The BroadReach Group invited Amy Helwig, MD, our EVP and an expert in clinical quality, informatics, and payment policy, to join a panel of provider, payer, and industry peers to discuss the current state of health equity. This esteemed group was facilitated by BroadReach's co-founder, John Sargent, MD, in a July virtual event.
Payer-provider executive and leader survey reveals health equity priorities and barriers
Dr. Sargent kicked off the health equity webinar by sharing BroadReach's 2022 survey with 192 payer, provider leaders and executives weighing in on the health equity landscape. Their report reveals four key findings:
- 73.5% of survey participants say health equity mission critical or extremely important to their organization to address.
- 43.8% don't know if they have any race, ethnicity or language data on their care population.
- 43.5% don't have any formal roadmap for promoting health equity across their people, process and technology.
- And, 53.1% who have some form of an informal roadmap are unsure if creating a formal roadmap will be a priority in the next 12-18 months.
While 95% of these healthcare executives and leaders “believe it's important for their organization to address disparities/inequities in health outcomes and quality measures," most are not pursuing it as a priority.
The survey uncovered nine barriers to operationalizing and furthering health equity initiatives. The number one reason was health equity data: lack of data, incomplete data, inaccurate data or the infrastructure needed to capture data.
Health plan CMO viewpoint on the state of health equity
The survey results led to a discussion, starting with Chris Esguerra, MD, Chief Medical Officer at Health Plan of San Mateo.
Dr. Esguerra shared that since conversations started around social determinants of health many years ago, that it's evolved into each organization answering the question of what to do about it and how to begin implementing strategies. “...at Health Plan of San Mateo…our whole vision and mission is healthy is for everyone. It's (health equity) is built into that vision."
“Health equity is your journey to do better for the population that you serve," and asking what better health outcomes mean from an equity perspective. It starts with data, highlighted in the leadership survey. Chris suggested that organizations integrate health equity efforts into the work that they're already doing and focusing on data and interventions related to what their data analysis reveals. Once an organization starts on this path, they quickly realize that they need to “be thinking about partnerships in the community, partnerships with providers." Primary to this is being clear on what the organization's, and the leader's, role in improving health equity for their members?
Medical director thoughts on health equity data challenges
Melissa Clarke, MD, Senior Medical Director of Healthcare Transformation and Health Equity at 3M Health Information Systems, picked up the data theme and the struggles organizations face with health equity data.
“Data really is in service to strategy, especially when it comes to addressing health equity," stated Dr. Clarke. She puts forth that organizations first have to have equity as a priority and be very intentional. “Bringing about equity and health really requires lessening that power differential by…diversifying your workforce to reflect those who you serve."
Organizations need to involve trusted members of the community and community-based organizations, ask members, but also be willing to make system changes to “remove the barriers that make it difficult for people to have access to care and positive health outcomes." Her focus is on understanding the member – “who they are and how their lived experiences intersect with their health, their healthcare utilization, and their health outcomes."
And, as value-based care programs highlight provider accountability for health outcomes, data on social drivers should shape understanding, used as part of risk adjustment so that organizations can compare outcomes across patient populations, ensuring analysis makes fair comparisons. She says, “You have to have a really firm foundation in understanding how complex your patients are clinically. Who are your sickest patients and how they're utilizing healthcare." Once interventions are in place, focus shifts to seeing how risk adjusted health outcomes evolve over time. These data can reveal which social factors are most influential and “which hospitals, practitioners, geographies, ethnicities have the highest risk and how you can have a laser focus in the direction of the right interventions."
However, health equity data can have bias so it's important to understand how bias might adversely impact the quality and level of care delivered to beneficiaries. She suggests that data analysts and users have awareness of the way data is captured and what bias pitfalls may skew insights.
Quality leaders and clinical informaticist shares health equity policy progress
Dr. Helwig is encouraged by recent progress on multiple fronts to both health equity policy and research. “We're seeing some new adaptions out of CMS to some of their alternative payment models." The Centers for Medicare & Medicaid Services (CMS) are now converting their ACO program to ACO Reach, which has a greater focus on health equity in their outcomes along with the newest generation that was just released for the oncology care model. These alternative payment models and other requirements will encourage providers to collect social drivers, put together health equity plans at the community level, and measure changes in outcomes over time.
While change is occurring at the national level with how CMS is establishing value-based payment models with equity requirements, there are changes at the state level as well. Here, it is “really directed toward managed care organizations that are contracting with states to deliver Medicaid services, manage long-term support services, and other care management programs for special needs populations."
She pointed to NCQA's (National Committee for Quality Assurance) new health equity plus accreditation program, which is a program that any health plan can apply for and become designated through certification. “If they're able to demonstrate that they have not only the infrastructure in place, but the programs and the actions at the community level, they could show their health equity impact and outcomes." Employers and their employees can look for this designation and see a demonstrable commitment.
There's also acceleration on health equity research. She notes, “…research is now focused on trying to discriminate and find those nuances in terms of what really is working at a neighborhood level, at a clinical level, at an individual level." Helwig added, “And, certainly, we have much more sophisticated data models that are combining different data sets so that you're able to have more precise identifications of neighborhood and community trends." As more requirements, policies, and incentives roll out, “these databases are going to be critical as one of the only ways that we're going to be able to determine whether or not we're making a long-term impact."
Practice leader looks at health equity from an oncology perspective
Alti Rahman is the practice administrator for Oncology Consultants, a large community-based oncology group in Texas. He wrapped up the discussion by focusing on health equity within oncology, which is the biggest single driver of cost in the U.S.
Mr. Rahman pointed out that a cancer provider comes into an individual's life after many life experiences. When a person is at the average age of 55 or 60 or older, they've gone through a set of life experiences, life events, that's going to have a very important impact on how their cancer journey could progress in terms of it having positive or poorer outcomes. He says that the practice focuses on intervening and helping manage those outcomes by “making sure patients get treatment started on time, making sure that they have access to other services through hospital systems and other community-based resources."
This makes “turning data into action and action into wisdom." Trust is critical and he honors that many have a mistrust of the healthcare system. “So, as we think through the care processes and how we train our staff, it becomes very important that our practice builds this focus on health equity into the foundation of what we're doing." He emphasizes the need to be culturally sensitive and competent.
Focusing on provider and staff burnout is crucial to health equity. “How can we as an organization take care of our frontline staff and make sure that we are applying the same thinking and thoughtfulness around what we do with patients with our staff as well?" The goal of care is to health equity helps create optimal outcomes in the cancer experience.
Common goals for improving health equity for diverse people
This panel brought together physicians and clinical leaders with varied backgrounds but common goals to reduce health inequities. As health plan and provider stakeholders look at their culture, commitment to health equity, as well as data, processes, and technology,