Healthcare executives call on Biden to take 'innovative, bold' steps to tackle health equity using AI, big data

More work to collaboratively analyze and act upon social determinants data will spur better outcomes and lower costs, according to a recent panel of experts from across the industry. (Getty/Orbon Alija)

The past couple of years have seen the U.S. healthcare system bow under the weight of two pandemics that could be mitigated with the intelligent use of individual and population health data.

COVID-19 placed a clear strain on the health system’s infrastructure, particularly when it came to public health agencies’ ability to collect and analyze patient data from a wealth of different sources, leaders from CommonSpirit Health, Blue Cross Blue Shield and healthcare AI vendors said Wednesday during Reuters’ Digital Health 2021 virtual event.

At the same time, structural racism and other issues related to social determinants of health have exacerbated outcomes across certain patient populations while driving up costs for individuals, health organizations and the broader public, said Alisahah Cole, M.D., system vice president of population health innovation and policy at CommonSpirit Health. 

This was a sentiment echoed by other industry leaders.

“It’s not a lack of data—we have so much data in this country now, in our healthcare systems and our EHRs and our patient registration systems,” Cole said. “The data is there but the analytics capability of that—what to do with that data—is something that we’re continuing to work on every day.”

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Cole and John Lumpkin, M.D., president of the Blue Cross and Blue Shield of North Carolina Foundation, said both of their organizations have been reworking their collection and organization of race, ethnicity, gender identity and other related data tied to health inequity—a change that “should be a very simple thing to do” but requires an internal data system overhaul, Lumpkin said.

Still, executives said the finish line of those efforts is worthwhile. Incorporating SDOH data can yield substantial health and costs benefits at the individual and population levels, they said.

For instance, John Showalter, M.D., chief product officer of clinical AI company Jvion, described an analytics tool his team built that characterized 10 million individuals’ likely vulnerability to COVID-19. He said that one client, the Medical University of South Carolina used these data to begin directly calling those at increased risk and as a result reduced COVID-19 incidence among that group “by more than 50%.”

Karly Rowe, vice president of new product development, care and identity management at fellow healthcare AI vendor Experian Health, stressed that these types of comprehensive SDOH data collection and analysis capabilities can be used to drive care initiatives that go beyond a single patient’s time in the doctor’s office.

“It’s really important to not only use the data to put together risk profiles at an individual level, but then use that detailed data to better understand how to coordinate and associate the right community programs or services to those individuals,” she said. “Who needs, maybe, a food service? Who maybe needs a voucher to go receive their health services? This really has been critical during the pandemic to help organizations understand [if] the vaccine can even reach some of our underserved populations.”

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But the challenge extends beyond the reach of individual organizations, Lumpkin said. COVID-19 revealed “a moral imperative” to link organizations’ data systems with those of public health agencies.

Here, he turned to efforts like Digital Bridge, an industrywide collaboration that has spent the past few years building transparent and automatic electronic case reporting capabilities into EHRs. Initially built for diseases like Zika virus, pneumonia and tuberculosis, the system hit the prime time with COVID-19 and has reported over 8 million cases from 7,000 facilities over the course of the pandemic, he said.

Other efforts like the Gravity Project, meanwhile, are looking to create national standards for representing SDOH data in EHRs so they can be shared with payers, providers and public health. Lumpkin said organizations need to step out of their silos and look to these types of collective initiatives if data-driven care is to progress.

“We clearly have learned we shouldn’t be trying to do it as separate systems,” he said. “We all need to work together to improve the health of people in communities and protect us against this pandemic and the next one.”

But as large as some organizations may be, it’s the public sector that wields the most power when it comes to establishing new standards in healthcare delivery. To close out the panel, each participant shared what they would impart to President Joe Biden and his administration about social determinants and big data in healthcare:

John Showalter, M.D., chief product officer of Jvion: “I would tell him SDOH are actionable both at the community and individual level, [and] that we do have better tools than we’ve ever had to tackle them. But what we need is resources—it can’t be funded at $400 a person when we’re spending $10,000 a person once they’re sick.”

Karly Rowe, vice president of new product development, care and identity management at Experian Health: “[I’d highlight] the funding of community programs, the assistance programs that are out there that many of our healthcare organizations are creating their own, standing up different services but making sure there’s the right infrastructure [and] there’s the right funding to support those programs to address the needs. Once you’ve identified them, you need to be able to connect the individuals to get the help they need to stay healthy, and I think that’s a continual gap that we have in our country.”

Renee Buckingham, president of care delivery organization for Humana: “Funding resources to help individuals address their basic needs will allow the rest of us to help engage them in taking better control of their health, and it’s critically important that we do that.”

John Lumpkin, M.D., president of Blue Cross and Blue Shield of North Carolina Foundation: “Focus on the health inequities that we have in our society. We have inequities based on race, based upon ethnicity and based on geography—and in some communities it’s all of those. If we can improve and have more equitable care, we will be a healthier nation.”

Alisahah Cole, M.D., system vice president of population health innovation and policy at CommonSpirit Health: “I would encourage President Biden to not focus on weaving in these broken systems that we have and to really step out and be innovative and bold and reimagine or reengineer these systems. So, a more holistic healthcare delivery system that provides access to everyone in this country regardless of their ability to pay or what they look like, and [one] that integrates all of these different functions that we discussed here today.”

Panel moderator David Nash, M.D., dean of Jefferson College of Population Health: “I’m all aligned with Alisahah—this system is so broke we’ve got to find innovative new ways. But everybody’s got to be inside the tent working together and turn the data into actionable information and make folks understand that it ain’t about going to the doctor, it’s gotten way more complicated than that. Awfully hard for an old guy like me, but I’ve come to understand that for sure after 35 years of practice.”