While U.S. health disparities have been the focus of remediation efforts for decades, the pandemic created a shared urgency and impact on a national stage due to lack of accessibility to resources in rural and urban communities, health care awareness and knowledge gaps, and technological challenges.
However, now in the post-pandemic era, health care organizations are finding new approaches to solving this problem through focused strategies and innovation. The following outlines key considerations for many organizations looking to address disparities in the communities they serve.
A study, funded by the National Institute on Minority Health and Health Disparities, part of the National Institutes of Health, revealed that in 2018, racial and ethnic health disparities cost the U.S. economy $451 billion, a 41% increase from the previous estimate of $320 billion in 2014. The study also found the total burden of education-related health disparities for persons with less than a college degree in 2018 reached $978 billion.
Conversely, providing more equitable outcomes could actually save the U.S. up to $1 trillion per year, according to the National Institute of Health, as a result of improving outcomes and patient experience. Bottom line, health care providers and insurers cannot afford not to address health inequities in the communities they serve.
Priorities and strategy
Advancing health equity should start with a strategy. Regardless of where an organization is along its health equity journey, an enterprise-level approach is core to defining strategic goals, prioritizing initiatives and creating alignment among leaders. The impacts of the pandemic were disproportionately felt across society, raising our collective consciousness to the reality that more needs to be done to achieve health equity. To this end, the Biden administration and the U.S. Department of Health & Human Services have prioritized achieving health equity through interventions to eliminate health disparities in vulnerable populations. The Centers for Medicare & Medicaid Services has also taken steps to align provider reimbursement with the addition of new health equity-related reporting measures to the Inpatient Prospective Payment System.
These strategic changes are foundational elements for organizations to implement health equity priorities programs, funding and collaborations through an organization’s people, processes and technology. Health equity strategies will continue to evolve over time as programs mature, the external landscape changes or an organization’s priorities shift.
A push for value-based care
A focus on value-based care and engaging patients in management of their own health will continue to reduce the care gaps in communities. Outcomes are better for providers, payers and individuals when patients have access to care and to their own health information.
Despite value-based payment’s potential to promote equity, models were, historically, not designed to do so, and as a result, unintentionally harmed patients and providers. The early models fell short with no requirements to address inequities and, without a focus on equity, models penalized providers.
To encourage providers to improve specific outcomes, payers rely on financial and nonfinancial levers, like reporting requirements or bonus payments. Yet few models historically used these levers to reduce inequities and advance equity.
Today, public and private payers are considering the unintended consequences of models and intentionally designing new ones or revising older models to promote equity. The Centers for Medicare and Medicaid Services Innovation Center recently evaluated its models to understand how they have hindered or supported health equity to improve the design of future models. It also launched the
Accountable Care Organization Realizing Equity, Access, and Community Health model, which explicitly focuses on addressing inequities. The model takes a multipronged approach to equity, including seeking a diverse range of participating providers and adjusting payments to account for patients’ social needs. This will increase providers’ capacity to treat disadvantaged patients.
Care delivery opportunities: Innovation provides a way forward
The movement toward taking care out of traditional clinical settings and into the home and communities continues to be a major driver of increased patient engagement. Patients who struggle to get transportation to a doctor’s office or clinic often become disengaged, failing to make appointments for routine exams and lab tests. Health equity can continue to be an aspirational goal whereby all people experience similar health outcomes regardless of access, race, ethnicity, socioeconomic status, education, neighborhood or other potentially disadvantageous social and structural determinants of health.
People with disabilities and people from racial and ethnic minority groups and rural areas are more likely to face multiple barriers to accessing health care. To improve health outcomes and reduce expensive, downstream interventions, digital adoption in health care is at an all-time high. According to the American Medical Association, about 25% of patients used telehealth in 2022, far exceeding the 5% who accessed care this way before the pandemic, with a continued positive outlook.
Other health care innovations and improvements can be seen in the advancement of wearables. In many cases, the devices are allowing people to personally monitor health functions, saving trips to and from clinics for screenings and allowing digital sharing of the information in real-time with care providers for assessment, if needed. However, while the way forward may be digital-first health care transformation, organizations should curate, assess and understand comprehensive data to make the best decisions for the groups they serve.
The takeaway
Without a defined strategy, ownership and accountability, health equity runs the risk of remaining an aspirational goal versus becoming a structured program with operational viability and resources. Understanding how other organizations are approaching health equity within and across sectors can provide important learnings for peers seeking to drive impact on outcomes and delivery. No single organization can solve the issue on its own. Health equity initiatives necessitate collaborative, coordinated action underpinned by strategic intent and measurable outcomes.
Danny Schmidt
Danny Schmidt is a senior manager in the assurance practice and a health care senior analyst for RSM US LLP. As a member of the Industry Eminence program, Danny works alongside the firm’s chief economist and his fellow senior analysts to understand, forecast and communicate economic, business and technology trends affecting middle market businesses.
Michael Haas
Michael Haas is a technology management consulting manager in RSM US LLP’s health care industry practice. In 2022, he was selected for the firm’s Industry Eminence Program as a senior analyst covering the health care industry, working alongside the firm’s chief economist and other program participants to analyze the trends and themes affecting the nonprofit and education industry and shaping middle market businesses. Michael is based out of RSM’s New York City office.
