clients develop strategies to achieve success within the value-based marketplace.