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 * June 8, 2023


HEALTH EQUITY: A BRIEF OVERVIEW FOR PROVIDERS




Imagine an asthmatic child experiencing an episode, but he does not have an
inhaler. His parents face one or more of the following: financial hardships,
inability to take time off from work to bring him to the doctor, lack of
transportation, language barriers. 

As a result, care will be delayed. By the time this child is seen, perhaps his
asthma has worsened. This means more tests and appointments than would have been
necessary had he been seen shortly after the episode, or better yet, simply had
an inhaler. 

This is health inequity. 

Health equity is crucial to the success of both patients and providers in 2023.
This concept aims to ensure that every individual, regardless of their
background or circumstances, has a fair opportunity to achieve optimal health
outcomes. 

A zip code shouldn’t determine whether a person has access to the care they
need.  


WHAT IS HEALTH EQUITY?

Health equity is defined by the World Health Organization (WHO) as “the absence
of unfair and avoidable or remediable differences in health among population
groups defined socially, economically, demographically or geographically.”

When certain groups are denied accessibility, not only do they miss out on
quality care, it causes the system to lose money. Healthcare providers play an
essential role in bridging the gap between disparate health experiences and
fostering a more inclusive environment for all patients. 


WHO IS AFFECTED BY HEALTH DISPARITIES?

These inequities fall heavily along racial, geographical, and socioeconomic
lines. Americans of color, LGBTQI, in rural areas, and of lower income are all
less likely to have equitable access to care. 

For example, “Black Americans have higher rates of diabetes, hypertension, and
heart disease than other racial groups, and Black children have a 500% higher
death rate from asthma when compared to White children,” according to the
Harvard School of Public Health.


HEALTH EQUITY AND THE HEALTHCARE SYSTEM 

When healthcare issues remain untreated, they can spread and generate further
complications, or co-morbidities, thus leading to the need for additional care
and increased costs. In fact, “$93 billion in excess medical costs per year are
due to these disparities.” 

Think back to our asthmatic child. Delaying care means more tests, possibly
additional health issues that could have been avoided. These costs don’t just
affect the boy and his family, they also impact the healthcare system.
“Minimizing these inequities by 2050 could erase more than $150 billion in
unnecessary medical care.” (Kellogg Foundation)

Josh Liao, MD, Enterprise Medical Director for Payment Strategy at UW Medicine,
notes that when you’re part of the healthcare mechanism, you need to examine the
whole body, all the “interconnected parts of systems.” 

How care is paid for, he points out during The Modern Patient Experience
podcast, drives the right or wrong behaviors. Unfortunately, equity is not often
one of the lenses through which payment incentives are measured or implemented.

The traditional payment model in the U.S. healthcare system, fee-for-service
(FFS) care has incentivized the system to work off of the theory that more care
is better care. Payment is made for each individual unit of care. In this
system, providers are very silo-ed; receiving care in this manner can be
challenging for patients with multiple health conditions and those who have
trouble advocating for their care. It is easy to see how disparities are
exacerbated under this model: FFS care requires multiple appointments and incurs
more costs. 

Recently the system has been moving towards a value based payment (VBP), in
which payment is to keep the patient healthy. This transitional care model has
been championed by CMS and pioneered in certain state Medicaid programs, such as
MassHealth.  Value based care provides the opportunity to more seriously examine
health disparities and outcomes.


PATIENT FINANCIAL EXPERIENCE AND HEALTH EQUITY

You may wonder how the topic of health equity affects the revenue cycle and
financial models. Healthcare discrepancies are not simply unjust. They’re also
bad for business. 

Revenue cycle professionals have a unique opportunity when it comes to promoting
health equity.

Financial hardship and medical debt place enormous strains on patients, and
disproportionately on marginalized communities. Patients delay seeking care for
fear of the high medical costs. According to the U.S. Department of Health and
Human Services, “uninsured adults are less likely to receive preventive services
for chronic conditions such as diabetes, cancer, and cardiovascular disease.”
Additionally, patients lacking a primary care provider are less likely to get
needed care. 

In 2022, The Commonwealth Fund conducted their Biennial Health Insurance Survey
to evaluate Americans’ health insurance coverage. “Forty-six percent of
respondents said they had skipped or delayed care because of the cost and half
(49%) said they would be unable to pay for an unexpected $1,000 medical bill
within 30 days, including 68 percent of adults with low income, 69 percent of
Black adults, and 63 percent of Latinx/Hispanic adults.” 

As Dr. Liao notes, these teams work with payer data that “provides a lens into
where the gaps and inequities are.” The information RCM teams extract from this
data should help inform future initiatives and decision making. 

A great example of this is when the AdventHealth RCM team used emergency room
visit data combined with a patient’s preferred speaking language and whether or
not they had a PCP in order to connect those patients with a local provider from
a similar cultural background. 


ADDRESSING INEQUITIES IN THE HEALTHCARE DELIVERY MODEL 

How do we address these inequities? Dr. Liao suggested a few steps he thinks we
should take moving forward.


INTENTION

Dr. Liao goes back to this word again and again. “Intention always proceeds
implementation.” It will be impossible to improve inequities across all
demographics at once. As we identify policies that will alleviate inequities for
certain demographics, we should take action. Perfect is the enemy of good, as
they say. 


THE WHOLE HEALTH OF AN INDIVIDUAL

Community, food security, housing, etc, are all factors that make up the whole
person. Thanks to a NYU Langone Health study, we know that a person’s zip code
can say more about their life expectancy than their genes or gender. (NYU)
“Healthcare is hyperlocal”, says Dr. Liao. Partnering with food banks, getting
vouchers for city buses, etc. It is important to think outside the box. After
all, “lack of access to reliable transportation results in 41% more excess days
in the hospital.” (HealthCare IT Today)


CONTAINING COSTS AND ASSESSING PAYMENT MODELS

Are the fee-for-service models working? How are providers being incentivized?
What is the quality of the dollar being spent? Dr. Liao points out that payment
is a very powerful motivator for care. The way we pay affects which programs we
implement and choose.  More clarity around standards and delivery will reduce
inequity moving forward.


FINDING WAYS TO ENCODE EQUITY INTO COST

Dr. Liao discusses joint replacement surgeries and the general push amongst the
medical community to move away from them; providers often consider these
procedures overused. It’s imperative to look at the patient population that one
is capturing in that assessment, however. People of Color chronically underuse
joint replacement procedures; these services are already underutilized in
certain communities, and now we are talking about suppressing the access even
further. 


LOOKING FORWARD

Addressing health inequity is not a quick or easy fix, but initiatives focused
on eliminating disparities and bettering health outcomes are being embraced
every day. AccessOne’s dedication to addressing both patient outcomes and the
financial health of the system is an innovative approach to improving the
healthcare landscape. 

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