May 10, 2023
In Disney’s Big Hero 6, the protagonist, Hiro Hamada, will get stuck in a problem after working on it for a while because he’s becoming too set in his way of thinking. And he is only able to find the solution thanks to his brother’s, Tadashi Hamada, words ‘find a new angle, look for another way out.’ Health inequality and discrimination is not a new problem in healthcare. It is a problem that people have been fighting for since the very beginning but we still have not found the solution to achieving health equity. So it might be time to listen to Tadashi and shake things up. Maybe by taking a step back and examining the problem in a new light and at a different angle can help us find the solutions we’ve been searching for.
To get that new angle, we reached out to our brilliant Healthcare IT Today Community to see what interesting angles they could think of to this problem. The following is their ideas. (Side Note: Be sure to check out Data’s Role in Health Equity and Technology and Health Equity as well)
Kimberly Hartsfield, Executive Vice President of Growth Enablement at VisiQuate
Shockingly, 58% of hospital bad debt comes from insured patients. While directly impacting the revenue cycle, it means those dollars aren’t available for clinical services. This highlights the dire need to address patient access to care. Even in large metropolitan areas, many individuals still lack adequate access to basic healthcare services, especially for mental health. While technologies such as telehealth offer a promising solution, we must continue striving to find more ways to effectively manage the revenue cycle to redistribute the available dollars where they count most. Then hopefully we’ll be able to provide care to every patient in need.
Colin Banas, M.D., M.H.A. Chief Medical Officer at DrFirst
We know that patients with chronic conditions who don’t take their medications as prescribed are more likely to have poor clinical outcomes. We also know that non-adherence to medication therapy can be exacerbated by social disadvantages such as access to transportation, language and literacy barriers, and economic obstacles. To support compliance with therapy and level the playing field for all patients, healthcare providers need access to patients’ medication history, including prescription fill data, so they can identify medication non-adherence on an individual and population level. Based on these insights, physicians, pharmacists, transitional care managers, and other clinicians can intervene with services that get patients back on track with their treatment plans.
Dr. Kyle Stanley, Chief Clinical Officer at Pearl
Mistrust in the medical system is one of the driving factors behind racial and ethnic disparities in healthcare. In order to achieve health equity, we must build a solid foundation of patient trust and communication. One way we can do this is by leveraging AI technology that provides objective insight and diagnostic support to providers. In dentistry, for example, chairside AI software has been instrumental in strengthening trust. In fact, a survey conducted by Pearl found that 71% of patients are more likely to trust their dentist’s diagnosis when their dentist is aided by AI software. This technology not only allows for more accurate diagnosis, but it also enables patients to better visualize what their providers are trying to communicate. Providers can use this insight to craft a treatment plan that is right for every patient. Healthcare isn’t one size fits all – every patient has different needs and circumstances. Implementing the right technology is a critical step in ensuring every patient stays engaged in their healthcare journey and receives individualized, equitable care.
Siva Namasivayam, CEO at Cohere Health
Providing equal access to quality care is the central tenet of health equity, a concept that has gained considerable traction in the last few years and has quickly become a priority for many healthcare organizations. Understanding a patient’s healthcare journey is crucial for improving outcomes, yet the ability to access treatments is often hindered by inefficient, disconnected processes inherent within the healthcare industry. In particular, prior authorization can be a burden for physicians and a barrier to care, one which has a disproportionate impact on underserved and disadvantaged populations. One way organizations can address care disparities is by examining how they can improve processes like prior authorization to ensure every patient receives the care they need when they need it. Since care journeys are often shaped by patient-specific factors such as out-of-pocket costs, access to transportation, and geographic location, health plans should also strive to provide physicians in underserved communities with intelligent, real-time decisioning tools that address the unintended consequences of a typically highly manual prior authorization process.
Mike Serbinis, Founder & CEO at League
Across a wide spectrum of services, it is evident that consumers need to feel that their digital experiences were built solely for their individual needs. In healthcare, that means understanding the unique challenges for each patient based on their social determinants of health and using technology to fill gaps that traditional healthcare models might have overlooked. Personalized solutions for patients that consider factors such as race, gender, socioeconomic status, and geography, are proven to drive more consistently positive health outcomes through increased levels of engagement from patients.
Bob Booth, MD, Chief Care Officer at TimelyCare
Expanding equitable affordable healthcare means doing so in a way that both prioritizes access for populations that have the most need and allows for equality amongst populations who have similar social determinants of health. For Gen Z, equal access to care is not enough. Organizations that focus on equity over equality ultimately better serve the wellness needs of all patients. Building a diverse provider network, providing cultural competency training, and enhancing accessibility features is key to providing on-demand, equitable access to care that embraces the background, identities, and lived experiences of each and every patient. The point is we have to be intentional about meeting people where they are.
Aaron Brandwein, Chief Revenue Officer at Net Health
The Population Health Institute found that social determinants of health (SDoH) account for more than 70% of health outcomes. To build better health systems and deliver care that results in measurable health equity improvement, it’s vital to consider a patient’s or population’s economic and social circumstances, such as access to education, health care, or even neighborhood and environmental conditions. Government policy is increasingly focused on incorporating SDoH into all aspects of healthcare delivery, from individual patient care planning to quality measures to population health objectives, as part of the government’s strategy for tackling health disparities. Data analytics can largely influence health equity, so providers must learn to leverage the patient information already available to better understand patient populations and their needs.
Sean Lynch, Vice President of Clinical Operations at Curebase
A major reason why health disparities exist in clinical trials today can be attributed to the burden traditional trial models place on participating patients. Historically, whether patients are able to participate in a clinical trial can depend on their access to primary care providers, the areas they reside, where they go to receive care, and having the ability and time to travel to sites, and the time to attend on-site portions of the trial, etc.
Modern clinical trials leveraging decentralized technology can directly address inequities in trials by alleviating these burdens. From virtual and hybrid site models, eClinical platforms, data-driven recruitment strategies, mobile sample collections, telemedicine, and more, industry leaders can expand patients’ access to trials, helping to ensure all necessary populations are represented in clinical research.
Florence Kariuki, RN, MHA, Chief Clinical Officer & Chief DEI Officer at HRS
Health disparities arise from multiple barriers that limit or influence people’s ability to effectively receive high quality care and achieve positive health outcomes, and yet, many of these barriers are often beyond individuals’ control. Recent healthcare advancements in technology have presented credible and promising solutions to help address many of these barriers. One example that holds immense potential to advance health equity is the utility of remote patient monitoring (RPM) solutions – which entails the use of technology to remotely collect and transmit physiologic and nonphysiologic health data from patients to healthcare providers, in between in-person care. By enabling patients to receive care in rural areas or non-traditional settings, or to access technology that is customized for their specific language and health literacy levels, RPM can reduce or eliminate many social determinants of health barriers and improve access to care for individuals. Along with other health policy, system infrastructure changes, and digital health solutions, RPM can and should be part of a multi-prong approach to advance strides in achieving health equity.
Craig Worland, Chief Development Officer at Southeast Primary Care Partners
The recent focus on health equity is long overdue, and no one is better positioned to address these large and growing inequities than primary care physicians. These practitioners ensure that all patients, regardless of socioeconomic status, receive the care they need. They are often the only medical touchpoint for patients in rural areas and are poised to deliver a lifetime of care for individuals who may not interact with the health system otherwise. When we support primary care physicians, we are supporting the patients who need convenient and accessible care in their community, regardless of socioeconomic status.
Brad Kittredge, Co-Founder & CEO at Brightside Health
While the widespread adoption of telehealth has made mental health care much more accessible on average, significant barriers still exist among certain populations. We believe the critical avenue to mental health equity is ensuring access to timely and high quality care through Medicaid.
Medicaid is the largest payer of mental health care services in the US and disproportionately serves disadvantaged groups and individuals. Programs and funding levels vary significantly by state, but in many cases reimbursement rates are lower than a provider’s expenses, resulting in a substantial shortage of quality mental health providers serving the Medicaid population.
How can we make high-quality and timely care available to all Medicaid beneficiaries? First, we can use telehealth to enable scalable, cost effective, and high-quality care models that are effective in these populations. Brightside Health’s peer-reviewed research showed consistent outcomes in a low-income population as compared to our population overall. Second, even where fee-for-service (FFS) rates are low, many Medicaid plans have been quite advanced in using value-based care programs to align incentives around impactful care delivery. The path to health equity runs squarely through Medicaid, and it’s critical that we work with states, health plans, and providers to ensure that timely, high-quality mental health care is available to every Medicaid beneficiary.
A variety of factors can contribute to health differences, from genetics to behavior to access to healthcare. For health plans, one critical area that can have a significant impact on health outcomes is member communication. Having lower health literacy and/or language barriers can play a role in healthcare outcomes. A Wellframe survey found that 27% of health plan members don’t understand all of the communications sent by their plan—and those who are non-native English speakers struggle even more. For instance, Spanish-speaking members are less likely to seek proactive, preventative health services, which contributes to less optimal health outcomes when compared to their English-speaking counterparts. This puts them at higher risk for conditions like diabetes and obesity, and associated complications.
In light of these barriers, health plans have a real opportunity to impact outcomes by enabling more effective member communication, multiple engagement channels, and advocacy solutions. And digital tools can play a critical role. These tools can be simple, such as: meeting members where they are through mobile experiences, providing staff decision support and efficiency options like message templates in multiple languages, and offering members guided care to the right resources or benefits for their individual needs. Simple tweaks like these can allow health plans to better focus on the members who need the most help understanding their health needs and insurance options. If health plans prioritize modern digital tools to enhance the communication and engagement with their members, we can meaningfully impact their gaps in care, services and health outcomes.
Lora Sparkman, Partner, Clinical Solutions, Patient Safety & Quality at Relias
More than any other healthcare professional, frontline nurses are most closely engaged with patients and their families throughout their healthcare journey. This means that nurses play a fundamental role in ensuring that patients receive inclusive and culturally sensitive care, which can go a long way to mitigating health disparities and addressing social determinants of health. Healthcare organizations can do their part to promote health equity by providing nurses with education and training on health disparities affecting diverse populations, and how culture affects attitudes, behaviors and expectations related to health, medications, and treatment regimens. Education should be data-driven and focused around improved health outcomes.
Alex Rothberg, Co-Founder and CTO at Intus Care
It’s so important to think about Social Determinants of Health (SDOH) at the same level that we think about physical and mental determinants of health, and to address health disparities as a system- wide level because so often the people with the loudest voices are not the ones who are facing the greatest headwinds.
The current healthcare system tends to focus on treating clinical conditions as they arise, rather than addressing the underlying factors that contribute to poor health outcomes. This often results in higher costs and poorer outcomes in the long run. For example, the U.S. spends nearly twice as much on healthcare as the OECD average, with, on average, worse outcomes. Instead of continuing to spend ever more money on the same clinical conditions, we should be investing smart dollars to address critical Social Determinants of Health (SDOH). By investing in initiatives that address poverty, discrimination, and other social factors that contribute to health disparities, we can help to prevent health problems before they occur and improve the overall health of communities.
This not only leads to better outcomes for patients, but also results in cost savings for the healthcare system as a whole. Adding SDOH to ICD-10 codes is a strong start to creating the infrastructure, and technology that proves the high impact of SDOH can inform the more data-driven innovators in VBC, but as long as SDOH codes are not part of the reimbursement model, better SDOH-informed care will be limited to the most innovative health systems and not widely available.
It’s time to shift our focus towards a more preventive and holistic approach to healthcare that takes into account all of the factors that affect health, and to own the fact that our healthcare system is not currently set up to address health equity in a sustainable and intelligent way system wide.
Misty Mattingly, Senior Vice President and Chief Dental Hygiene Officer at Sage Dental
Instead of passing additional regulations that continue to restrict care delivery options we should enable a provider’s full capability of their skill set. With staffing shortages, there are not enough providers to support today’s population. Expanding providers’ roles/duties, as well as access to digital tools and modes of care such as telehealth is essential in increasing access to care. For example, teledentistry is uncommon, but has valuable applications for patients living in care deserts. Patients can have consultations with their dental provider, avoiding unnecessary and costly trips in some instances.
Eric Lisle, Chief Executive Officer, Co-Founder and President at Southeast Primary Care Partners
Primary care physicians are on the front line of healthcare and have a tremendous opportunity to reduce barriers and increase access to care for their patients. They see the impact of health disparities and inequities on a daily basis, and work with their patients to overcome challenges, connect them to resources and specialists, and serve as a dependable source of health information throughout the lifespan. Often the only reliable source of healthcare for individuals, particularly those in rural areas, primary care physicians can address health issues before they start, helping patients avoid costly emergency department visits or even hospitalizations. Primary care physicians are doing the critical, on-the-ground work of helping their communities get and stay healthy, helping them to thrive. We should support these physicians in any way we can, so they can remain focused on patient care.
Kevin Marasco, Chief Marketing Officer at Tebra
Health equity is not just a moral imperative but a business imperative. Income, location, affordability, and insurance should not determine one’s access to quality healthcare. As leaders, we must prioritize building a healthcare system that works for all, beyond people’s circumstances.
This includes leveraging technology such as online marketplaces and telehealth to connect patients with providers beyond their region and eliminate disparities that are reinforced by social determinants of health. By creating a level playing field, we can ensure that everyone has the opportunity to have access to care and lead a healthy life.
Amanda Hansen, President at AdvancedMD
Healthcare disparities among various populations and demographics is a serious issue for our industry. One in five adults suffer from a mental health issue every year and, according to the American Psychiatric Association, minority groups often bear a disproportionately high burden of disability due to mental disorders. Minority groups also face greater obstacles in receiving mental health treatment or services. It’s a complex situation with many factors driving inequities across the healthcare landscape and there is no single solution. But one trend has definite promise: More and more primary care physicians are integrating behavioral health services into the patient experience, helping to remove the stigma around seeking care and serving as an aid by finding the mental health resources for the patients who need it. These are two key tactics that directly address mental health inequity. Telehealth – and the ability to deliver mental health services via virtual appointments – is also a game changer for mental health equity as it expands the availability and reach of mental health services regardless of geography.
Josh Klein, CEO at Emerest Connect
The only way to create a truly holistic healthcare system is for the industry to reorient its priorities. That means centering social and behavioral health in everyday practices and treatments. You are not going to discover a patient’s background and environment by looking at vital signs. That is why we need to create platforms, plans, and experiences that touch every part of a person’s wellbeing – physical, social, mental, and behavioral. By examining patient conditions across these areas, we can cut through systemic forms of discrimination and achieve better health outcomes for all.
Jessica Paulus, VP of Research at OM1
Historically, the healthcare industry has lagged in addressing health equity by accurately representing the breadth and diversity of the general population in research populations, missing an opportunity to understand and remedy longstanding disparities in outcomes by race. But with the advancement of technology and data, sectors including pharmaceutical sciences, have the opportunity and responsibility to better understand the root causes of inequity and enact lasting change. This is especially important when considering patient access to care, treatment plans, and subsequent outcomes.
One question that needs to be addressed is “for whom is this therapy likely to be most beneficial, or potentially harmful?” While many studies are designed and statistically powered to describe efficacy and safety “overall,” rarely is the benefit and risk evenly or uniformly distributed across a patient population – historically, leaving out marginalized groups who may be differentially impacted with respect to disease incidence, severity and access to diagnostic and therapeutic modalities. By utilizing real-world data (RWD), the industry can work to introduce inclusive precision medicine approaches for each patient – individualizing care to address the meaningful social needs that impact disease burden and highlighting subgroups of patients who should be prioritized for certain types of preventive or treatment strategies.
The key is determining the comprehensive set of factors that may drive an individual patient’s disease risk into the research design, and this set often includes social determinants of health (SDoH) for many chronic and other conditions. With race and ethnic status being highly predictive of dramatic differences in the burden of many diseases, it’s critical to be highly aware of the impact that including – or excluding – factors like race can have on all kinds of clinical research designs and tools, including prediction models. While many studies look at one aspect of a patient’s SDoH at a time, it’s critical to look holistically, creating a multidimensional picture to understand how these SDoH are working together.
Using RWD that includes patient, clinician, environmental and more drivers of health, researchers can draw critical insights to further the industry’s understanding of disparities; conclusively helping identify where the gaps in patient care are, and finally bringing health equity to the forefront.
Allyson Livingstone, Executive Director of Diversity and Inclusion at athenahealth
There is no one-size-fits-all approach to make healthcare more equitable. In the past few years, telehealth has helped many marginalized groups access care. Although it can be an entry point to deeper patient engagement, it is not an equalizer. Despite the relative increase in access for some groups, research by athenahealth analyzed telehealth usage from 2019 to 2022 and found that disparities persist, particularly among Black and Hispanic patients. The medical community needs to look beyond technology as a one-stop solution that will make healthcare equitable and address the wide range of complex factors that lead to health disparities.
Patients, especially those who are excluded from healthcare, need settings where they feel safe, connected, and comfortable. To achieve truly equitable healthcare for all, every stakeholder in healthcare must do their part and work together, only then will the narrative change. Patients need tailored interactions with providers who are trained on implicit bias, systemic racism, and delivering care in a culturally competent way — to everyone, and they need supportive federal, state, and payer policies that make it possible for them to access quality care in whatever way is best for them.
So many new angles for us to look at! Thank you to everyone who shared their experience and perspective and thank you to all of you for reading these! We’d love to hear your ideas on new ways to approach health equity, so comment your thoughts down below and on social media.