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Advancing equity in health care begins with measuring racial and socioeconomic disparities

The first in a two-part series focusing on how CEOs can lead health care organizations in using data to improve disparities, social determinants and community partnerships.

Tom Sullivan | October 21, 2020

While health inequities are widely recognized as a substantial problem in the U.S., hard data segmenting health outcomes by race and socioeconomic metrics among patients and members is not commonplace. Without that information, however, CEOs are unable to understand the scope of disparities or build strategies to solve the problem.

“No one is doing this work perfectly,” said Tosan Boyo, Senior Vice President of Hospital Operations, John Muir Health. “There is no super-advanced organization that has mastered the art of health equity.”  

To advance health equity, CEOs can lead their organization’s efforts to drive change in two key areas:

    • Leveraging data to improve health equity
    • Building scalable models and community partnerships to address social determinants of health

This article will examine leveraging data to improve health equity and the second in this two-part series will focus on building scalable models and partnerships for social determinants.

“It comes down to what we are going to do versus what we are going to talk about. Now it’s time for action,” said Rod Hochman, MD, President and CEO, Providence. “What we have to do is mobilize all of us to action.”

Reality check: What health care is doing today  
Health Evolution conducted a preliminary survey to determine the current state of leveraging data to address equity.

How does your organization currently approach stratifying its data by race, language or socioeconomic status to understand potential health disparities?

    • We have stratified patients or member health outcomes but we have only used these results internally – 35%
    • We have stratified patient or member health outcomes and shared those results externally/publicly – 29%
    • We have not yet stratified outcomes by race, language or socioeconomic status – 12%
    • Other – 24%

“We’re seeing some of the deadliest statistics around COVID-19 — and that tracks to long term inequities and structural issues,” said Laurie Zephyrin, MD, Vice President of Health Care Delivery System Reform at the Commonwealth Fund. “We need to use data and metrics to better understand outcomes and experiences in health systems within communities that are typically more segregated. Then, we can target resources where it is needed the most.”

Measuring data to address established problems
Carrie L. Byington, MD, Executive Vice President of UC Health said the system looks at outcomes data by race and ethnicity.

“Recently, we have also linked our primary care population to the Area Deprivation Index, which enables the system to classify patients based on the characteristics of their neighborhood,” Byington added. “These types of data-driven insights can lead to novel ways to address what have been very recalcitrant issues. The data are changing the way that we’re approaching population health.”

Mark Smith, MD, Founding President and former CEO, California HealthCare Foundation said other metrics such as income, census track or zip code data can also be useful.  

Myechia Minter-Jordan, MD, President and CEO, DentaQuest Partnership for Oral Health Advancement, cautioned against confusing race data with lower income.

“We know very clearly that some of the inequities within Black and Brown communities exist regardless of income, particularly as you think about maternal mortality, etc.,” Minter-Jordan said.

Boyo added that when looking at patient outcomes and stratifying the data, CEOs should also lead their organizations in considering workforce data as well.

“We’ve learned that looking at the workforce is absolutely critical because it really helped us understand what might be unintentionally perpetuating the disparities,” Boyo said. “Leadership concerns about the internal and external perception of disparities within the organization can limit the impact the community truly needs. What really matters is the commitment to stratifying quality outcomes by race, being transparent with the findings and then intentionally closing the gaps. Following through on the commitment is critical. This is how we drive efficacy.”

Ultimately, segmenting and measuring health outcomes by race and socioeconomic condition is a beginning rather than the end goal.

“Measurement alone is not sufficient,” Zephyrin said. “We need to be able to target the investments and create accountability so that we can actually have the action that can advance equity and address systemic racism.”

What comes next
To identify best practices that are already working in some sectors of the industry and then disseminate those broadly, the Health Evolution Forum Community Health and Advancing Health Equity roundtable ratified Work Groups to address: leveraging data to improve health equity and building scalable models and community partnerships to address social determinants of health.

The goal of the Work Group on Leveraging Data to Improve Health Equity is to enable CEOs to identify, track and manage the impact of race on clinical care and prevention. The Forum will measure progress based on the percentage of organizations that institute practices to segment and report health outcomes data by race and socioeconomic metrics.

Until CEOs widely institute best practices for measuring health outcomes by race and socioeconomic outcomes, there is no way to eradicate or ease those disparities.

“If you would like not to pay attention to this issue,” Smith said, “the easiest way to not pay attention is to not collect the racial data so that you don’t have disparities to point out.”

Related articles: 
Addressing racism as a social determinant of health
The trust factor: Why life sciences CEOs must go all in on social determinants
The ACA faces an uncertain future: How can CEOs plan ahead? 

About the Author

Tom Sullivan, EVP & Editor-in-Chief of Digital Content

Tom Sullivan brings more than two decades in editing and journalism experience to Health Evolution. Sullivan most recently served as Editor-in-Chief at HIMSS, leading Healthcare IT News, Health Finance, MobiHealthNews. Prior to HIMSS Media, Sullivan was News Editor of IDG’s InfoWorld, directing a dozen reporters’ coverage for the weekly print publication and daily website.