Though healthcare disparities are not new, the COVID-19 pandemic brought the starkest and glaring gaps in care to the forefront. While the healthcare industry and federal and local governments have in some ways stepped up to tackle health equity, experts agree there is still a long way to go.
From the need for better data collection to price transparency, the way the current system is set up is not working for everyone.
Fierce Healthcare got comments from more than two dozen healthcare stakeholders about what they think is next for health equity in 2022. Here are the biggest takeaways:
1. Providers will resume major tech initiatives
COVID-19 demanded a shift in resources away from big tech projects to support clinicians and patients, said Colin Banas, M.D., chief medical officer at DrFirst. Health systems have since only been able to focus on solutions that are “lightweight,” like chatbot initiatives.
“They were looking for quick wins and for ways that would support their core business,” Banas said.
One example of a quickly implementable solution is the automated delivery of negative COVID-19 test results by email. “If you can automate those things with technology and alleviate the human factor, then you free up the human workforce to go and do more value-added things,” Banas said.
A silver lining of the pandemic was health systems becoming more agile in their decision-making and how quickly they deploy tech solutions, he said, adding that he felt the field “advanced 10 years in 10 weeks.” As health systems start to put the pandemic behind them, Banas expects organizations to once again start working on big tech initiatives, in particular ones meant to address patient engagement, population health and value-based care.
2. Data and measures help ensure accountability
“There’s no doubt that the pandemic put a much more intense spotlight on health disparities,” said Health Evolution President Richard Schwartz.
Looking ahead, the industry wants to be more data-driven. Yet many organizations struggle to collect data. While it is critical to improving patient outcomes and managing costs, several experts told Fierce Healthcare that a lack of interoperability and data sharing between payers and providers hinders these efforts. And the first step in that formula is having a shared baseline understanding of the disparities out there and how to track them, Schwartz said.
That’s the goal of the Health Evolution Forum, a collaboration between hundreds of healthcare executives. The forum is also working with the policy community and the private sector to make sure these standards become widely adopted.
“We have to move quickly to leverage this time and this opportunity to make change,” said Laurie Zephyrin, vice president of health system equity at the Commonwealth Fund. Policies and measures play an important role in evolving the system with interventions that work, like expanding community-based organizations or insurance coverage, and in providing incentives that keep everyone accountable.
Importantly, these efforts must not be undertaken individually, but rather in partnership with others, urged Leon Caldwell, senior director of Health Equity Strategies and Innovation at the AHA Institute for Diversity and Health Equity. “You really can’t move the needle in isolation of other partners that hold a piece of this very dynamic and complex system,” he said. The AHA plans to launch a national framework meant to mobilize members around health equity in the early part of 2022.
3. Precision healthcare needs more attention
Routinely collected data are greatly underutilized in healthcare, which leads to inequities, said Dan Riskin, M.D., founder and CEO of Verantos, a firm specializing in real-world evidence. Without those data, organizations are largely in the dark about what treatments work for unique groups of patients.
While randomized clinical trials exist, their scale is cost-prohibitive, and they are therefore limited in scope, Riskin argues. They cannot accurately assess the effects of a treatment on every population. Real-world evidence could offer that insight—yet traditional models rely on single-source claims data that are not measured for accuracy, Riskin explained. That leads to what is known as low validity.
“COVID made it clear that getting good data is hard,” he said, referring to retractions from top medical journals. Concerns over data integrity and health equity have accelerated Riskin’s business, he said.
“If we create a standard for what is good—even if it’s really hard to do—then everyone in this industry will start to create good evidence,” Riskin said, applauding the Food and Drug Administration (FDA) for putting out draft guidance on the use of real-world evidence. If demand for high-validity real-world evidence goes up, patients and outcomes will be marginally better for it.
4. Behavioral therapy should be rethinking its model
Thanks to the pandemic, there has been a decrease in stigma around mental illness and the advance of mental health literacy, said Nina Vasan, M.D., chief medical officer at mental health startup Real and a professor of psychiatry at Stanford University (where she also founded and directs Brainstorm: The Stanford Lab for Mental Health Innovation). “Where I thought we would be five or 10 years from now is where we are today,” she told Fierce Healthcare.
The reason for the recent widened array of behavioral health offerings is because more people are seeking them out, Vasan argues. “This year is by far the most historic year because almost everyone felt some symptom of mental health,” she said.
Now, providers need to think about the way they can help build a sustainable treatment model. There is a big supply-demand disconnect between the number of providers available and the number of Americans in need of behavioral health services, Vasan said. It’s important to acknowledge that the one-to-one care model is simply not enough.
Instead, Real advocates for a one-to-many model, which is more scalable and empowers patients to help themselves. At Real, for instance, therapists have designed evidence-based, 8-week-long courses that aim to equip users with a better understanding of their mental health and with concrete coping mechanisms via exercises and tools. Based on clinical data the company has collected, Vasan said, Real users experience a reduction in anxiety and depression symptoms by a third.
She acknowledged that the traditional therapy model is still important (a range of options will always be needed). But in its current iteration, the system is oriented toward the clinician, not the patient—for instance through arbitrary parameters like sessions kept to once a week and during business hours.
“We need to stop building for ourselves,” Vasan said, “and start building for the people who we’re trying to treat.”
5. The acceleration of home-based care
The pandemic prompted the acceleration of care at home, thanks in large part to telehealth and its capabilities. While the model has many advantages, from mitigating COVID-19 surges at hospitals to revealing the social needs of patients, the coming year will see more stakeholders and policymakers working together to fill digital gaps, said Chris McCann, CEO and co-founder of Current Health.
"While home-based care is improving health equity in some ways, it can also leave patients who lack access to digital tools and skills behind if not done correctly," he told Fierce Healthcare.
For example, not every patient has access to broadband or is digitally literate, especially those who are older or from lower socioeconomic backgrounds.
Current Health is a member of Moving Health Home, a collaboration between stakeholders advocating for policies that enable at-home care for all. What's really needed for home-care success are better payment models, and McCann expects to see a lot of focus on that area from the Centers for Medicare and Medicaid Services (CMS) and commercial payers as well. Hospitals that work with Current Health are also working on broadening payer relationships in order to expand access to care at home, he said.
"It will be up to technology providers like Current Health to provide the data that demonstrates the models are effective – and why it’s the right investment – and to equip healthcare organizations with the technology and services they need to be able to do so equitably," McCann said.
6. Workforce shortages can be corrected
The path to staff retention and productivity is diversity, experts told Fierce Healthcare. From there, a culture of inclusion is key to facilitating equity.
“You have to be doing all three to get to where you really truly want to go,” said Margot Savoy, M.D., senior vice president for education at the American Academy of Family Physicians (AAFP). Had health systems listened to patients about gaps in care years ago, the pandemic likely would not have hit marginalized communities as hard, she emphasized.
Now, with workforce shortages looming, clinicians need space to process and heal from the devastation of COVID-19, especially in hard-hit areas. And employers need to invest more in better wages and benefits for workers. The AAFP saw many medical assistants and nursing techs leave the field altogether during the pandemic over social needs like child care, Savoy told Fierce Healthcare.
Workforce shortages will also lessen if payment models take into account social determinants of health. When providers are not reimbursed for tracking social needs and don’t prioritize doing so, they are more likely to leave, which only exacerbates inequities further. “There’s a level of frustration when there’s nothing you can do for a patient because of those circumstances,” said Danielle Jones, director of the AAFP’s Center for Diversity and Health Equity.
7. Cost transparency will take center stage again
While enforcement was lax during the pandemic, Banas of DrFirst expects price transparency regulations to return front and center in 2022. “It’s hard to achieve equity if people are blind to what things cost,” he noted.
He expects to see a greater uptick in the adoption of these standards, as well as in platforms that provide visibility into what medications cost. Cost transparency should not only apply to healthcare costs, argues Noor Ali, M.D., a health insurance adviser.
“I notice the disparity more when it comes to selecting options for healthcare coverage, especially in the ACA federally regulated marketplace,” she told Fierce Healthcare, adding that so long as premiums and coverage options are determined primarily by income, the disparities will continue. “We cannot have equity if income level remains the basis of healthcare coverage quality.”