Integrating Health Equity into Health Cost Containment Efforts 

Focus Area:
Sustainable Health Care Costs
Health Equity Peterson-Milbank Program for Sustainable Health Care Costs

Large shares of people with health insurance say that they cannot afford needed health care, according to a new affordability report from the Commonwealth Fund that offers policy recommendations for each insurer type. Delays in receiving care or missed care due to costs is making them sicker, the survey finds.

Other research finds ongoing disparities in health outcomes among certain populations. As Bailit Health reported last year, state health care cost growth target programs not only provide insight into cost growth drivers that make care unaffordable but also can incorporate health equity considerations into their design, analysis, and reporting. Today, we share updates from three states that have recently updated and integrated their health care affordability and equity strategies and discuss how the federal AHEAD Model offers new health equity opportunities. 


In 2023, Oregon’s Cost Growth Target Advisory Committee established a Cost & Equity Workgroup that has drafted a Cost and Equity Framework to organize recommendations on opportunities to integrate equity into health care cost containment efforts throughout the Cost Growth Target Program cycle.  

The framework summarizes past and current activities related to health equity and provides a menu of potential opportunities for various stakeholders including the legislature, the advisory committee, the Oregon Health Authority, health plans, and provider organizations. These options include building equity into the cost growth target statute, engaging with tribes and TRICARE to voluntarily provide data, stratifying data from cost driver analyses by demographics, geography, income, and insurance status, and using health equity impact assessment tools. The Cost & Equity Workgroup will continue to refine and build on this draft framework in 2024. 

Rhode Island 

In Rhode Island, the Public Health and Health Equity Measures Work Group was charged with selecting public health and health equity accountability measures and developing approaches to analyzing and publicly reporting performance against the state’s public health improvement goals. In October 2023, the work group recommended six measures to the Cost Trends Steering Committee. They suggested that the following measures be reported at the state level, with either a total population target or a target focused on reducing inequities: 

  1. Adults without a usual source of care 
  2. Childhood obesity  
  3. Fatal overdoses 
  4. Inadequate prenatal care 
  5. Infant mortality rate 
  6. Severe maternal morbidity   

The work group recommended that the Office of The Health Insurance Commissioner evaluate and report performance on the recommended measures in the spring when it publishes the annual report on the cost growth benchmark and quality measures. Additionally, the work group recommended an annual review of the measure specifications to keep up with changes in data collection and reporting methodologies.  


In September, Massachusetts released a new dashboard that will report performance on health equity measures along with health care cost trends data annually. The interactive dashboard measures affordability, health care utilization, and health outcomes disparities by race and ethnicity and income, comparing Massachusetts’ performance to previous year and relative to national performance.  

AHEAD Model 

In addition to state efforts to integrate health equity into health care affordability efforts, in September 2023, the Centers for Medicare & Medicaid Services announced the States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD Model), a state total cost of care model that tests state accountability for health care cost expenditures and growth while increasing investment in primary care. The AHEAD Model Health Equity Strategy includes:  

  • developing state health equity plans and quality targets, 
  • enhancing partnerships between states, providers, and the community, 
  • increasing safety new provider recruitment, 
  • Using social risk adjustment for provider payments, 
  • Utilizing health related social needs screening.  

In October, Milbank hosted a webinar to explain the AHEAD Model to interested stakeholders. A recording of the webinar is available.