COVID-19 and the social injustice crises of 2020-2021 shined a new light on the systemic disparities in the U.S. health care system. Some disparities – such as with maternal and infant health – have been understood within the industry. But startling new research published last month found that Black children experience higher complication rates that White children after having their appendix removed, an indication that such inequities are more widespread than previously believed.
A dearth of data hinders a more comprehensive understanding. Recognizing that fact, a Health Evolution Forum work group has been convening across the past year to agree on a consistent set of measures and approach to collecting, stratifying, and analyzing disparities data. Already, approximately 40 leading organizations have signed the corresponding Health Equity Pledge, committing to collect data about race, ethnicity, language and sex (REaLS) and then share what they learn to develop best practices that are ultimately disseminated broadly across the industry.
Going forward, the Health Evolution Forum will convene executive leadership and subject matter experts to develop real-world solutions around:
- Increasing collection of voluntarily self-reported (gold standard) race, ethnicity, language, and sex data
- Strengthening industry partnerships to dismantle collection and stratification barriers, including with large employers
- Driving more consistent adoption of data standards and definitions for improved stratification and review
“A concerted commitment to such collection and stratification for all key quality and performance metrics is critical to understanding and, most important, redressing disparities,” said Richard Schwartz, President, Health Evolution. “We are pleased to serve as a learning lab for this important endeavor and welcome other industry leaders to join in.”
Per results from a preliminary 2021 survey conducted by the Health Evolution Forum, the vast majority of responding organizations are collecting some patient/member data on race and ethnicity, but sizeable shortfalls remain in these collection efforts. Fewer organizations are tracking data at all on language and sex and only 30% regularly review the disparities data they do collect. And none of the respondents stratified these data for all or nearly all (greater than 90%) of their business lines.
“Too few organizations are actually analyzing disparities data internally, developing dashboards, embedding it into clinical workflows, and making it public,” says Laurie Zephyrin, MD, who is a Forum Fellow, and Vice President, Advancing Health Equity, at The Commonwealth Fund.
These substantial gaps limit awareness and ability to implement equity-focused interventions and establish accountability mechanisms that strategically address health disparities.
To reduce variation in the ways data is applied to advance equity, Forum Fellows and other organizations pledge to, in the next three years:
- Collect REaLS data for at least 50% of the organization’s patient, member, or customer population
- Stratify and regularly review these collected data by the top-priority quality or access metric for 90% of major business lines and/or departments/divisions of adequate size
- Participate in the Health Evolution Health Equity Learning Lab by sharing stratified data for select measures to facilitate anonymized benchmarking and to identify best practices for reducing disparities
“It was important for us to figure out how to address this issue in ways that could resonate with everybody in our health care system, because our health care system doesn’t exist outside the void of the social polarization in our country,” said Mark Smith, MD, a Forum Fellow and Founding President & Former CEO, California Health Care Foundation. “Equity is not separate from quality…it is part of quality. One doesn’t have to necessarily agree with my definition of social justice or yours to have equity as a professional aspiration and goal to which we hold ourselves and our institutions accountable.”
Organizations that have signed on to the Pledge to date:
Health plans: Blue Cross and Blue Shield of North Carolina, Blue Cross Blue Shield Association, GuideWell & Florida Blue, SCAN Health Plan
Health care providers: AIRnyc, Cancer Treatment Centers of America, Cityblock Health, Eleanor Health, Everside Health, Galileo, Gillette Children’s Specialty Healthcare, Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Hazel Health, John Muir Health, Link Primary Care, Marshfield Clinic Health System, Monogram Health, Nemours Children’s Health System, Northwell Health, Oak Street Health, Rebalanced-Life Wellness Association, Spectrum Health, SUN Behavioral Health, Thomas Jefferson University and Jefferson Health, University of Arkansas for Medical Sciences, University of California Health, VillageMD
Other organizations and individuals: ARCHANGELS, Accountable Care Learning Collaborative, Bloom Standard | Newborn Foundation, Capital Rx, Change Healthcare, eMed, Genome Medical, Health Level Seven, Inc., Mark Smith – Founding President & Former CEO of California Health Care Foundation, Newtopia, North Carolina Department of Health and Human Services, Primary.Health, Socially Determined
The Health Evolution Forum is underwritten by: