Why Attaining Health Equity Requires an Ecosystem Approach
Solutions in healthcare are complex. We liken it to an orchestra: Great music is only made when the instruments harmonize.
By Ava Nasrollahzadeh, Project Leader, BCG; Sid Thekkepat, Partner and Director of Venture Architecture at BCG Digital Ventures; Suchita Shah, Managing Director and Partner, BCG; and Nate Beyor, Managing Director and Partner, BCG
Solutions in healthcare are complex. We liken it to an orchestra: Great music is only made when the instruments harmonize.
This is especially true to attain health equity, which we define here as the absence of disparity in health and its determinants (social, economic, or otherwise) that adversely affects disadvantaged or marginalized populations.
The term has become omnipresent across the healthcare space (in podcasts, articles, and studies), and rightfully so, since achieving anything close to it will require broad commitment from traditional healthcare leaders, tech players, non-profit alliances, and more to work together.
We spoke to four experts — Jaime Bland, CEO at CyncHealth; Caitlin Donovan, Global Head of Uber Health at Uber; Esther Farkas, Chief Strategy Officer at Unite Us; and Andrew Parker, Founder and CEO at Papa — to understand the areas we’ll make the most progress in the coming years and the unlocks required to accelerate change.
Before proposing solutions to achieve health equity, it is necessary to understand the root cause of these disparities.
Access to care is where experts think we will make the most progress
Most experts pointed to access to care as the area we’ll see the most progress in when advancing health equity. While the experts all felt that an ecosystem approach was key to driving health equity forward, they had slightly different views on how to unlock progress:
Esther Farkas, Chief Strategy Officer at Unite Us, a healthtech platform that uses software to address SDOH (social determinants of health), focused on the expansion of care settings:
“Historically care was thought of in a one-dimensional way and only existing in traditional care settings like a hospital or clinic. The pandemic shined a bright light on the inadequacy of limiting care setting and accelerated many different access points, including in our communities. Having a more diverse care environment is where we will see the most growth.”
Caitlin Donovan, Global Head of Uber Health, meanwhile, highlighted the role that payers can play in sustaining access:
“Access and sustaining care is where we’ll see the most progress in addressing health inequities. But solving for access at scale requires addressing the way benefits are designed — supplemental benefits do not adequately align incentives today.”
Andrew Parker, the founder and CEO of Papa, a senior-focused social support startup, reinforced care settings to identify patient needs:
“Access, and understanding needs, is where I’m especially optimistic. Our health system is increasingly recognizing that health happens at home and in our communities — and we’ll invest in SDOH accordingly to drive meaningful outcomes for all populations.There is a risk of overinvesting in understanding needs, however. Once you have a sufficient baseline, the focus should be on action.”
There’s no panacea to achieve health equity — and there’s no singular organization that will get us there
Among this group, there was a strong desire for collaboration and understanding that a complete ecosystem is required to tackle a problem with this complexity. Few companies understand this better than Uber Health, which sees itself as the connective tissue bringing together point solutions across services onto one platform. Uber Health enables access to care through Uber’s platform, which is enhanced by a number of third-party partnerships.
“Uber Health enabling transportation to patients who don’t have a credit card and don’t live in a city is very impactful on its own, but does not change the system. If we can partner with providers and health plans, we can use their existing touchpoints with patients to find the right members in need and extend benefits so a patient doesn’t have to pay out of pocket,” explained Donovan.
In an ideal world, these players coordinate to form a closed feedback loop. If a patient schedules a virtual appointment with a provider — one that is covered by insurance — who ensures that the patient gets the lab work done in advance to make the appointment meaningful? Where will that lab work be done? Will it require transportation or be conducted at home? And after the appointment, how will the patient get access to the medication they need? Who will ensure that medication was not only dispensed, but also picked up? Who then ensures that medication is taken at the prescribed frequency?
These questions lay out the coordination problems that must be tackled in just one episode of care, let alone across a patient’s broader care journey. To enable this, Donovan looks to benefit and network design as a key part of the solution.
Access to holistic care requires more trust with data exchanges
It would be reductive to position the coordination challenge as a financial one where payors simply need to expand their benefits to cover more services.
In order to secure reimbursement for services that address SDOH, Jaime Bland of Nebraska-based health information non-profit CyncHealth views the ecosystem as a set of data inputs. “In order to demonstrate the ROI from using SDOH and highlight our gaps, we need claims data, social care data, medication history, and clinical data to prove the interventions applied in clinical and social care drives outcomes,” she said.
The data needed to build the ROI and outcomes argument reside across multiple stakeholders, and Bland believes that the biggest issue in this space is the lack of trust with sharing the data. As incumbent organizations all make the shift to digital, they are also increasingly protective of their data, viewing it increasingly as owned versus shared for the purposes of data following the person.
Further challenges come from the regulatory side, given that CyncHealth is an independent non-profit and relies on state funding through Medicaid and public health agencies to operate. “The challenge is often not a policy one for funding, but rather a people and education one. New Medicaid directors may come in and be less familiar with the health information technology topic and try to redirect the existing funding elsewhere,” Bland said. To mitigate the impact of leadership turnover, she suggests greater top-down education from CMS and HHS, rather than major policy changes.
Health equity is as much a social mission as it is a clinical one
Using “health”-centric terms, like “health equity” and “healthcare” broadens the goal so it is not solely in the arms of traditional clinically focused players. Indeed, holistic determinants of health are often determined by social and environmental circumstances.
While the pandemic highlighted the role of social care in a person’s overall health, the infrastructure has not kept pace. Medical coding, for example, which is required for billing and reimbursement, still focuses on clinical care and fails to capture several forms of social injury or support, noted Farkas of Unite Us.
“We have codes for breaking femurs, but in social care, the codes are much broader and less targeted toward those services. This makes it incredibly difficult for social care providers who don’t have the same admin that a traditional PCP might have…We want it to be easy to reimburse these social providers,” she explained.
To that end, Unite Us released a new payments technology, the Social Care Payments solution, to help plans reimburse social services just as they would any other clinical service.
One such social health provider is Papa, which has built a proprietary social index to map the needs of older adults across a social care continuum. Metrics such as the CDC’s measure of unhealthy days, loneliness assessment results, and zip codes roll up into one North Star. That data point then informs a “social prescription,” which provides a recommendation for the cadence and type of visits that would be most valuable.
For example, Papa says its enrollees living in communities of color are 200% more likely to have no one for social support. But, by working with health plans and employers in delivering this type of support, Papa provides the boots on the ground to address unmet needs — ultimately reducing loneliness and improving health.
The work ahead
Meaningful progress has been made in recent years — from recognizing the impact of SDOH to setting up data exchanges to prove the ROI of social care, and even building the infrastructure to integrate social with clinical coding and payments. Still, the path to attaining health equity is complex with multiple stakeholders.
Delivering the right solution to the right patient requires data to personalize interventions and financing to sustain them. Broad approaches simply won’t work and there’s a need to go deeper and engage with challenges at a community level.
With these requirements in mind, we encourage readers to push the orchestra metaphor further as we collectively expand and strengthen the ecosystem.
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