In this series, Health Evolution is examining the year 2021 in health care through the lens of our eight imperatives. We will be examining the trends that were at the top of CEOs’ minds throughout the past year and what may come in 2022. This week: Escalating Health Equity
The status of health disparities in America was made worse by the COVID-19 pandemic. The struggles that started in 2020 have continued to escalate in 2021.
In a new wide-ranging report, the Commonwealth Fund found that the average life expectancy of Black, Hispanic, and American Indian/Alaska Native people fell more sharply during the pandemic than those of White people. These populations are also “less likely to have health insurance, more likely to face cost-related barriers to getting care, and more likely to incur medical debt,” according to the report. They also are more likely to live in poverty, work in low-paying, high-contact industries, and to reside in high-risk living environments. In every state studied by the Commonwealth Fund, there were disparities. Even in the states where minorities scored above the national average, they still trailed White people in outcomes.
“The U.S. health care system is not immune from the systemic inequities that plague American society. Our health care is characterized by long-standing disparities in access, quality, and outcomes for people of color that were unveiled for many by the COVID-19 pandemic. We can do better, and we can start by tackling systemic racism, ensuring people have the health care coverage they need, and resolving racial disparities in care,” said study co-author Laurie Zephyrin, MD, Commonwealth Fund Vice President for Advancing Health Equity.
These are the challenges that health care CEOs in every corner of the industry are trying to address in some way, shape or form. Earlier in 2021, leaders of Health Evolution Forum’s Work Group on Leveraging Data to Improve Health Equity, which includes Zephyrin, received commitments from more than 40 leading organizations to collect, stratify and review race, ethnicity, language, and sex data (REaLS) data.
Beyond the use of data, health disparity-related initiatives and research efforts have taken hold across the industry. Much of it has come in the form of addressing the social determinants of health, a somewhat controversial phrasing that encompasses factors influencing the health of individuals and populations, such as socioeconomic status, housing, zip code, transportation, education levels, employment and health insurance, food insecurity and others.
A recent survey from Mercer found that nearly half of all large employers – and about two-thirds of those with 20,000 employees — say that addressing health equity and the social determinants of health will be an important priority over the next 3-5 years. A report from NORC at the University of Chicago found that Medicare Advantage plans are increasingly investing in social determinants of health benefits. An analysis of 57 health systems in Health Affairs found that they were spending billions on programs addressing housing and employment, and hundreds of millions on education, food security, and community context.
FarmboxRx CEO Ashley Tyrner has created a program that allows patients to use over-the-counter benefits to purchase curated boxes of produce that are tailored to chronic conditions and delivered to patients’ homes nationwide. With more than 50 health plan partners signing on to this plan (up from three plans in one year), the shift has been successful enough that FarmboxRX is cutting back on sending produce boxes directly to consumers.
“We spend an estimated $53 billion annually on diet-related chronic conditions. We cannot sustain that, right? That number is continuing to grow year on year. So, health plans are desperate to make changes to their members’ health and instead of treating the member repetitively with prescriptions and medications that can cause other problems and mask the underlying problem, which is a chronic related diet condition, they are looking at nutrition and there’s a shift in the market,” Tyrner says.
Communication and trust
Those working to reduce health disparities say that communication and trust are two of the biggest barriers they face on a consistent basis. In the Twin Cities in Minnesota, Axis Medical Center, a federally qualified healthcare center (FQHC), serves primarily an immigrant patient population with one foot in America and one foot in another nation, says Jonathan James, MD, Axis’ chief financial officer and an epidemiologist. More than half of Axis’ patients live at or below the poverty line and more than 80 percent are best served in a language other than English.
“These people have some difficulty navigating the health system simply by the barrier of language,” says James. There are also cultural difficulties, he notes. “Most of them have never seen snow. They arrive in Minnesota in the dead of winter without a jacket and it’s 3 degrees outside.”
To deal with the language barriers, Axis employs international medical graduates who can interpret for these patients. This doesn’t just allow for patients to understand what the clinician is trying to tell them, but it makes them feel more at ease, James says. “They see someone who looks like them and speaks their language. It resonates when that person can tell [the patient], ‘Yes I understand. I know where you’re from. I’m from there too.’ There is a confidence and trust that’s built,” James says.