The work of the Raising the Bar project is based on a series of assumptions that informed the approach to this work and will be reflected in the project’s output.

Raising the Bar’s approach to developing principles:

  • Raising the Bar strives to develop principles that are:
    • Aspirational—principles will be bold, not just reinforce positive elements of the status quo.
    • Actionable—principles will be accompanied by steps to put them into practice.
    • Adoptable—principles will be compelling, tested with stakeholders who will lead uptake, and reference factors and incentives that may make adoption easier.
  • Raising the Bar rests on the work of pioneers and champions of health systems and other organizations have already done to advance equity, improve health, and enhance the health care experience of individuals and families. Raising the Bar strives to lift up past and ongoing successes and identify where more progress is needed.
  • Raising the Bar principles will be informed by a variety of evidence. This should not be limited to formal research or any single perspective (e.g., financial return on investment). The project will rely on a combination of rigorous research; the expertise and experience of our project participants (including direct outreach to individuals with lived experience and to advocates); and an understanding of new work that holds promise but is not yet formally documented.
  • Measurement is critical to raising the bar. Culturally appropriate measures should be adopted or developed to drive desired outcomes, integrated to the extent possible with measures and systems in routine use. These measures should be incorporated into payment and accountability strategies.

Raising the Bar’s view of the health system, and the project’s target for principles:

  • Raising the Bar principles will focus on the health-care sector as the actor, while widening the aperture of its scope of action. Examples could include closer coordination with other stakeholders, sectors, and groups to address social-risk factors and/or providing leadership in areas where it is most needed.
  • Many players have a role in assuring health and well-being, including those who provide and pay for physical health and mental health services; perform public health functions; and deliver social services. Health and well-being require more than quality health care—it requires all these players to be a part of the effort.
  • Even within the health care delivery system itself, there are a broad range of players, such as health plans, payers, small and large hospitals, urban and rural clinics, and community health workers. Within institutions, a diverse set of individuals and skills are critical. There is a role for all of these actors to play in raising the bar toward a health system that addresses the whole range of needs of individuals, families, and the places they serve—as well as making strides toward health equity.
  • Health care organizations are not alone in grappling with broader social and economic determinants of health—but they have a unique opportunity to identify and lead efforts to address these issues among various stakeholders.  Health care has direct relationships with those burdened by the health consequences of these conditions, has a history in contributing to these burdens, and is well positioned to change course in a way that benefits patients and communities.

Raising the Bar’s focus on health equity:

  • Achieving health equity requires concerted, proactive efforts to confront persistent inequities based on race, disability, gender, sexual identity, as well as other factors that affect health, well-being, and life experience.
  • COVID-19 has brought more public attention to the intersection of race, health, and economic status, reinforcing Raising the Bar’s focus on underlying systemic issues and the need to address health equity concerns.
  • Making fundamental improvements in our health system requires authentic and ongoing engagement of the individuals, families, and communities that are served, and their perspectives, experience and expertise must be affirmatively sought out and acted upon. Raising the Bar will ensure these groups play a meaningful part in these improvements.

Working Draft – as of January 27, 2021

These Assumptions will evolve as the project moves forward.