At times, Dr. Joseph Wright, director of health equity at the University of Maryland Health System, feels like he’s playing catch-up.
A year after his tenure at the Baltimore-based provider, Wright revisited the annals of medicine to uncover ancient science and the biases that may still exist in clinical care. ready.
He searched for and removed racial factors from the decades-old risk calculators and other clinical tool vendors still using that contribute to health outcomes. worse health for people of color.
Wright also made an effort to stratify safety and quality data by race and ethnicity to reveal disparities. Now, he’s working with researchers and medical schools to update the scientific record and train the next generation to deliver more equitable care.
“The landscape has changed a lot, and I think the industry is more acutely aware of the systemic inequality that exists,” says Wright. “But now that the bad data has been removed, it is clear that we have a responsibility to not only address the disparities, but also deliberately eliminate the activities that often lead to these disparities.”
Wright is among a growing number of healthcare executives tasked specifically with delivering on the industry’s enduring promises to address inequality and disparity. This requires confronting centuries of clinical and organizational practice influenced by discredited racist notions or that fail to take into account the health consequences of racism and segments of the population. have special needs due to their race, ethnicity, and other attributes.
The survival of these newly minted executives stems from a strategic shift among healthcare organizations that prioritize eliminating health disparities. Margaret Larkins-Petigrew, director of clinical diversity, equity and inclusion at the Pittsburgh-based Allegheny Health Network, who started this movement that has gone mainstream as the nation struggles with the COVID-19 pandemic and the murder of George Floyd in 2020. role in November 2020.
Health equity leaders are trying to maintain that momentum and transform clinical practice, workforce development, and public health while moving away from the traditional fee-for-service business model. To be successful, these executives must steer their employers away from one-time investments and toward long-term operating systems and clinical models that improve care. health care for underserved people.
They have accelerated efforts to collect data on race, ethnicity, sexual orientation, and other identifying data for quality and safety analysis, which they use to understand how results vary. between specific population groups. Using those data, health equity leaders are working alongside academics, clinical groups, and trade associations to re-evaluate clinical tools and practices that contribute to disparities. deviated. They have also launched efforts to screen patients for social determinants of health and are establishing cross-industry partnerships to connect people to community resources.
“We know what our goals are. We just took them down, one by one.” Wright said. “Yes, we want to move faster. But we know, in terms of direction, that we’re on the right track.”
business case
Health equity leaders are aligning their goals with the future of value-based care and gathering data to support them.
A Deloitte report released this year estimated that disparate health outcomes could cost the US healthcare system $1 trillion annually by 2040, almost triple that. over the next 20 years and account for 12.5% of healthcare spending.
According to Deloitte, the annual cost of excess health services provided by the disparity is $320 billion and the rate of increase is far outpacing the overall spending trend. The consultant advises providers to switch to value-based care arrangements that encourage effective, high-quality care. The financial rewards will increase if providers close the gap, Deloitte reports, something health equity leaders insist on driving change in the marketplace.
“The reality is that health equity is our business and our basis for competition. You need to change the frame to say it’s not edge, separate and clear. It needs to be embedded in it all.” Kulleni Gebreyes, the US director of health equity for healthcare consulting at Deloitte, who started the newly created role in February, said Dr.
These financial incentives link directly to initiatives from the federal Center for Medicare and Medicaid Innovation. Leaders of the Centers for Medicare and Medicaid Services are pushing organizations to engage in models of responsible care that include equity measures.
Disparities in community and clinical care
The task of identifying and addressing disparities is underway as hospitals gradually take on more financial risks. By adding race, ethnicity, language, sexual orientation, ZIP code, and other data to health outcomes, providers can get a more holistic view of what affects their health patients and take action to address those factors.
For example, by stratifying maternal health outcomes by race, providers have found that black women are nearly three times more likely to die during pregnancy than black women. white. Those findings prompted organizations to expand access to doulas, midwives, and other resources that research has proven improves quality.
Healthcare organizations are using similar efforts to address other differences, often involving forging partnerships beyond clinical care.
The Allegheny Health Network established a program with more than 40 community-based groups to expand prenatal, perinatal, and doula services to try to reduce black infant mortality in Pittsburgh. .
CVS Health has launched a “health zone” in five high-poverty ZIP codes, where the company is working to increase access to food, transportation and healthcare. CVS partners with Uber Health to coordinate rides to appointments, food pantries, and safety net providers.
Blue Cross and Blue Shield of Minnesota have partnered with TurnSignl to test a smartphone app that provides on-demand legal services during traffic stops following the Daunte Wright’s manslaughter by a police officer. The incident occurred in April 2021.
Dr. Joneigh Khaldun, director of medical equity at CVS Health, who started her position in October 2021, said: “If you just put fairness into the way you make decisions, that’s it. is how you can rotate the needle.
When clinical care needs to be updated to address disparities, health equity leaders work within a “culture of equity” to educate providers on best practices. new and address care bias. That requires creating an environment of “cultural competence and humility,” says Larkins-Petigrew.
Larkins-Petigrew distributed a diversity engagement survey to Allegheny Health Network employees to assess where biases exist and what training is needed. She also works with employee resource teams and assigns 125 people to lead diversity, equity, and inclusion in every department so that discussions take place in smaller groups among colleagues. , she speaks.
“You are entering a space where people are very uncomfortable—and you are not comfortable either—but you are responsible for leading the way to a comfortable place where people feel as if they can talk about it. problems will create Larkins-Petigrew said.
The next generation of doctors
Health equity leaders aim to renew the science of health disparities by tapping academic institutions and industry groups to update curricula and build a body of research and The new, powerful standard. Organizations such as Baltimore-based Sutter Health and Johns Hopkins Health System have established health equity institutes that bring together executives, clinicians, researchers, educators, and data analysts. data and policy experts to develop solutions.
Sutter Health’s Institute has published research showing that racial bias is associated with pulse oximeters delaying care for Black patients with COVID-19 by up to 4.5 hours. Another study determined that pregnant Hispanic patients were 2.4 times more likely to develop COVID-19 than pregnant non-Hispanic white patients.
“We have to start small,” said Leon Clark, director of research and health equity at Sacramento, California-based Sutter Health, who began his role in April 2020. and go fast. -deck,” he said at HLTH 2022 in Las Vegas last month. It’s important to build strategic partnerships and take the patient’s perspective when identifying problems and creating new models of care, he said.
At the University of Maryland Health System, he said, Wright and leaders of the University of Maryland School of Medicine have eliminated race-based medicine and outdated clinical practices in medical education. He also works closely with trade associations to set standards for clinicians in different specialties.
Wright is a board member of the American Academy of Pediatrics and chair of the equity committee. He was the lead author of a policy statement published in August calling for an end to race-based medicine and recommending that healthcare organizations and medical associations identify and eliminate guidelines. using race as a factor for clinical decisions.
Wright later announced that the University of Maryland School of Medicine would remove race as a variable in its Normal Birth after C-section calculator, a tool widely used to determine if a patient giving birth should give birth. caesarean section if they have had a cesarean section before. The racial adjustment has caused more Blacks and Latinos to have caesarean sections than necessary, Wright said. Instead, the University of Maryland replaced that factor with chronic hypertension, which is a better indicator of birth outcomes, he said.
“The only way to maintain and systematize the corrective actions we are taking is to include it in the training program,” says Wright. “It is transformative work. It’s a generational job. And I think it would be naive of all of us to expect that we’ll be free of all this in 10 years’ time. We have a little bit of heavy lifting.
