November 17, 2021

58% of health systems say equity is a top priority. What are they actually doing?

Daily Briefing

    Health equity has become a top priority for many health care organizations. In Modern Healthcare, Nora Tepper details several new federal and commercial efforts to expand and improve health equity initiatives.

    How your health equity strategy may be falling short

    Health equity is a top priority for many health care organizations

    According to a survey from the Institute for Healthcare Improvement (IHI), 58% of health systems identified equity as a top priority in 2021. This is a significant jump from 25% two years ago.

    The federal government has also begun prioritizing health equity initiatives. For example, CMS has issued a request for information on metrics to assess equity among providers and made "providing equitable care" a central feature of its strategic plan, Tepper writes. In addition, in a September blog post outlining her vision for the agency, CMS Administrator Chiquita Brooks-LaSure wrote, "For every decision being made, we're asking ourselves, 'How is this action advancing health equity?'"

    Current federal and commercial health equity efforts

    According to the IHI survey, 38% of health systems said inconsistent data collection was a major barrier to health equity measures. This has led several organizations to implement new data collection strategies, Tepper writes.

    For instance, CMS this year approved new medical codes to track food insecurity and housing instability or homelessness. This information will help researchers collect data on the costs of social factors on patient outcomes and the health care industry.

    Separately, UnitedHealth Group (UHG) in June launched an in-house predictive analytics system to screen and predict patients' social needs. According to UHG, the system assigns each member a personalized health score, which will be used to connect patients with community resources, better understand their social needs, and lower the organization's health care spending. (Daily Briefing is published by Advisory Board, a division of Optum, which is a wholly owned subsidiary of UnitedHealth Group.)

    In addition to data collection improvements, CMS and commercial payers are working to incorporate equity into value-based payment models, Tepper writes.

    Currently, CMS is evaluating three of its value-based care payment programs (hospital readmissions reduction, hospital value-based purchasing, and hospital-acquired condition reduction) for their impact on health outcomes and costs across patient groups. According to Tepper, hospitals working with underserved communities have been more likely to be penalized through these programs.

    "Equity has not been on the forefront of value-based care models, and that’s why for the last decade, we've been disproportionately penalizing hospitals that care for poor populations, that care for racial and ethnic minority adults," said Rishi Wadhera, head of health policy and equity at the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center. "Value-based care programs and, specifically, the three hospital-based pay-for-performance programs, probably propagated inequities unintentionally."

    In addition, Blue Cross Blue Shield of Massachusetts (BCBS) in September said it will update its Alternative Quality Contract system to financially reward providers for improving care for patients of color.

    According to a report in the New England Journal of Medicine, BCBS Massachusetts slowed its rate of medical spending by up to 12% and improved care over an eight-year period by offering providers population health payments. The organization also offered awards for long-term improvement in quality, patient outcomes, and individual experiences.

    "Why are we including this financial incentive? It's really to create an immediate and large and sustained business case for provider organizations to make investments that are going to be needed to really move the needle on equity of care," said Mark Friedberg, SVP of performance measurement and improvement at BCBS Massachusetts.

    Some of the largest commercial insurers are also making efforts to improve health equity by hiring equity experts, investing in providers' digital infrastructure, and screening patients for social determinants of health, Tepper writes. For example, Humana and CVS Health's Aetna both hired their first chief health equity officers this year.

    "Social risk adjustment in health care performance measures is becoming increasingly factored [into] payment models,” said Kedar Mate, president and CEO of IHI. "It's not just CMS, it's also commercial and private payers. Many of them are moving exactly in the same direction and gathering the information necessary to create provider specific reports, share those reports, and start having a conversation with their providers around how to support them, where there are documented disparities that are present." (Tepper, Modern Healthcare, 11/16)

     

    Advisory Board's take

    Going beyond the surface—3 hallmarks of a robust heath equity strategy

    By Lauren Woodrow

    As the story highlights, priorities surrounding health equity have boomed in the last year. And as great as it is to see deepened interest in equity efforts, not all actions have equal impact (which is why we see ample different approaches and strategies, with payment models being one of many).  Recognizing this reality, we dove deep in efforts to uncover the actions that best support health equity. Our research has found three hallmarks of a robust and credible health equity strategy:  

    1. Putting real dollars on the line; 

    2. Setting internal accountability for meeting equity goals; and,  

    3. Creating a transparent database of qualitative and quantitative efforts to ground efforts.  

    These three things demonstrate a willingness to be a strong partner in the journey to advancing health equity. But we can't stop here.  

    Sustainable change requires organizational transformation

    As with any business priority, health equity requires a high amount of strategic rigor in the design and implementation. Too often we've seen leaders follow statements aimed at advancing equity with efforts that are relatively one-off programs, not true organizational transformation. These short-term projects also tend to rely on a small group of motivated volunteers, rather than holding all staff accountable for their role in either advancing (or impeding) health equity. Defaulting to one-off passion projects alone will ultimately undermine the viability of a long-term health equity strategy—and prevent organizations from meeting the very real needs of their employees, patients, and community. To ensure equity receives the resources and attention it needs and deserves, organizations must commit a dedicated, fully resourced team to advancing equity, but also embed equity goals in every strategy and department. It is promising to see companies like Humana and Aetna investing in actual positions dedicated to health equity. But here’s the thing—it is not the hiring of chief health equity officers that will move the needle; it is the action and change that must follow. 

    Patient outcomes are just one piece of the puzzle

    Health equity doesn’t just apply to patient outcomes. Patient outcomes are tightly intertwined with workforce DEI and community-wide root causes. Addressing one of these pillars has a ripple effect on the others, and to make meaningful progress you must address all three. Advancing equity can have a positive impact on your employee value proposition, your consumer experience, your future product offerings, and can prepare you for future downside risk. But it’s important to remember that equity is inherently valuable simply by its nature.  

    Parting thoughts

    As the health care industry continues to devote resources to health equity, remember that our work is only beginning. Everyone in health care has a role to play, from payers to providers to pharma and policymakers. And when advancing equity is seen as a non-negotiable—that's when real progress gets made.

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