LAS VEGAS—The COVID-19 pandemic put a spotlight on existing healthcare disparities, but, in communities throughout the U.S., public health leaders have been trying to tackle systemic inequities for years with limited success.
“We have operated in siloes for far too long. What COVID taught us is we have to work collaboratively, together, all of us playing nicely in the sandbox with one mission: making sure lives are protected,” said Denise Fair, chief public health officer at the Detroit Health Department.
"Enough is enough. We are tired of having the same conversation about barriers,” Fair said during a "view from the top" panel discussion Tuesday at the 2021 Healthcare Information and Management Systems Society (HIMSS) Global Conference.
COVID-19 "exposed the wounds of racial and economic injustice," said Michael Petersen, M.D., chief clinical innovation officer at NTT DATA Services and the moderator of the panel. "While there were some isolated innovation gains, what remains are persistent, systemic access to healthcare challenges, which continue to negatively impact our underserved communities."
There have been some "bright spots" in addressing health inequities but, by and large, efforts have not had staying power, said Ronald Copeland, M.D., senior vice president and chief equity, inclusion and diversity officer at the Kaiser Permanente health system.
"We’ve been working in a fragmented system with a misalignment of incentives for policymakers, health systems, health insurance companies, practitioners and safety net organizations. We are scattered on this playing field and are not all rowing in the same direction," he said.
"And we need more rowers," Petersen quipped.
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Copeland agreed that collaboration between providers, payers, communities and technology companies will be critical to get at the root problems that lead to health inequities.
"Technology has not been part of the conversation and has to be part of the conversation," Fair said. "And technology has to be designed with the end-user in mind and created equitably for everyone. We need to have conversations with technology at the center."
Technology companies can help health systems and communities take data-driven approaches to reduce inequities and can also help to make evidence-based healthcare information accessible to a wide population.
Ivor Horn, M.D., director of health equity and product inclusion at Google, pointed to the tech giant's Health Equity Tracker and its work on YouTube Health, which provides evidence-based medical data to users seeking information.
Research shows roughly 7 in 10 people turn to the internet first when they’re looking for health information. Google has the opportunity to build products that guide users to the right resources and find the information they need, Horn said.
In response to the COVID-19 pandemic, Google also created virtual agents so anyone can book appointments and get critical vaccine information in whatever way they’re most comfortable with, whether that’s over the phone, through text, or on the web.
But partnering with community-based organizations is key to going that last mile, Horn said.
"Those working on health equity have too often found themselves siloed, with limited ability to scale their projects. It's a small project here and a small project there," she said. "We're now making the shift to look at how do we scale and we can think about what role technology can play."
"None of us can solve it all alone," she added.
But technology has its limitations. In Detroit, 40% of the city's 700,000 residents don't have access to high-speed internet, and 25% don't have access to the internet at all, Fair said.
For the city's vaccination strategy, the public health department teamed up with community partners, such as a large mortgage firm, to create a massive call center where any resident could access educational resources, COVID-19 testing and vaccination appointments. The city also partnered with churches to set up vaccination sites.
"In the middle of a crisis, we couldn’t just wait around for the bells and whistles of this new technology project," Fair said.
Tackling health inequities requires a culture shift at organizations, health leaders said.
The focus on health disparities as a result of the COVID-19 impact opens up opportunities for the healthcare industry and its partners to "take a giant step," Copeland said.
"It will require transformation and require us to go on a learning journey and collaborating together," he said. "Technology is a powerful tool, but if you put it on top of the chaos we have right now, we’ll be disappointed."
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Going beyond "screen and connect" strategies
Health systems and payers are ramping up efforts to address social determinants of health, or the social factors that impact a person's health status. Efforts to help patients and health plan members with issues like food insecurity, transportation or housing can play a role in reducing health inequities.
Healthcare organizations are increasingly turning to technology companies to take a more data-driven approach to social determinants initiatives.
Legacy health IT player Cerner recently expanded its platform to help customers identify SDOH factors. Cerner teamed up with artificial intelligence company Jvion to integrate the company's social determinants of health insights into its products.
The Cerner Determinants of Health dashboard and supporting set of tools, integrated into the Cerner EHR, aim to help clinicians pinpoint disparities and suggest goals and resources within the patient’s care plan to help target intervention opportunities. Cerner said the technology provides clients with a more concise way to identify and address social and behavioral health factors patient risk while offering context and clinical guidance to adopt for improved health outcomes.
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A new crop of startups also have entered the market including Unite Us, NowPow, Healthify and Aunt Bertha as well as analytics companies Arcadia, Signify Health and Health Catalyst.
Many of these software platforms work as a referral service to help connect people to social services.
But Ryan Bosch, M.D., president and founder of Socially Determined, said efforts to address social determinants of health issues need to move beyond just referring someone to social services on a one-time basis.
Socially Determined developed a cloud-based platform that offers social risk analytics and data visualization solutions for the healthcare industry. The company's SocialScape platform pulls in TransUnion’s Aggregated Credit Data, consumer data, SDOH data and geospatial data to provide a holistic view of the risks facking individuals, according to the company.
"Social determinants of health is a five to 10-year investment. It’s not 'let’s refer a vulnerable population to a food clinic, and we’re done.' The 'screen and connect' strategy is necessary but it's so much broader than that," Bosch told Fierce Healthcare during the HIMSS21 conference.
"I hope we can elevate the conversation to so much more than just 'screen and connect'. When we talk about solutions at scale that means lifting up the whole population by providing interventions like stable housing or green grocery stores and health literacy around vaccines," he said.