Time for Health Industry to Deliver Value-Based Equitable Care
A Conversation with Visionary Leader Dr. Yele Aluko
Our world is at a watershed moment. Fractures in the public health system that have been present for decades have recently become apparent to us with the impact of the COVID-19 pandemic. We have seen public health statistics associated with fear of vaccination, health disparities, and racial inequities. What’s been revealed to a broad audience ranging from people and families trying to stay healthy to business and government leaders is that our health system extends into every aspect of our lives in ways that we never considered before — and that we can no longer delay the fixes that it requires us to make.
Clinical leader, cardiologist, voice for public health, and chief medical officer at the well-known global consulting and advisory firm EY — Yele Aluko, MD, MBA — shares thoughts on these pressing health urgencies in this exclusive Q&A with Medika Life contributing author Gil Bashe.
Gil Bashe: Dr. Aluko, you’ve been in clinical practice as a leader in cardiology for many years and you have served as a leader in several important health industry organizations, including the American Red Cross, American Heart Association, American College of Cardiology and Association of Black Cardiologists, and we are both members of the International WELL Building Institute. One key question: What led you to make the transition from clinical practice to industry and join EY as chief medical officer?
Yele Aluko, MD: I left the patient’s bedside with the deliberate intent to develop a broader platform and louder megaphone for messaging on the imperatives for the health industry to re-engineer its business models in a manner that places patients at the center of its focus. I don’t make this assertion lightly. It is time for the health industry to be able to define and deliver high-quality outcomes, be held accountable for those outcomes, understand the cost of care to deliver those outcomes, eliminate unnecessary care variation and by so doing, deliver the best outcomes at the best cost across the value chain consistently and reliably. By so doing we shall be successful in delivering value-based care to all.
Bashe: The whole experience of COVID-19 has brought to light some of the greatest struggles we’re dealing with in public health, particularly with health inequities. You’re the co-author of an article that lays out three pillars with which people have to engage: testing, vaccination and education. That’s broad territory. Why did you decide to choose those three pillars?
Aluko: The intent really was to sensitize the reader to understand that COVID-19 is likely here to stay at some level (even when the pandemic is over), and to do this with three very targeted messages. The first is the awareness of the need to be able to diagnose COVID-19 not just efficiently, but more cost-effectively through testing going forward. Second, the importance to continue to educate people about the merits of vaccination, about its science, and its safety. The third is to emphasize the imperative of vaccinating as many people as possible, with the goal to achieve herd immunity to prevent widespread transmission. That’s the rationale behind those three pillars.
Bashe: Three very necessary pillars, and yet, we are dealing with a sudden slowdown in the rate of vaccination. When the first two mRNA vaccines became available people rushed to get an appointment as if we were giving away free movie tickets. What are the challenges that we need to define right now and what might we do about them?
Aluko: We do know that there is a percentage of people that aren’t sure about the vaccine, about safety, about the science. Those are the people now that need to be further educated about the merits of vaccination. This is likely to require more nuanced, targeted, and customized communication strategies to provide credible information about the safety and the science of the vaccine, so that people can then make informed decisions.
There’s also the logistics issue around vaccination, where certain rural communities are harder to penetrate with infrastructure and where the lack of needed logistics have also compounded the delay in getting more people vaccinated. Then there’s the historical issue of vaccine hesitancy within vulnerable populations; even though this is an established and age-old problem, public health systems and the health industry itself have not invested resources to truly understand the complexity of the vaccine hesitancy problem, let alone develop strategies to solve for it, and as such it still remains poorly understood and minimally impacted.
EMPLOYERS MUST REALIZE THEY’RE IN THE HEALTH BUSINESS
Bashe: Two questions about the role business leaders can play in health. What role do employers have in encouraging their employees to get vaccinated? Wouldn’t it be a better investment for employers, instead of paying out for sick care, to get into the well care initiative? To start to work with their employees to reduce their weight, to monitor their cardiovascular health, to exercise and build muscle mass as a way of preventing the need for hip replacement or knee replacement?
Aluko: Employers need to be aligned on the imperative and the role they can play around the test-vaccinate-educate pillars. They can facilitate testing and vaccinating, as well as provide education so that people make informed decisions. While there’s a whole lot of swirling conversation around the pros and cons of mandating or not mandating vaccines and all that, fundamentally employers can facilitate the processes of engaging the people within the context of those three pillars.
This pandemic has paralyzed several businesses and has adversely impacted most. All companies as such are now realizing that they are indirectly in the business of healthcare, and to develop workforce resiliency, businesses need to do a better job around understanding the health risks and vulnerabilities within their workforce and develop proactive resiliency processes.
Most large businesses now have employee assistance networks to provide support resources, but questions are now arising: What percentage of people are actually using these resources? How do we track that and should we? And if then we find that 25% or 30% of people have never had a physical examination in the past five years, what should we do?
There’s now a shifting conversation about what is the responsibility of a business in understanding the vulnerability of the workforce and incentivizing their employees to be more proactive about engaging in healthy lifestyles and diminishing their risk for disease.
Bashe: For leaders in executive positions at a global enterprise who need to have informed choice and to share wise counsel with their organizations, would you mind sharing some of the authoritative voices that are important to you?
Aluko: I would hesitate to do that without informing them ahead of time, but let me just say that we draw from our internal competencies as a leading global health consulting firm, but we also have access to global insights and best-in-class practices depending on what questions or problems are posed. When needed we leverage our access to health industry and public health leaders. We tap into an entire national network and, when necessary, a global network of health industry intelligence. We seek information, evaluate it, distill it and apply it with a reference source as needed. I don’t have a static portfolio of specific people; what I do have is the ability to customize insight that is relevant to problems that are important to us and to our clients done in a manner that we can provide actionable solutions.
VARIANTS OF INTEREST, CONCERN AND HIGH CONSEQUENCE
Bashe: There’s a lot of conversation about COVID-19 variants right now. What are your thoughts on the variants and vaccines? Do you feel that we have a good safety net at this point? From your perspective, do the current vaccines work against emerging variants?
Aluko: The CDC follows variants’ activity very closely. Variants are generally considered in three categories as defined by the CDC: the first is a variant of interest, where the viral structure has changed through mutations but infectiveness of the virus or its response to available antiviral treatment has not changed in a meaningful manner. The second is a variant of concern, where the mutated virus is identified to be less responsive to standard anti-virus treatments or other types of interventions, but in addition this variant may be more transmissible from one person to another. The third and the most worrying category is the variant of high consequence, when the mutated virus variant is now seen to be more infectious, may be more deadly, and may not be responsive to vaccines.
The current evidence suggests our vaccines do work well against variants of interest and variants of concern. Thus far, using genetic sequencing of the viruses, no variants of high consequence are being identified in the United States. This is important to know because it does have impact on the need for potential booster shots going forward. If we do present with a circumstance where the virus mutations are so overwhelming that it’s a new virus over time intervals — such as one year, 18 months, or two years — then a different architecture of vaccines will need to be reengineered within those determined intervals.
DIFFERENCES BETWEEN HEALTH DISPARITIES AND HEALTH EQUITY
Bashe: Switching to questions that we’ve talked about before: health disparities and health equity, and if there’s a difference between the two. Could you define the difference, but also why it’s important that we differentiate?
Aluko: This is a very important question because it should not be presumed that audiences understand what health equity is, and indeed we shouldn’t presume that our audience at large is aware about the impact of health disparities.
Health disparities speak to different outcomes from a medical condition that different groups of people experience. We saw that in COVID-19, more Latinx and African Americans died from COVID-19. This is an example of disparity in outcomes (death) in different populations (black and brown people) with the same disease (COVID-19).
It’s important to understand that there is a myth that health disparities as just described are driven by genetic differences in black and brown people. Indeed, these disparities are, more often than not, not genetic. More commonly they’re driven by what we refer to as the social determinants of health: where people live, the type of work they have access to, what community, societal and environmental exposure they experience that impacts their financial or health literacy, or exposes them more to disease risk and vulnerability, etc.
Health equity is an aspirational yet achievable goal, where we are able to eliminate health disparities so that each person — irrespective of their background, socio-economic status, gender, race, station in life — has an equal opportunity to achieve their best health outcomes in their lifetime. Achieving health equity requires eliminating health disparities.
Bashe: What’s your level of optimism around health equity in the United States?
Aluko: My optimism, on a scale of one to 10 is about a 7.5. But that’s a good place to start. The needle moving towards health equity is predicated on society being willing to dismantle the systemic drivers and resultant behavioral issues that have led to the current structures we have that perpetuate health disparities and keep us far away from achieving health equity.
The current conversation going on nationally about societal justice, about health equity, drives a moral imperative. This conversation is going on across health systems, big business, government, and in philanthropic organizations. Everybody’s talking about how we need to fix this wrong, so the time is now. We have a convergence of goodwill that drives my optimism. But we must seize the moment and translate it into actionable solutions.
Bashe: One last question: In addition to test, vaccinate and educate, what other things would you state to America that we need to start on right now to achieve health equity?
Aluko: I will speak to three action items that address your question. The first would be for business, community and political leaders to acknowledge the health disparities problem to be real, and that ignoring it (as has been done) has consequences for all of us. This problem has existed for centuries: it is serious, and it is dangerous, it is impacting the health of our society. Recognize the problem, understand it and empathize around it, and commit to being a part of solutioning for it — that’s number one.
Secondly, what needs to happen is that all businesses, not just those in the health industry, need to develop strategies to address this. We spoke about moral imperative: businesses now have an imperative in seeing, having a lens and a better understanding into the resiliency of their workforce. All businesses should consider developing health equity strategies and this needs to be driven from the C-suite.
The third would be to hold society at large — government, advocacy, corporate and philanthropic organizations — and of course the health industry itself that dispenses healthcare, accountable for the execution of strategies developed and programs implemented to reduce and ultimately eliminate health disparities.
People must be held accountable, and by doing so on these three imperatives, we will move the needle over time towards health equity. I am optimistic that if we have these three imperatives in place, we will be successful over time.
Bashe: I think that you have mapped out a strategic roadmap for corporate America to not only get past the pandemic, but the waves of public health pandemics that we’re facing: the pandemic of obesity, the pandemic of heart disease, the pandemic of noncommunicable diseases, the pandemic of health inequities. I think you’ve given us a grand plan, much like when the President goes before Congress and gives the State of the Union address.
Dr. Aluko, thank you for your words and direction and inspiration.