Leavitt Partners Future Frame Series – Health Disparities: A Time For Action

Many healthcare industry leaders understand that health disparities are a problem, and likely have made public-facing commitments to underscore those concerns. But it is hard to know where to begin to make systemic changes that will reduce disparities. On Thursday, October 14, 2021, Leavitt Partners’ CEO, Andrew Croshaw, moderated a LinkedIn Live broadcast featuring Maddy Shea, Ph.D., Principal at HMA, and Chisara Asomugha, MD, MSPH, MHS, Principal Consultant at FutureHealth Strategies and Advisor to Leavitt Partners. The group discussed how health disparities (due to race, ethnicity, gender, geography, and other socioeconomic factors) place a financial and moral burden on our healthcare system, and increasingly place a reputational burden on the industry that is failing to address them.

Andrew began the discussion by reflecting on the past eighteen months and the moment we find ourselves in regarding openness to greater action. The moment has been defined by major events such as the seemingly unrelenting COVID-19 pandemic and the death of George Floyd and others that catalyzed a call for racial justice. The moment is being shaped by policy and politics, reflected in the establishment of the Health Equity Task Force under the Biden-Harris Administration’s call for an all of government approach to improving health equity. Solving for health equity requires a systemwide approach.

A Framework for Advancing Health Equity
Dr. Shea warned that thinking of a problem as “too big” can stymie the imperative to get started and can make clear solutions feel opaque. She highlighted the U.S.A Health Equity Framework, developed by the Centers for Medicare & Medicaid Services (CMS), to show a “continuum of action” to reduce disparities. While these steps might sound obvious, it can be harder than you think to understand the nature of the issue (finding the data), to find evidence-based, community informed solutions, or to find the right partners.

Future Frame Blog

For more information on the CMS Equity Plan for Improving Quality in Medicare, click here.

 

The Case for Partnership
Dr. Asomugha, as a public health expert and a frontline pediatrician, has a unique perspective on how to combine the efforts of public health and clinical care to address disparities. Addressing health disparities, she argues, isn’t a problem that the public health sector can or should be solely responsible for solving. Public health workers have sounded the alarm of how social factors can impact health and well-being, and it’s important for business leaders to recognize that public health is not only a partner but an ally in achieving health equity. As one example of a productive partnership, Dr. Asomugha highlights Henry Ford’s Health System in the Detroit region and how they are partnering with universities and local organizations to advance health equity.

Dr. Asomugha contends that business leaders can’t talk about costs without talking about quality, and they can’t talk about quality without addressing what is driving health disparities (including structural barriers, institutional racism, and other forms of oppression). This requires internal and external reflection. To help leaders assess where their organization needs to go, Dr. Asomugha introduces another frameworkContinuum on Becoming an Anti-Racist Multicultural Organization, to help organizations move along the continuum from seeing racial and cultural differences as deficits, to knowing and celebrating racial and cultural differences as assets. Externally organizations need to come together in partnership to re-evaluate what is (and is not) being measured and who is (and is not) at the table. Health equity isn’t just something that happens out there, but requires inward focus about the role our internal structures play in maintaining or transforming our healthcare system.

Andrew observed that this conversation reflects an exciting evolution away from tracking only clinical measures toward figuring out how to track complicated social factors. Dr. Asomugha shared examples in Oregon with better measures of sexual orientation and gender identity data and the 2021 report from the Assistant Secretary for Planning and Evaluation that looked at social determinants of health in measurement development. These efforts are preliminary, but they are promising. We should ensure that the data stratification doesn’t obfuscate disparities but allows healthcare leaders to address them head on.

Inflection Point vs. Tipping Point
Dr. Shea celebrated that so many stakeholders—national health plans, states, hospital systems, counties, and the pharmaceutical industry—are seeking to understand what they can do to advance health equity. She believes this momentum is being driven by three factors:

  1. The blatant outcome disparities in different racial and ethnic groups during the COVID-19 pandemic
  2. The Call to Action to end violence perpetrated against Black community members
  3. The Biden-Harris Administration’s prioritization of health equity and infusing it into every policy consideration

These factors have created opportunities for public and private organizations to be innovative and actionable. For example, Dr. Shea reflected on how states are now requiring managed Medicaid plans to describe their intention to address health equity, hospital systems have increased accountability to their respective communities, and companies from the pharmaceutical industry are looking internally to assess their impact on health equity. All of Dr. Shea’s consulting work is directly addressing health equity head-on, not as a tangential or invisible factor.

Dr. Asomugha clarified that an inflection point is a point on a curve that demonstrates a change in direction, while a tipping point is the point at which a series of small changes leads to a significant seismic shift. For her, we are at a tipping point over a hundred years in the making. Choices that have led to a reckoning that puts a spotlight on health equity. Time will tell if the industry will meet this moment with fortitude. The industry is currently making changes that have the potential to create the equitable healthcare system we need. Some recent examples include the Biden administration’s Executive Order establishing advancing health equity in government, establishing the Equitable Data Workgroup, and infusing $2.5 billion dollars into the public health system to advance equity. Research organizations are looking at how to reflect the complexities of the communities they are working with. These actions happening at the federal, state, and local levels, Dr. Asomugha believes, are anticipating a shift that will help support action to achieve health equity.

What Can We Expect?
Andrew concluded the conversation with some expectations regarding health equity in the near term:

  1. Healthcare companies should anticipate continued policy action on health equity.
  2. Rules and regulations will expect more of healthcare stakeholders in exchange for participation in federal programs like Medicare and Medicaid.

Healthcare businesses that serve patients must be specific in their plans to make structural changes to address health equity, including showing additional accountability to closing these gaps. For more on how Health Management Associates and Leavitt Partners can help, please contact andrew@leavittpartners.com.

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