Bringing About Change For More Equitable Health

In late 2022, the National Committee for Quality Assurance (NCQA) identified the first organizations to complete its pilot Health Equity Accreditation Plus (HEA plus) program. This option builds upon the NCQA's Multicultural Healthcare Standards to incorporate standards for assessing and addressing social determinants of health. The HEA plus distinction is only bestowed to health plans and health systems that successfully meet all of the program's standards and demonstrate success in areas such as data collection, social needs data stratification, community partnerships, identification of health equity needs, and drawing linkages between programs and cultural health needs.

Pillars of the healthcare community such as Geisinger Health Plan, UPMC for You, and Health Net of California were among the pilot cohort that collaborated with the NCQA to validate the certification based on the respective organization's advanced capabilities to promote health equity for all, work collaboratively with community organizations, and execute solutions to support and address the social needs of its member populations.

Health equity in 2023

As healthcare organizations cement budget, goals, and plans for 2023, advancing health equity is a foundational theme for programmatic efforts, quality measurement, and recognition programs. Organizations of all sizes are taking an introspective look into corporate responsibility for advancing equity, both for the populations served and for ensuring alignment of equitable standards to operations and company values.

I recently had the opportunity to participate in a panel at UNC's Business of Healthcare Conference to discuss the responsibility healthcare organizations have to advancing health equity and how continued innovations can drive change in the industry.

The term health equity is reinvigorated—why now?

Inequities in healthcare are well-known, but the challenges have always been where to start, how to access funding to support improvement efforts, and how to successfully drive improved outcomes within historically marginalized communities.

The intersection of the COVID-19 pandemic and racial injustices in the US put a global spotlight on systemic racism and health inequities. The silver lining to emerge following the challenging last few years is that, as a nation, organizations are being tasked with supporting change efforts and improving health access and outcomes for all. Leading organizations, those that set the tone for expectations of all healthcare organizations, such CMS, NCQA, IHI, and others, have started to embed health equity requirements and advanced data stratification into their frameworks to keep organizations accountable to driving change. The long-term goal is to have equitable health for all persons and populations.

The Joint Commission (JC) has continued to embed responsibility to health equity into their programs to drive change in healthcare communities. Beginning in July 2023, the JC will offer a Health Care Equity (HCE) certification available to hospital locations that are either currently accredited through the JC and/or those that align to federal hospital regulations.

The intent of the certification is to highlight care facilities that excel in providing equitable care and service to their patients. Additionally in 2023, the JC will convert a previous standard centered on healthcare disparities as a care delivery priority into a new National Patient Safety Goal aimed to improve health equity efforts within organizations. The new goal will be applicable to JC-accredited locations inclusive of ambulatory health centers, behavioral health facilities, and hospitals.

Have organizations adopted a 'convenient' or limited view of health equity?

As members of the healthcare community, it's imperative we work to build a more just system with a commitment to do no harm and to serve everyone. Many organizations are seizing the moment and publicizing their long-term commitment to health equity. The American Hospital Association (AHA) has the #123forEquity Campaign, an initiative aimed at hospitals and health systems, that pledges a commitment to enhancing demographic data stratification, increasing cultural competency trainings, committing to operating under a diverse leadership structure, and improving community collaboration. To date, over 1,700 hospital and healthcare systems have endorsed the AHA's pledge, since enacted in 2015.

Health technology companies have also identified their responsibility to equity advancement. More than 80 digital health technology companies have signed the Digital Health Equity Pledge through the Executives for Health Innovation Network, emphasizing the importance of accessibility, diversity, respect, and public policy in the work they do.

For smaller companies and those with limited funding in this area, it is an overwhelming task to identify where to start efforts, which populations are in most need, and how to define long-term organizational equity goals that align to their mission, vision, and values. As pillar organizations continue to evolve the definitions of and responsibilities to health equity, there is opportunity for the broader healthcare community to unite in support of long-term industry goals and to cultivate transparency. This collaboration encourages additional conversation about the barriers and limitations encountered, so organizational and community partnerships can develop to support shared populations and like-minded businesses can collaborate on strategies for improvement.

Maintain health equity as a priority in times of limited funding and resources

Consideration for a commitment to health equity should fall in the same category as an organization's commitment to patient experience, often considered a key performance area. When there is an abundance of funding and/or stake in patient experience, organizations concentrate efforts. However, when funding is restrictive, new and creative budget-friendly approaches have to be employed to ensure patient experience continues as a priority within the business model. The same applies for health equity.

Securing ample funding for an initiative is always an ideal situation because funds support the prioritization of time, energy, and people resources for a specific project. The challenge is that the approach to health equity work cannot be thought of as an initiative with a finite budget and a project delivery date. The concept is here to stay; therefore, the commitment to health equity should be approached as a foundational component of an organization's core beliefs and values. The idea of providing equitable care for all should be embedded in every workstream. Even when barriers, such as limited funding and lack of resources, are present, the priority commitment remains.

Build an organizational structure committed to health equity in 2023 and beyond

A diverse workforce, reflective of the community an organization serves, is a critical component necessary to align a company's mission to health equity. A diverse workforce helps to support cultural concordance; the idea that when patients and providers share the same race and ethnicity, health outcomes and trust improve. It's important that an organization's internal structure aligns to the health equity messaging shared externally. End users, members, and patients want to connect and build trusting relationships with healthcare professionals who understand their lived experiences in addition to their healthcare needs.

For companies that do not yet reflect a diverse workforce, a good place to start is evaluating the internal status quo to identify gaps that exist in the organization. It's challenging to develop cultural competency within an organization if the work has not been done to identify and strategize how to approach the hierarchy of operational needs. Taking the time to evaluate how implicit biases, structural racism, administrative policies, and team-member behaviors impact operational practices is a worthwhile investment. After an in-depth internal evaluation, efforts, such as ongoing cultural sensitivity trainings, hiring a diverse workforce, and updating policies, can be employed to support the commitment to health equity.

Incorporate a commitment to health equity into existing initiatives

Many healthcare improvement initiatives are in support of a concrete outcome. Instead of treating a pledge to health equity as an isolated business initiative, it should be part of health equity strategic planning embedded into existing models. Incorporating health equity concepts into new or existing initiatives provides less of a concrete outcome and instead supports the opportunity to evaluate outcomes on a deeper level and adjust tactics as needed to support the overarching goals of an initiative.

Operational teams should be tasked with ongoing monitoring of work outputs to better understand the inequities that may exist within specific service lines to make corrections early and often.

• “Does the recruitment strategy for a clinical trial accurately represent the population you are targeting?"
• "Does the digital health solution have equitable access to all end users:  considering connectivity, literacy levels, language barriers, and rural communities?"
• “Does the data adequately stratify the population for social determinants of health that impact effectiveness or next steps?"

Better assessment of operations gaps and limitations can provide opportunities to engage with community partners, enhance recruitment strategies for clinical trials, identify additional areas for data stratification, embed changes to workflows, and invest in third-party evaluations to further enhance the commitment to health equity.

Increase attention to data

Healthcare data analytics are a key driver in promoting sound business decisions to benefit equitable outcomes for target audiences. Data that represents a variety of sources and provides enhanced opportunity for population stratification is a powerful tool in supporting health equity initiatives. Access to complete robust data, representative of multiple sources, such as claims, social determinants of health, and clinical encounters promotes a whole picture from which to base decisions and interventions. Data that is free of bias can identify operational practices that would benefit from increased attention to equity, communities of greatest need, and target interventions for the greatest impact.

Reach your organization's health equity goals

At RTI Health Advance, we work with healthcare companies across the continuum of care who are looking to navigate health inequities that exist in their populations. We meet them where they are in their journey by evaluating the status quo, identifying a tailored menu of options that are appropriate and achievable, and working with them to implement evidence-based, best-practice approaches to managing health equity needs in support of our clients' established and emerging business models.