OAKBROOK TERRACE, Ill. — Addressing the social determinants of health and achieving health equity is sometimes characterized as a feel-good moral duty for health care, but one quantitative stat that can’t be ignored is that 80 percent of health care spending is driven by social factors.
Health care leaders and innovators came together to push the health equity dialogue forward during the first Health Equity Forum hosted by the American Hospital Association and the Joint Commission Friday. Leaders in attendance discussed how hospitals and health systems are addressing those social determinants of health, and why achieving health equity is essential to bringing that 80 percent mark down.
“Pinpointing why disparities in care exist and eliminating them must be a priority in every health care setting,” Rick Pollack, president and CEO of the American Hospital Association, said in a video to kick-off the meeting.
The forum included case studies from systems that have worked to improve diversity and health equity. Kimberlydawn Wisdom, M.D., senior vice president of community health and equity and chief wellness and diversity officer for the Henry Ford Health System, described how Henry Ford has made health equity a pillar in its strategic structure to try to ensure that it is part of their future. This means that, during senior leadership meetings, leaders make a point of bringing up any community-focused efforts, alongside more routine issues such as HR, finance, quality and safety.
Attendees also learned how Ascension Health’s 140-plus hospitals have numerous community partnership programs that address the social determinants of health. For instance, its Bridges to Hope program with St. John Providence Health System in Detroit seeks to address issues of economic independence. These types of partnerships are key to improving disparities within communities, said Tamarah Duperval-Brownlee, M.D., vice president of care excellence for St. Louis-based Ascension.
And while making the moral argument for such programs is important, creating a business-focused case for equity in care is equally vital, Pollack said in his introduction. “Equity of care for every patient and community is the right thing to do. Advancing diversity across the field is the right thing to do, but … there is also a strong compelling business case for advancing equity of care and fostering greater diversity.”
To inform that process, Kedar Mate, M.D., chief innovation and education officer for the Institute for Healthcare Improvement, outlined six ways to build the business case for equity, which he mentioned were borrowed “heavily” from Marshall Chin, M.D., from the University of Chicago. The six areas are:
- Collect and report clinical data stratified by race, ethnicity, language and socioeconomic status: “The rest of the entire business case hinges on the availability of this information. Start by collecting this kind of data,” Mate said.
- Incentivize preventative and primary care: “The bulk of disparities we see can actually be addressed if we have greater investment in primary care and preventative care. We must implement more aggressive risk-sharing agreements and shared-savings plans that encourage greater investment in preventative and primary care.”
- Develop equity-accountability measures across payers: “This is the idea that we need to create or add race, ethnicity and language dimensions to existing outcome measures. It’s not about increasing the overall measurement burden. The idea is not to add new measures; it’s about stratifying those measures by race, ethnicity, language and socioeconomic status.”
- Use them to incentivize the reduction of health disparities: “We could be incenting systems to achieve threshold levels of performance for reduction in disparities or to reward improvement. They could be built into ACOs and other shared savings systems.”
- Assist the safety net: “I can’t say this any more clearly. We have to provide adequate Medicaid reimbursement to our safety nets. That’s where a lot of our patients are going to be seen. We have to risk-adjust clinical performance scores for socio-demographic information. We have to be careful about decreasing federal subsidies before those health insurance plans have an opportunity to enroll patients in their care.”
- Launch demonstration projects to test payment and delivery system reforms: The Centers for Medicare and Medicaid Innovation can do this, but there are others who can do this as well.
“I fundamentally believe equity is our moral and professional duty, and all of us in this room would do this work regardless of how we’re paid, “ Mate said. “But if we want to see the impacts that we’re hoping for … we absolutely need a business argument that’s going to help us scale and sustain this work.”
Chief safety officer for the Joint Commission, Ron Wyatt, who co-chaired the forum with Tomás León, president and CEO of the AHA's Institute for Diversity in Health Management, says the issue is deeply important to him and others who are involved in the effort. “We cannot achieve equity if we don’t love the people we take care of,” said Wyatt. “This is not hard work. This is heart work.”
For more on this topic, you can watch Ron Wyatt discuss health equity's role in quality in this H&HN video, and read our interview with Tomás León, president and CEO of the Institute for Diversity in Health Management, to learn the important role health equity is playing in health care. Also, tools and more info can be found at the AHA's Equity of Care website.