Health equity affects all of us—either directly or indirectly—and the lack of equity could be pushing us into a financial crisis. Health equity is the fair and just opportunity for every individual to achieve their full potential in all aspects of health and well-being. Health inequities cost us $320 billion a year. If we don’t change course, that number could reach $1 trillion by 2040.
In 2001, the National Academy of Medicine published Crossing the Quality Chasm, which highlighted equitable care as a priority in health care. While many health care organizations have focused on health equity since that report, the care patients receive (and the outcomes they experience) can still vary widely by race, age, income, ethnicity, gender, and ZIP code.
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Jay Bhatt and Kulleni Gebreyes Jay Bhatt, D.O., MPH, MPA is the Executive Director of the Deloitte Center for Health Solutions (DCHS) and the Deloitte Health Equity Institute (DHEI), directing the research, insights, and eminence agenda across the life sciences and health care industry while driving high-impact collaborations to advance health equity. Prior to Deloitte, […]
Consider this: Nearly 80% of hospitals and health systems say they are asking their patients about housing needs. However, just 32% of those organizations connect patients to services to address needs that are identified. This gap signals the opportunity for hospital and health system leaders along with employers, and community partners to envision new care and wellbeing approaches—as well as new business models—that allow care to be trusted, sustainable and equitable.
As care providers and often the largest employer in the communities they serve, hospital and health systems are typically well positioned to advance health equity directly through care they provide, going upstream with prevention and through influence on the drivers of health that impact health outcomes
There are four key actions to consider for addressing health equity among employees and executives (internal) and the patients and communities they serve (external).
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- Organization: Ability to effectively address health disparities in a community requires an organizational strategy to address diversity, equity, and inclusion for its workforce.
- Offerings: Having an equity lens that examines the services that are available to patients is essential to eliminating inequities related to access to quality care. Value-based payment models that provide financial incentives for quality and outcomes can enable equitable care delivery models.
- Community: Establishing relationships with trusted local organizations can provide insight into the lived experience of the population. This could lead to collaborations to improve health equity. Health care organizations should look for ways to integrate their data with data from their community partners and the lived experience.
- Ecosystem: Recognizing that hospitals and health systems, health plans, suppliers, vendors, and non-profit community organizations are all a part of the health care ecosystem. Health system leaders should try to work with organizations that are focused on diversity, inclusion and health equity.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Our research has found that to advance ongoing work, community health ecosystems likely will need additional partners, shared goals, technology, and metrics. But most importantly, they will need the participation and leadership of more community members.
There is also growing recognition that health equity should be a core part of environmental, social, and governance (ESG) strategies. Developing ESG frameworks and measurements is becoming critical. Many hospitals and health systems already have the materials they need to build the foundation for a sound health equity strategy. But hospital and health system leaders tell us that navigating referrals around the social needs of a community can be challenging.
CHNAs as intelligence and a foundation for a hospital health equity strategy
Community Health Needs Assessments (CHNAs), which were outlined in the 2010 Affordable Care Act (ACA), require tax-exempt hospitals and health systems to identify the perceived health issues in a community, conduct quantitative analyses of actual health issues, appraise existing efforts to address those issues, and formulate a plan for future action. The provision was created to help hospitals understand the needs of their communities, identify whether they were spending money appropriately, and to document it. The IRS expects hospital executives to use CHNAs to benchmark themselves and to assess their efforts.
While CHNA’s could be a useful tool in assessing issues that impact the health of a community, hospital executives might be missing an important opportunity. CHNAs could be a powerful tool for determining where to make community-based investments. The data collected on CHNAs, combined with other information, could help guide a community health strategy. This information could also help identify local organizations that might be willing to collaborate. Consider a community that has an unusually large diabetic population and a high number of diabetes-related amputations. Peeling back the onion in that community might reveal a high number of liquor stores, limited greenspace, a lack of primary care providers, and few places to buy affordable, healthy food. Maybe some amputations could have been avoided if a value-based payment model provided clinicians with a financial incentive to focus on prevention and wellness, rather than the number of procedures performed. We know that social issues and the environment can impact health outcomes. Questions that help assess those risks might help inform community health strategy, investment, and collaboration for better health outcomes
Hospital-CBO collaborations as a multiplier for scale
Hospitals and community-based organizations (CBOs) often have competing priorities and different cultures. Hospitals can play a critical co-convening role with CBOs. That makes it important that hospital leaders outline strategies, roles, and expectations when forging partnerships with community groups. In 2016, for example, Indiana University Health created a memorandum of understanding when it partnered with a local food bank to distribute healthy food in neighborhoods with high rates of food insecurity.
In Chicago, the Alliance for Health Equity has built a bridge between hospitals and the communities they serve. The Alliance is a collaborative of 37 hospitals that work with health departments and more than 100 CBOs to improve health equity, wellness, and quality of life. The groups worked collectively to develop a CHNA to summarize the health needs facing the population and to determine how to address those needs.
In Virginia, three hospitals collaborated to identify and address social issues that were negatively impacting members of the community. The hospitals developed a unique process of community visioning where community members openly shared their observations and ideas with hospital employees. They determined unemployment was the most important driver of health that needed to be addressed. The Supporting East End Entrepreneur Development (SEED) Program was created through a partnership between Local Initiatives Support Corporation (LISC) Virginia and local health system to help revitalize a neighborhood. Each hospital agreed to make an annual $150,000 contribution to the program for three years. The program, which launched in 2011, provides up to $25,000 in grant money to individuals looking to either expand or start a business in the Church Hill neighborhood. Through the program, 14 small businesses have received training and financial support. Not only did this improve economic mobility, but it also had a favorable impact on the health of residents.
- Trinity Health created the Transforming Communities Initiative (TCI) to improve health and well-being in eight participating sites. TCI relied on community partnerships that focused on policy, systems, and environmental (PSE) change strategies.
- Data assets, such as the March of Dimes Maternity Care Deserts Dashboard, can provide a more comprehensive view of maternity care desert locations. The Dashboard also offers information about the relationship between maternity care deserts and health issues related to race/ethnicity, income status, and chronic health inequities among women of childbearing age
Future of health equity: Pace of change and sustainability
Health Inequities is America’s chronic condition showing up in poverty, discrimination, bias, wealth gaps, and injustice. Many health systems and health plans have mission statements that emphasize equity and the health of their communities. Some organizations have had health equity leaders, diversity departments and/or teams in place for years.
What is new is the momentum to change the status quo, alignment among stakeholders, and calls for accountability. The combination of the Covid-19 pandemic and demonstrations over social injustice spurred many organizations to enhance their diversity, equity, and inclusion efforts. The aspiration is that this work is not for the moment but for the long haul, and that it is grounded in trust. Trust is the key to accelerating pace of change and achieving sustainability.
Photo: undefined undefined, Getty Images
Editor’s Note: The authors confirm that none of the entities named in the article are clients of Deloitte. They are collaborators of the Deloitte Health Equity Institute.
Jay Bhatt, D.O., MPH, MPA is the Executive Director of the Deloitte Center for Health Solutions (DCHS) and the Deloitte Health Equity Institute (DHEI), directing the research, insights, and eminence agenda across the life sciences and health care industry while driving high-impact collaborations to advance health equity. Prior to Deloitte, Dr. Bhatt served as senior vice president and chief medical officer at the American Hospital Association. While there, he also served as president of the Health Research and Educational Trust and helped lead the Institute for Diversity and Health Equity. Dr. Bhatt earned a B.A. from the University of Chicago; Doctor of Osteopathic Medicine (D.O.) from Philadelphia College of Osteopathic Medicine; Master of Public Health from the University of Illinois at Chicago; and Master of Public Administration from the Harvard Kennedy School of Government. He is board certified in Internal Medicine and Geriatrics.
Kulleni Gebreyes, M.D. is Deloitte’s US Chief Health Equity Officer and a US Consulting Health Care Sector Leader. She holds an MD from Harvard Medical School and an MBA from Johns Hopkins. Dr. Gebreyes is a physician leader with more than 20 years of experience in the health care industry across the commercial and public sector and drives care delivery transformation for health care organizations. She has developed and implemented strategies for population health management and value-based care, physician alignment and patient activation, diversity, equity and inclusion, and the drivers of health. She is an active advocate for vulnerable and underserved communities.In partnership with providers, payers, and employers, Dr. Gebreyes has successfully developed and implemented clinical analytics tools and applications that reduce operating costs and promote appropriate utilization of resources.
