Presentation Abstract

Title: Future Directions for Achieving Health Equity in Preventive Services

Since the passage of the Affordable Care Act (ACA) in 2010, more than 20 million adults in the United States have gained health insurance coverage through the expansion of Medicaid to low-income adults and the provision of subsidized private coverage through insurance exchanges. The ACA has eliminated cost-sharing for effective preventive services, including screening for cancer, diabetes, and cardiovascular disease. The ACA has also bolstered the financial health of safety-net hospitals and community health centers.

These advances have made preventive services much more affordable and accessible, particularly for US adults who face the greatest disparities in preventive services. Importantly, African American and Hispanic adults and those with low incomes have benefited substantially from improved access to effective primary care that is essential to prevent and screen for cancer, diabetes, and cardiovascular disease.

This broader policy context provides an important framework for interpreting the Evidence Report on Achieving Health Equity in Preventive Services commissioned by the Agency for Healthcare Research and Quality for the Pathways to Prevention workshop. This report highlights the limited evidence from interventions focused on patients and providers to address disparities in preventive services. Some randomized trials have shown reduced disparities in cancer screening with patient navigators, but evidence is generally lacking for other interventions to reduce disparities in preventive services, especially for diabetes and cardiovascular disease. Future efforts to achieve health equity in preventive services should assess the impact of the ACA, while also learning from broader community-based interventions such as those implemented in Chicago and New York City and from the Medicare Advantage program.

About Dr. Ayanian

John Z. Ayanian is the inaugural Director of the Institute for Healthcare Policy and Innovation, which includes over 600 faculty members from 14 schools and colleges at the University of Michigan—where he is also the Alice Hamilton Professor of Medicine, Professor of Health Management and Policy, Professor of Public Policy, and a practicing general internist. Dr. Ayanian has led influential studies of access to care, quality of care, and health disparities related to race, ethnicity, socioeconomic factors, and insurance coverage. He currently leads a team of 15 faculty members conducting the federally-authorized 5-year evaluation of the Healthy Michigan Plan, which has expanded Medicaid coverage to more than 650,000 adults in Michigan. From 2014 through 2016 he served as an associate editor of The New England Journal of Medicine, and in 2016 he was elected to the Academy Health board of directors.

Dr. Ayanian is an elected member of the National Academy of Medicine and a Master of the American College of Physicians. He has received the John Eisenberg National Award for Career Achievement in Research from the Society of General Internal Medicine and the Distinguished Investigator Award from Academy Health. He earned his bachelor’s degree in history and political science from Duke University, his medical degree from Harvard Medical School, and his Master of Public Policy degree from the Harvard Kennedy School. He completed residency and fellowship training in primary care internal medicine at Brigham and Women’s Hospital and a postdoctoral fellowship in health services research at the Harvard School of Public Health.

Dr. Ayanian did not disclose any conflicts of interest for this workshop.