As the COVID-19 pandemic rages on, equitable, high-value care is more necessary than ever given that the pandemic continues to disproportionately impact Black people and communities of color. Black Americans are dying at twice the rate for their white counterparts. Clearly, there is work to do to achieve high-value care, defined by the Institute of Medicine as “the best care for the patient, with the optimal result for the circumstances, delivered at the right price.”
In a recent AcademyHealth webinar, experts presented their thoughts on a key component of progress needed to advance high-value care: equity. Speakers Soma Saha, founder and executive lead of Well-Being and Equity (WE) in the World, and Dawn Johnson, Founder and CEO of DHJ Services, emphasized the need to address the history of inequity embedded within our health system and to ensure equitable care is being delivered by a diverse workforce who understand how to use data to improve interventions and advance equity.
Addressing Inequities to Deliver High-Value Care
A key theme of the webinar was that clinicians need to address structural barriers and other social issues, including poverty and racism, when delivering care. Presenter Soma Saha discussed her experience screening for social determinants of health at Cambridge Health Alliance, which revealed that more than half their patients spoke a language other than English and at least 80 percent were on public insurance. It was clear they needed to change the way they delivered care and center equity to improve health outcomes.
Saha also noted that addressing diabetes and prediabetes in the community required her to look beyond the information included in a patient’s health record. She highlighted a correlation between impoverished areas and the eventual development of prediabetes and premature mortality, pointing to the interplay between one’s income bracket and health and well-being.
Saha outlined how inequities in care are rooted in a history of structural racism, redlining, and lack of access to community infrastructure, including jobs, parks and other healthy spaces, and even clean water. The impact of this legacy has been exacerbated by the current pandemic, specifically regarding communities facing unemployment due to COVID-19, and who may lack access to testing and treatment, as well as clean water for hand washing.
She concluded that care providers must consider how factors such as race, geography, income level and others interact with one’s health and experience of the health care system, as well as the disproportionate effects of COVID-19 on vulnerable communities.
Importance of Diversifying the Health Care Workforce
Presenter Dawn Johnson highlighted one effective way to address these inequalities: creating a diverse workforce so patients receive health care from professionals who look like the community they are treating. If patients believe their practitioner has a bias or attitude, it creates a lack of trust between the patient and provider, she said. Johnson noted that trust is often more easily built when a caregiver looks like you and/or understands your culture and background. According to Kaiser Health News, Black Americans are more likely to “seek out Black providers because they’ve experienced cultural indifference or mistreatment in the health system.” However, Johnson noted during her presentation, minority groups almost never get to receive care from culturally similar health care providers. This lack of diverse care contributes to low-value care.
Further, Johnson highlighted that this lack of diversity in the health profession could have long-term impacts on the field by creating future doctor shortages. She noted that people of color are less likely to pursue a profession in health care due to the lack of diversity in the field. As Johnson stated: “I cannot be what I cannot see.”
Using Data to Improve Interventions to Advance Equity
Lastly, presenters highlighted how the use of data could improve interventions to advance equity. Johnson noted the important first step of using data to understand both your community and your health care organization. For example, not everyone collects race, ethnicity, language, and disability data from their patients, workforce, and community. And even when organizations have this data, they often don’t know how to leverage it to create policies and programs that improve care, she noted. In order to measure equity and understand the structures organizations are working within, data must be used and distributed. Additional training and having a diverse workforce will help to breakdown barriers to data collection.
Saha noted the importance of looking at the structural factors in addition to individual-level data. Health service researchers and practitioners have the opportunity to “think fundamentally differently about who, and how we define value and how we create value.” And instead of looking at just race in data, researchers and practitioners should examine health outcomes, partner with those who experienced inequities, and consider how structural factors, including race, resulted in such outcomes in the first place.
Listen to the full webinar here.
The webinar described in this post was presented as part of the AcademyHealth, ABIM Foundation, and Donaghue Foundation Research Community on Low-Value-Care, a professional hub for stakeholders working to eliminate Low-Value Care.