Health equity affects us all, directly or indirectly—and the lack of equity can put us in a financial crisis. Health equity is a fair and equitable opportunity for each individual to achieve their full potential in all areas 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.
Published by the National Academy of Medicine in 2001 passing the quality standard, It emphasizes fair care as a priority in health care. While many health care organizations have focused on health equity since that report, what patients receive (and the outcomes they receive) can still vary by race, age, income, ethnicity, gender, and zip code.
Consider this: About 80% of hospitals and health systems say they are asking their patients about home needs. However, only 32 percent of these organizations connect patients to services to address identified needs. This gap suggests an opportunity for hospital and health system leaders to work with employers and community partners to envision new approaches to care and safety, as well as new business models, that make care more reliable, sustainable and equitable.
As caregivers and often the largest employer in the communities they serve, hospital and health systems routinely address health equity directly through the care they provide, prevention, and health drivers by influencing health outcomes.
There are four key actions to address health equity between staff and executives (internally) and the patients and communities they serve.
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- Organization: The ability to effectively address health disparities in the community requires an organizational strategy to address diversity, equity, and inclusion for the workforce.
- Supplies: Having an equity lens that examines services provided 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.
- Society: Establishing relationships with trusted local organizations provides insight into the lived experience of the population. This can lead to collaboration to improve health equity. Healthcare organizations must find ways to integrate their data with their community partners and life experience data.
- Ecology: Recognizing that hospitals and health systems, health plans, providers, vendors, and nonprofit community organizations are all part of the healthcare ecosystem. Health system leaders should try to work with organizations focused on diversity, inclusion, and health equity.
Our research found that community health ecosystems may need additional partners, shared goals, technology, and metrics to advance sustainable work. But most importantly, they need the participation and leadership of many community members.
There is growing recognition that health equity should be an integral part of environmental, social and governance (ESG) strategies. Developing ESG frameworks and metrics is becoming critical. Many hospitals and health systems already have the materials they need to build a foundation for a health equity strategy. But hospital and health system leaders tell us that navigating referrals around a community’s social needs is challenging.
CHNAs as a basis for intelligence and strategy for hospital health equity
Community Health Needs Assessments (CHNAs), defined in the Affordable Care Act (ACA) of 2010, require tax-exempt hospitals and health systems to identify health issues in a community, conduct quantitative analyzes of actual health issues, and evaluate existing efforts. To resolve those issues and plan for future action. The provision was created to help hospitals understand their community’s needs, identify and document whether they are spending money wisely. The IRS expects hospital executives to use CHNAs to measure themselves and evaluate their efforts.
While CHNAs can be a valuable tool for assessing community health issues, hospital executives may be missing an important opportunity. CHNAs can be a powerful tool for determining where to make community-based investments. Data collected on CHNAs, combined with other data, can help guide community health strategies. This information also helps identify local organizations that may be willing to collaborate. Consider a community with an unusually high incidence of diabetes and diabetes-related amputations. Peeling the onion in that community reveals a high number of liquor stores, limited Greenwich space, a lack of primary care providers, and places to buy affordable and healthy food. Perhaps some amputations could be avoided if a value-based payment model incentivized clinics to focus on prevention and wellness rather than the number of procedures performed. We know that social factors and environment influence health outcomes. Questions that help assess those risks can help inform community health strategy, investment, and collaboration for better health outcomes.
Hospital-CBO collaboration as a multiplier.
Hospitals and community-based organizations (CBOs) often have competing priorities and different cultures. Hospitals can play an important collaborative role with CBOs. That makes it important for hospital leaders to outline strategies, roles and expectations as they form partnerships with community groups. In the year In 2016, for example, Indiana University Health created a memorandum of understanding with a local food bank to distribute healthy meals in highly food-insecure neighborhoods.
In Chicago, the Alliance for Health Equity has built bridges between hospitals and the communities they serve. The Alliance is a collaboration of 37 hospitals working with health departments and more than 100 CBOs to improve health equity, safety and quality of life. The groups worked together to develop a CHNA to summarize the health needs of the population and determine how to address those needs.
In Virginia, three hospitals have partnered to identify and address social issues that negatively impact community members. The hospitals have developed a unique community feedback process where community members can openly share their observations and ideas with hospital staff. They determined that unemployment was the most important health driver that needed to be addressed. The Support East End Entrepreneur Development (SEED) program was created through a partnership between the Local Initiatives Support Corporation (LISC) of Virginia and a local health system to help revitalize a neighborhood. Each hospital has agreed to make an annual contribution of $150,000 for three years. In the year The program, which began in 2011, provides up to $25,000 in grant money to individuals looking to expand or start a business in the Church Hill neighborhood. 14 small businesses received training and financial support through the program. This not only improved economic activity, but also had a positive effect on the health of the residents.
- Trinity Health created the Transforming Communities Initiative (TCI) to improve health and wellness at eight participating sites. TCI is based on community partnerships that focus on policy, systems and environmental (PSE) change strategies.
- Data assets such as the Dimes Maternity Care Deserts Dashboard, Maternal care can provide a more comprehensive view of wilderness areas. The dashboard also provides information on the relationship between maternity care deserts and health issues related to race/ethnicity, income status, and chronic health inequities among women of reproductive age.
The future of health equity: speed of change and sustainability
Health inequity is a chronic condition in America characterized by poverty, inequality, discrimination, wealth gaps, and inequity. Many health systems and health plans have mission statements that emphasize equity and the health of their communities. Some organizations have established health equity leaders, diversity departments and/or teams for years.
What is new is the movement to change the status quo, the alignment between stakeholders and the question of accountability. The combination of the Covid-19 pandemic and protests against social injustice have prompted many organizations to step up their diversity, equity and inclusion efforts. The wish is that this work is not for the moment but for a long time and is based on trust. Trust is key to accelerating the pace of change and achieving sustainability.
Photo: Uncredited, Getty Images
Editor’s note: The authors confirm that none of the entities mentioned in the article are clients of Deloitte. They are affiliates of the Deloitte Health Equity Institute.
