The role of structural racism in healthcare experience and outcomes is painful.
Black mothers are three times more likely to die from pregnancy-related causes than white women. Black children are 7.6 times more likely to live in low opportunity neighborhoods, which results in an average 7-year reduction in life expectancy. Black people ages 45-54 are six times more likely to die of COVID-19.
But are we really comprehending this as an industry?
I spent the lion’s share of my career implementing new technology to electronically capture the work of a health system. We implemented necessary but generic applications to modernize the work and collect data that had previously been quarantined to paper records on dusty shelves and in offsite storage boxes. Sure, this wave of digitizing health information provided us with more insights, but it’s clear now that medical interventions are not the answer to poor health outcomes, healthy equity and racial disparities. Medical interventions are not the answer to the financial problems plaguing health systems and the industry at large. Medical interventions are also not the answer to promoting and driving health.
Social determinants of health account for 60% of health outcomes. Research has shown that it takes an average of 17 years for new knowledge, validated by research, to be applied in standard clinical practice. We have known for roughly 10 years that community health workers, for example, can improve outcomes and there is strong evidence that they lead to a better experience, less avoidable utilization and better patient engagement. Yet not all organizations have implemented this innovative model of care in their communities and only a handful of states reimburse for such services.
There are a whole range of reasons why health systems, payers, policy makers and others with influence in the healthcare industry may be distracted from making progress in addressing social gaps that will lead to better health. The strategic priorities are endless and there is no shortage of barriers to decision making. In my previous roles with provider organizations, I felt constantly overwhelmed with the demand and pace of change. But with a 2020 perspective, it feels like those initiatives were noisy distractions, often even counterproductive to the change that will ultimately produce the outcomes everyone so desperately seeks.
We know what to do.
Addressing social determinants cannot be segregated to a community benefit or population health office. Social determinant study, intervention, and progress must be a priority threaded through the entire organization. This is not about philanthropy or demonstrating your not-for-profit status, it's about actually creating health—for the benefit of your consumers/patients/members, your providers and your communities. It's about creating health for the financial viability of the system itself.
Each of us has a responsibility to get serious and get to work. Here are several suggestions for how to get started:
- Don’t assume. Know. Listen to your employees, patients and community members who have experienced racism and bias in your facilities and communities. Actively seek input, collaboration and insights prior to action. Explore digital solutions to understand social needs among your patients and in your communities that can provide you with information now and without placing the burden on frontline providers.
- Focus on hiring. Deliberately hire people of color from the communities you serve to support patients of color.
- Partner with organizations that represent the values and expertise to implement the change that is needed. Within AVIA’s Medicaid Transformation Project work, we looked for solutions that offered the best capabilities to meet the needs of vulnerable populations. As a result, without direct intention of seeking minority owned solution companies, the project produced a list of recommended solution companies in which 40% of the companies were owned by minorities and 21% by people of color. Those with lived experience provide a perspective others simply cannot have; and have potential to serve up better solutions.
- Engage with community members about their health through culturally tailored care. COVID-19 accelerated digital interactions with healthcare providers with such force that there was sometimes no time to ensure that implemented solutions had potential to reach the very communities that needed them most. It is estimated that 36% of Americans have low health literacy and therefore may not be reached with your general communications and virtual tactics. This has the unintended consequence of increasing the disparity gap and leaving your vulnerable communities even more susceptible to COVID-19 outbreaks.
- Invest in expansion of services to address social determinants. Doing so does have potential for a return on your investment, even in a fee-for-service reimbursement model. Health systems already invest money in uncompensated care. Shifting these investments upstream to address social determinants can help a system lose less or address specific needs before patient visits become more expensive, complex readmissions, ED visits or longer lengths of stays. A $2 billion health system with 20,000 annual Medicaid emergency department visits has a $3 million-plus opportunity from the implementation of a community resource referral platform. The same health system with 100,000 managed lives has an approximate $9 million opportunity by pairing social determinant analytics with community health workers in a fee-for-value scenario. The use of such digitally-enabled infrastructure becomes increasingly essential in mitigating the shift of commercial to Medicaid and uncompensated care created by the wake of COVID-19’s new normal.
- Focus on Medicaid. The number of Medicaid beneficiaries has been projected to grow anywhere from 11M to 23M due to growing unemployment and economic downturn. While 40% of people in the United States are of color, they represent 60% of Medicaid beneficiaries. If you want to make an impact in racial disparities and health inequity, Medicaid is a valuable place to start. While difficult, this work is best done across groups with common interests. Reach out and develop partnerships with other health systems, payers and state Medicaid directors to transform care together.
Healthcare will be forced to change and downstream improvement will come to address social determinants over time. But communities of color cannot afford for us to wait. We must accelerate our partnerships, adoption of solutions and their digital enablers. We will literally save lives and the very systems that care for them.
Amanda DeMano is a Vice President at AVIA.