Equity in health care affects all of us—directly or indirectly—and lack of equity can push us into financial crisis. Health equity is the fair and equitable opportunity for each individual to achieve their full potential in all aspects of health and well-being. Health care 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 emphasizes equitable care as a priority in health care. While many health care organizations have focused on health equity since this report, the care patients receive (and the outcomes they experience) can still vary greatly by race, age, income, ethnicity, gender, and zip code.
Think about it: Nearly 80% of hospitals and health systems say they ask their patients about housing needs. However, only 32% of these organizations connect patients with services to meet identified needs. This gap signals an opportunity for hospital and health system leaders, along with employers and community partners, to envision new approaches to care and well-being, as well as new business models that enable care to be reliable, sustainable, and equitable.
As providers of care and often the largest employer in the communities they serve, hospitals and health systems are typically well positioned to increase health equity directly through the care they provide, upstream with prevention, and by influencing the drivers of health that influence health outcomes
There are four key actions to consider in addressing health equity among employees and leaders (internal) and the patients and communities they serve (external).
- Organization: The ability to effectively address health disparities in a community requires an organizational strategy to address the diversity, equity, and inclusion of its workforce.
- Suggestions: Having an equity perspective that looks at 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 models of care delivery.
- community: Establishing links with trusted local organizations can provide insight into the lived experience of the population. This can lead to collaborations to improve health equity. Healthcare organizations must look for ways to integrate their data with data from their community partners and lived experience.
- Ecosystem: Recognizing that hospitals and health systems, health plans, providers, marketers, and nonprofit community organizations are part of the health care ecosystem. Health system leaders should seek to work with organizations that are focused on diversity, inclusion, and equity in health care.
Our research found that to advance current work, community health ecosystems will likely 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. The development of ESG frameworks and measurements becomes critical. Many hospitals and health systems already have the materials they need to build the foundation for a robust health equity strategy. But hospital and health system leaders tell us that navigating recommendations around community social needs can be challenging.
CHNAs as intelligence and foundation for a hospital’s health equity strategy
Community Health Needs Assessments (CHNAs), which were outlined in the Affordable Care Act of 2010 (ACA), require tax-exempt hospitals and health systems to identify perceived health problems in a community, perform quantitative analyzes of actual health problems, assess existing efforts to address these problems and formulate a plan for future action. The provision was created to help hospitals understand the needs of their communities, determine whether they are spending money appropriately, and document it. The IRS expects hospital managers to use the CHNA to benchmark and evaluate their efforts.
Although CHNAs can be a useful tool for assessing issues that affect community health, hospital leaders may be missing an important opportunity. CHNAs can be a powerful tool for determining where to make community investments. Data collected on CHNAs, combined with other information, could help guide a community health strategy. This information can also help identify local organizations that may be willing to collaborate. Consider a community that has an unusually large population of diabetics and a high number of diabetes-related amputations. Peeling back the onion in this community can reveal a large number of liquor stores, limited green space, a lack of primary care providers, and few places to buy affordable and healthy food. Perhaps some amputations could be avoided if a value-based payment model provided clinicians with a financial incentive to focus on prevention and health rather than the number of procedures performed. We know that social and environmental issues can affect health outcomes. Questions that help assess these risks can help inform community health strategy, investment and collaboration for better health outcomes
Hospital-CBO collaboration as a scale multiplier
Hospitals and community-based organizations (CBOs) often have competing priorities and different cultures. Hospitals can play an important role in co-habiting with CBOs. This makes it important for hospital leaders to outline strategies, roles and expectations when building partnerships with community groups. In 2016, e.g. Indiana University Health created a memorandum of understanding when it partners with a local food bank to distribute healthy food to neighborhoods with high levels of food insecurity.
In Chicago, Alliance for Health Equity build a bridge between hospitals and the communities they serve. The Alliance is a collaboration of 37 hospitals that work with health departments and more than 100 CBOs to improve health equity, well-being, and quality of life. The groups worked collectively to develop the CHNA to summarize the health needs facing the population and determine how to meet those needs.
In Virginia, three hospitals have collaborated to identify and address social issues that negatively impact community members. Hospitals have developed a unique process of community vision where community members openly shared their observations and ideas with hospital staff. They identified unemployment as the most important driver of health to be addressed. The Supporting entrepreneurial development in the East End (SEED) The program was created through a partnership between the Local Initiatives Support Corporation (LISC) Virginia and the local health system to help revitalize a neighborhood. Each hospital agreed to make an annual contribution of $150,000 to the program over three years. The program, which started in 2011, provides up to $25,000 in grant money to individuals looking to expand or start a business in the Church Hill neighborhood. Under the program, 14 small businesses have received training and financial support. This not only improved economic mobility, but also had a beneficial effect on the health of residents.
- Trinity Health created An initiative to transform communities (TCI) to improve health and well-being at eight participating sites. TCI relies on community partnerships that focus on policy, systems and strategies for environmental change (PSE).
- Data assets such as March of Dimes Maternity Care Deserts Dashboard, may provide a more comprehensive view of desert locations for maternity care. The dashboard also offers information on the relationship between maternity care and health problems related to race/ethnicity, income status, and chronic health disparities among women of childbearing age
The Future of Health Equity: Pace of Change and Sustainability
Health care inequity is a chronic condition of America, manifesting itself in poverty, discrimination, bias, wealth disparities, and injustice. Many health systems and health plans have mission statements that emphasize the equity and health of their communities. Some organizations have had health equity leaders, diversity departments and/or teams for years.
What is new is the impetus to change the status quo, the alignment between stakeholders and the calls for accountability. The combination of the Covid-19 pandemic and demonstrations against social injustice has spurred many organizations to improve their diversity, equity and inclusion efforts. The aspiration is that this work is not for the moment, but for the long term and based on trust. Trust is the key to accelerating the pace of change and achieving sustainability.
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Editor’s note: The authors confirm that none of the individuals named in the article are clients of Deloitte. They are fellows of the Deloitte Health Equity Institute.