Providers using data and partnerships to address health inequity in 2022
The pandemic has taught healthcare providers a lot about how they fall short when it comes to quality and access. This insight is influencing how facilities are preparing to tackle long-standing issues of inequity among the populations they serve.
“COVID-19 has broken apart and shined a spotlight on these deep fractures in our society and the general inequity in our healthcare that has reinforced the need for all of us to radically transform the concept of community health,” said Danielle Dang, medical director for implementation and new markets at City Block.
To overcome disparities and provide equal access to testing, vaccines and treatment, healthcare professionals attempted to meet residents of vulnerable, underserved and marginalized communities where they are.
Many health systems have tailored their language to be culturally and linguistically appropriate when educating individuals about vaccine efficacy, and have set up mobile vaccination efforts, drive-through clinics and mass vaccination sites, said Maryellen Guinan, principal policy analyst at America’s Essential Hospitals, the lobbying group for safety-net hospitals. Others have expanded walk-in appointment availability and extended facility hours to be more easily accessible, she said.
Even so, the pandemic nevertheless worsened chronic illnesses and conditions such as diabetes and cancer due to patients deferring care, Debbie Salas-Lopez, senior vice president of community and population health at New Hyde Park, New York-based Northwell Health.
“As a system, as a society, we’re only as healthy as the unhealthiest community member,” Salas-Lopez said.
Next year, providers will look to build on the successes they have notched with equity and access by engaging further with their communities, said Kalpana Ramiah, vice president of innovation and director of the Essential Hospitals Institute, an arm of America’s Essential Hospitals.The wall between a hospital and its community is very porous, and what happens on one side affects the other, Ramiah said.
Partnering with local organizations to actively address social determinants of health such as housing, food and transportation helps facilities mitigate public mistrust, build permanent relationships and develop long-term healthcare strategies, said Dr. Carol Horowitz, co-director of the Institute for Health Equity Research at Mount Saini’s Icahn School of Medicine in New York.
To better serve vulnerable populations, providers are beginning to work as a team with scientists, information technology and quality experts, as well as policymakers and industry stakeholders, Horowitz said.
Community leaders, schools and minority-owned businesses can also assist in implementing community-centric health and wellness interventions, Salas-Lopez said.
Relying on community members to identify needs and collaborate toward goals is critical to building trust, said Dr. Timothy Eberlein, an oncological surgeon at the Washington University School of Medicine’s Siteman Cancer Center in St. Louis.
“You can’t just swoop in with a great idea and some money and say, ‘Gee, I wanna do this,’ but then when the money runs out, the program closes and the community is left to fend for themselves,” Eberlein said. “It’s incredibly important that you develop a long-term strategy with each of these communities.”
Collecting more data about inequities in the healthcare system is a second key component for the next year.
Looking at genomic, clinical, demographic and other information will allow providers to deepen their understanding of socioeconomic factors and address patient vulnerabilities, said Dr. John Frownfelter, chief medical officer at Jvion, an artificial intelligence software vendor.
Generalizing problems and solutions without taking into account the unique experiences of individuals isn’t going to cut it anymore, Frownfelter said.
In collaboration with the Institute for Healthcare Improvement, the Commonwealth Fund is part of an initiative where the work between the hospitals and communities serves to identify specific targets for improvement, obtain better data and create a set of action plans, said Eric Schneider, senior vice president for policy research at the Commonwealth Fund.
These action plans will be led by hospitals’ executive leadership and chief equity officers hired to ensure operations are changed.
Most importantly, healthcare leaders must be held accountable to their pledges to foster equity.
This means ensuring efforts go beyond revising mission statements and conducting brief diversity trainings to developing inclusive recruitment protocols and actively intervening where inequities exist in communities, said Dr. Laurie Zephyrin, vice president for advancing health equity at the Commonwealth Fund.
Financial and regulatory pressures can be ways to motivate healthcare leaders to examine internal cultures, attitudes and beliefs and take remedial action, Zephyrin said.
Providers looking to address disparities will also need to promote public policies that would bolster their efforts One example of this is the extension of pandemic-era policies easing access to telehealth for Medicare and Medicaid beneficiaries, Schneider said. Access to technology, broadband and other resources necessary for telemedicine also are important components.
“Historically, Medicaid patients have been ignored by the healthcare system,” Dang said. “We know that they are more likely to be living in primary care deserts, where quality healthcare is really hard to come by, and face barriers such as lack of transportation and child care.”
Advocates also are pressing Congress to pass more components of the Black Maternal Health Momnibus Act that seeks to address poor outcomes for Black mothers and children. This month, President Joe Biden signed into law a portion of that package aimed at military veterans.
“These inequities have been generations in the making,” Horowitz said. “It’s not going to take us 2022 to fix them. We need to have some patience, and we have to keep at it.”