A decade of value-based payment policy has done little to reduce health inequity in the US. Despite modest successes in improving quality and cost efficiency, value-based models and alternative payment models can also unintentionally exacerbate inequities encountered by historically marginalized communities. [JAMA Network]

Although consensus about the need to reform payment policy around equity has grown, effective reforms must reconcile existing tensions between financial incentives and equity goals.1 For instance, holding clinicians accountable for total spending (a core mechanism for achieving cost-efficiency through value-based payment) could inadvertently discourage clinicians from caring for historically marginalized populations for whom spending can be more challenging to control.

Policymakers must systematically address such issues to translate moral imperative into policy reform. This Viewpoint presents a potential guiding framework of strategies that align payment model components with equity goals (eTable in the Supplement).

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