Issues for Improving Quality of Care for All Americans

Minorities Are the Emerging Majority
The U.S. Census Bureau reports that by midcentury, the United States will have no clear majority population group, but rather a rich mosaic of cultural, ethnic, and racial backgrounds. The nation’s current minority populations are emerging as the majority. This fundamental dynamic presents society with an urgent need for credible, objective, reliable data and minority expertise to inform a health-care infrastructure capable of reducing or eliminating health disparities and improving health-care quality for all, including at-risk ethnic and racial minorities. Today’s health system is not structured to accommodate such diversity, even as it struggles to incorporate innovations in genomics, proteomics, and new approaches to personalized medicine, prevention, treatment, risk assessment, and surveillance.

Minorities Must Participate in Health-Care Reform
The National Minority Quality Forum is committed to linking the disparities movement with the quality-of-care movement. Today’s performance-measurement and pay-for-performance systems are being implemented without input or feedback from minority stakeholders. These new systems are also being embedded in new health-information-technology infrastructures. Lack of minority participation in quality-of-care determinations is putting minority health at further risk and may increase disparities rather than reduce them.

Minorities Are Not Adequately Represented in Clinical Trials
Underrepresentation of minorities in clinical trials has resulted in science that is inadequate to support recommendations of effectiveness for minorities. Powering clinical trials with sufficient minority participants may be the greatest challenge in determining what constitutes effective and safe care.

Application Research Is Needed to Validate “Best Practices” for Minorities
Fostering cultural competency among health-care providers, educating and training tomorrow’s providers and health professionals, and implementing state-of-the-art technology are important issues for improving minority health status. However, there is a lack of fundamental applied science focusing on managing risk, implementing prevention programs, treating illness, and monitoring quality of care for racial and ethnic minorities. Performance and quality measures are being generalized and applied to minority populations without much-needed research.

The Health-Care-Financing System Must Be More Responsive to Human Variation
The current American health-care-financing system is normed to the current majority. Changes in population will demand fundamental changes in the system. Health plans will need to anticipate that their member base will become more diverse and that this diversity could bring with it differences in disease-risk profiles and treatment modalities. Pioneering drug companies will have to determine whether to continue relying on the traditional method of developing medications to answer the requisite safety and efficacy questions when current minorities become the collective majority. As government moves to manage costs and set standards for quality, it will have to remember its responsibility to the larger American community lest it institute policies that leave us ill prepared for our future.

Raising Minority Awareness Requires Minority Leadership
The National Minority Quality Forum is working to raise awareness in minority communities that they must participate in the national debate on health-care reform. Public- and private-sector leaders of performance-measurement and pay-for-performance programs must recognize and address the potential for increasing, rather than decreasing, disparities in the quality and safety of health and medical care. The Forum will work with quality-improvement leaders to participate directly in raising awareness of needed changes.