A practical approach to improving health equity: eight steps

Healthcare organizations can make meaningful progress and build a healthier business by focusing on access to care.

Ensuring equitable care for every population they serve is a moral imperative for healthcare organizations. Increasingly, investing in health equity measures is also good for business. Organizations can build resiliency and flexibility and improve outcomes for all their patients when they take a strategic approach to improving health equity.

These strategies must integrate the administrative, clinical and technological capabilities required to identify and rectify health equity disparities. In particular, healthcare organizations can greatly improve access to care, a key social determinant of health (SDoH) over which they have tremendous influence. 

Expanding equity-driven access: eight key steps

To learn more about the present state of healthcare equity, we studied the efforts of more than 30 health plans and provider organizations. Most had merely implemented healthcare equity projects, as opposed to forming a true strategy. It was often unclear how these health equity projects related to the overall mission of the organization, and how each was supported by existing infrastructure. It was not surprising, then, that most of the organizations we studied were reporting disappointing results.

While healthcare organizations often address multiple SDoH, access to care is the factor over which they have the greatest control. Access arguably is also the key to improving other equity measures as well as health outcomes. Developing a health equity strategy that initially focuses on this component should bring underserved members and patients into the organization’s orbit. Then any additional SDoH needs they have can be identified and addressed.

Achieving equitable access requires more than a policy statement. It must be supported by specific capabilities that span administrative, clinical and technology functions. To that end, we’ve developed a list of key steps and capabilities required to execute a holistic approach to expanding access to care:

1.    Get the data strategy right

Decisions about how to expand access to care must be driven by data, not intuition. Most healthcare organizations can’t afford to experiment; they must expand care and services where they will have the most impact. A comprehensive data strategy will provide the insights and feedback needed to make optimal access and equity interventions.

The data strategy begins with data acquisition from multiple sources. To help a large healthcare provider identify social determinants, we used health and prescription drug claims data; electronic health record and health information exchange data; behavioral data; community data; contact center data; and social data. The goal is to create a unified member/patient profile from these data sets.

Incorporating personal and social attributes as well as clinical data enables precision risk stratification and segmentation. Using our natural language processing and text mining algorithm, our client uncovered specific social determinants, including the fact that 16% of the patients in the target group had difficulties accessing care.

Advanced analytics, artificial intelligence and machine learning tools can use parameters such as ZIP Codes and income or education to infer missing data and potential SDoH issues, such as living in a neighborhood with minimal public transit options, that could affect care access. Google and others are working to ensure that medical large language models are sensitive to markers of health inequities and social determinants.

Data analysis can also reveal disparities in care quality, cost and experiences by population sub-segments. For example, a large health plan client found a significant number of high-risk pregnancies in a cluster of counties it served. Without intervention, these could result in poorer maternal and neonatal-related outcomes.

Understanding these gaps and calculating their costs provides evidence for the potential impact of equity-driven interventions and guide investment priorities. Our health plan client realized that ensuring its high-risk maternity patients followed through on their care referrals was critical for good outcomes. To that end, we built a solution that combined digital and physical outreach to key community centers to follow up on patient referrals.

2.    Reduce barriers to care access and coverage

Organizations can identify and address barriers with data-driven approaches to benefit design. Our client recognized offering maternity programs that coordinate clinical, behavioral and social services like nutrition and education in counties with high-risk pregnancy numbers could improve access and outcomes. To reduce transportation obstacles, we helped create a registry and maps to make sure patients were referred to services convenient to their homes.

Navigation and health literacy services plus workplace/employer collaboration also lower barriers. Navigators can help members understand and use their benefits effectively. For example, a healthcare organization could work with an employer to organize worksite clinics so employees don’t lose wages by taking time off to visit their physicians.

3.    Build provider capacity and align payment methodologies

Organizations should ensure access to adequate numbers and types of providers and should make certain they are available at times convenient to the target population. They should also ensure that providers have a variety of backgrounds and experiences so they can provide care appropriate to an individual’s race, ethnicity and preferred language (REaL). Healthcare organizations may build health equity measures into contracts and “pay for equity” models that tie reimbursement to specific equity measures, such as social screenings, needs assessments or completed referrals.

For high-risk pregnant women, an organization could use AI and analytics tools with its data to match patients with physicians who can provide holistic care within those patients’ cultural contexts. This will improve adherence to care plans and thus clinical and behavioral outcomes.

4.    Improve the inclusivity and quality of stakeholder experiences

Organizations must deliver compassionate experiences focused on optimal health outcomes. This likely means redesigning communications and services to be culturally and linguistically appropriate. They must leverage digital and physical member touchpoints to conduct social risk assessments, provide education, and set up and follow through on referrals. Analytics can help identify high-risk members while potentially minimizing the need for surveys and questions that could be seen as intrusive.

5.    Measure the right outcomes and integrate social determinants into programs

AI tools enable healthcare organizations to go beyond Z codes to find SDoH data in clinical notes and other unstructured data. Using those tools as well as claims, clinical and third-party data enables precise segmentation of populations and personalized care programs that align with them. Accurately capturing and codifying SDoH data is a prerequisite for accurate risk scoring. That data is also essential to stratifying quality metrics and dashboards across various quality measures, including the Centers for Medicare & Medicaid Services’ (CMS) Star Rating and the Healthcare Effectiveness Data and Information Set (HEDIS). It can aid in achieving health equity standards, such as National Committee for Quality Assurance Health Equity and Health Equity Plus credentials and the Joint Commission’s Health Care Equity accreditation.

6.    Keep physical and social services at the forefront

Technology such as a digital community directory and referral system can help organizations create and monitor a closed-loop referral infrastructure so they can see whether individuals follow through on referrals. Organizations must support digital capabilities with a diverse set of community partnerships to better understand community needs and resource availability or gaps.

7.    Build a strong partner ecosystem

Healthcare organizations can collaborate with federal, state and local initiatives on expanding use of care by improving health literacy and communicating about available services. Organizations can evaluate where their vision and goals complement existing community efforts to avoid duplicative or competing efforts.

8.    Support initiatives with workforce diversity and training

It will be easier to incorporate health equity by design with a workforce that is attuned to potential inequities created by how systems and processes are structured. Organizations must also formally review and remediate systems, policies and procedures for inherent bias and barriers. Reinforce this remediation by aligning process metrics with health equity goals. Offer training in culturally and linguistically appropriate services (CLAS) and cultural competencies at all levels of the organization.

Next steps

Many factors influence health equity, and it may not be clear to all stakeholders that improving access to care is where the organization is likely to make the greatest impact. Answering the following questions can help an organization clarify its thinking about where to focus its equity investments:

• How “at risk” is your organization and what are its incentives to address SDoH and health equity from a business perspective?
  
  
• How does your organization plan to improve quality and access to comply with new equity measures from CMS that will influence its Star ratings and new accreditations from NCQA/HEDIS and the Joint Commission?
  
  
• How well does your technology suite support the role you want your organization to take in improving health equity?
  
  
• How well are you able to leverage data and analytics to identify and address health equity issues?
  
  
• What is your ability to exchange data and incorporate the resources of community-based organizations in your health equity efforts?

The stronger the business health of the organization, the better equipped it will be to meet not just the challenges of equitable access to care but the industry’s overall economic and competitive pressures. Intertwined administrative, clinical and technological capabilities are essential for all care delivery, not only those focused on righting inequities. Implementing a health equity strategy focused on improving access to care through those capabilities will improve the health of the entire organization even as it addresses equity issues in the populations it serves.