Health equity gets a scorecard: IHI’s new plan to standardize disparities data

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"Advancing Health Equity: An Approach to Systematically Identify and Evaluate Health Disparities" © IHI

The Institute for Healthcare Improvement (IHI) has released a new framework designed to help health systems consistently measure and address health disparities. Titled "Advancing Health Equity: An Approach to Systematically Identify and Evaluate Health Disparities," the white paper outlines a four-step method that aims to establish an industry standard for equity measurement across health care settings.

“At IHI we often say, ‘measure what matters,’ and this framework provides a first-of-its-kind process for health care organizations to identify inequities in patient populations and measure efforts to reduce them,” said Sylvia Trent-Adams, Ph.D., RN, president and CEO of IHI.

The framework, developed with input from more than 35 experts through IHI’s Health Equity Accelerator, responds to what the organization calls a long-standing gap in standardized methods to quantify inequities. The release comes as federal and state regulators increasingly require hospitals and insurers to stratify quality data by sociodemographic characteristics.

The four-step approach

The IHI model breaks health equity measurement into four sequential steps:

1. Identify and prioritize a focus area, population, and metrics.
2. Determine stratification attributes including race, ethnicity, language, and disability status.
3. Choose reference points to evaluate disparities against peer or benchmark groups.
4. Quantify and characterize disparities using both statistical and contextual significance.

According to the report, each step is adaptable for use in hospitals, clinics, payers, and community-based organizations. The goal, said IHI Senior Project Director Nikki Tennermann, is to turn “fragmented data into measurable outcomes,” enabling benchmarking across systems.

The white paper also includes guidance for combining quantitative data with community input, emphasizing that equity cannot be achieved through metrics alone. Organizations are encouraged to consult with patient and community representatives to assess the real-world meaning of identified disparities.

Beyond compliance

While many health systems already stratify data to meet requirements from the Centers for Medicare & Medicaid Services (CMS) and The Joint Commission, IHI’s framework emphasizes the need for shared standards and consistent application.

The framework aligns with emerging state programs like Massachusetts’ Hospital Quality and Equity Incentive Program and California’s Hospital Equity Measures Reporting Program, both of which link funding or reporting requirements to equity performance.

Scott Cook, Ph.D., co-director of the “Advancing Health Equity: Leading Care, Payment and Systems Transformation” program at the University of Chicago, said the framework can help “turn inequities into action, transforming insights into better care, reduced suffering and saved lives.”

The approach builds on prior IHI initiatives, including the “Framework for Health Care Organizations to Achieve Health Equity” and the “Rise to Health Coalition,” which advocate integrating equity into every level of care delivery and governance.

The business case for equity

Beyond ethical and regulatory imperatives, the IHI paper outlines a strong economic rationale for health equity. Deloitte estimates that disparities cost the U.S. $320 billion in 2021 and could exceed $1 trillion by 2040.

Reducing inequities, the report argues, can lower costs, improve workforce productivity, and strengthen a health system’s long-term sustainability.

“We encourage health care organizations to adopt this measurement approach to help drive transformational change in understanding and eliminating health disparities,” Trent-Adams said.

Measuring equity, IHI adds, is not only a compliance issue but a driver of quality improvement and financial resilience.