Health Law Daily Wrap Up, HEALTH CARE REFORM NEWS: ASPE shares tool to assess successes in equity policies, (May 20, 2024)
By Jody Coultas, J.D.
The tool presents scenarios to help illustrate the difference between outcomes and indicators, including indicators to monitor the extent to which the design and implementation of an equity initiative reflects the perspective of lived experience partners.
The Department of Health and Human Services Assistant Secretary for Planning and Evaluation (ASPE) has shared a tool for private and public health and human services partners that can be used to measure the progress and success of efforts to advance equity in policies, practices, and programs. It is intended to increase the effectiveness of health and human services programs for all, including implementing efforts to ensure equitable outcomes. The tool provides examples of short-, medium-, and long-term outcome scenarios (ASPE Report, May 14, 2024).
To address inequities in policy and program outcomes, health and human services programs can work to make their grantmaking, research, program delivery, and policymaking more equitable by: (1) Addressing structural and systemic barriers and factors contributing to inequitable access and opportunity; (2) Assessing and changing policies, programs, and practices to create more opportunity; (3) Shifting internal culture, resources, and approaches to be more inclusive; and (4) Institutionalizing a focus on equity by building related internal capacities.
Getting started. At the outset, the ASPE urged groups to address underlying drivers of inequity before trying to measure outcomes. The tool suggests conducting a needs assessment of individuals and communities with inadequate access to the services that includes a root cause analysis to identify underlying issues contributing to inequities. A needs assessment is the process of identifying the current conditions for the individuals and communities the group seek to serve, the desired conditions or outcomes, and the gap or distance between the current and desired states. A root cause analysis helps ensure that efforts are relevant and central to the inequities the group is attempting to mitigate, while also recognizing community and individual strengths. The ASPE also suggests reflecting on the environment, or facilitating conditions, of the organization, and provides several questions to facilitate that discussion.
Also, groups implementing this tool should consider how to engage people with lived experience, which will provide insights to inform policies and programs. A lived experience is knowledge based on an individual’s perspective, personal identities, and history, beyond their professional or educational experience.
Finally, the ASPE suggests creating a theory of change to conceptualizing plans and a logic model that clearly outlines equity-related outcomes. A theory of change articulates assumptions about how change will happen. A logic model helps you operationalize the theory of change at a tactical level.
Indicators and measurement approaches. Groups using this tool should then develop and implement a plan to monitor progress. If equity is measured in the context of a specific program, it may be helpful to consider how measures fit into the different steps in a participant’s experience of the program, such as: ability to access and enroll in programs; ability to receive timely and adequate benefits and services; and whether participants achieve expected program outcomes.
Which equity-related outcomes to measure will directly relate back to an initiative’s theory of change and logic model, and may include improvements in outcomes for groups served that have disparities in those outcomes compared to other groups and measuring internal and external factors.
To monitor progress, identify indicators that demonstrate progress towards an outcome. Indicators are evidence that the initiative is on-track for success. These indicators should be specific, observable, and measurable. Outcomes and their indicators should tie back to the initial need identified before the measurement phase and the associated actions taken to address the need.
Short-term outcomes are immediate changes, often those within the organization that occur within weeks or months, as well as simple external-facing changes. Medium-term outcomes refer to intermediate or prerequisite changes within or outside the organization’s policies and programs that occur within months and years. Long-term outcomes are desired impacts internal or external to the organization that may take years or decades to occur.
IndustryNews: NewsStory HealthCareReformNews GeneralNews HealthReformNews QualityNews