Reimagining healthcare for all
Advancing health equity continues to be both a challenge and a strategic priority for healthcare and life sciences (HCLS) organizations, which play a critical role in improving health equity for their patients, communities, and employees. Not only is it “the right thing to do,” but there is also a strong business case to be made to pursue health equity.
Dr. Ian Tong — Chief Medical Officer and Health Tech Advisor at Included Health — recently joined Slalom’s Disrupting Healthcare series and shared that although health disparities have existed for decades, health inequity still exists. Many organizations wait for more accurate REAL-D (race, ethnicity, ancestry and language, and disability) and SOGI (sexual orientation and gender identity) data rather than changing structural operations to address health equity now. Dr. Tong suggests this is indicative of a system that repeatedly does the same things yet expects different results. We must disrupt this cycle for health equity to be achieved.
Defining health equity as distinct from health equality
While health equality provides the same resources to everyone, regardless of specific need, health equity distributes resources in a way that enables everyone to reach their own optimal health outcomes. When we say, “healthcare for everyone,” we are referring to health equity.
Radical, equitable healthcare transformation cannot be accomplished alone by a single healthcare entity or digital health company. Instead, organizations across the HCLS ecosystem must work together and seek to understand its patients. Failure to understand the entire, complex picture of a person’s well-being could unintentionally do more harm. Take the social determinants of health (SDOH), for example — the social, economic, and environmental factors that influence 80+% of a person’s health. For many, these factors have an adverse impact on health and wellness. To alleviate the negative impacts of one’s SDOH and de-silo a highly-siloed ecosystem, we need to aggregate everyone’s voices, leveraging digital technology and tools to create holistic solutions to improve health equity.
Data has demonstrated its ability to contribute to an equitable healthcare ecosystem.[1] Data availability and quality are foundational to address health disparities and advance health equity. We need data to:
· Accurately capture ROI and build a compelling business case to obtain leadership and stakeholder buy-in;
· Identify where disparities exist (in terms of health outcomes, access to care, health literacy, and digital access) and design the right approaches;
· Direct resources to programs that achieve progress; and
· Measure success and pivot where needed.
When we can refine ROI with real-world data, refocus resources onto successful efforts, and invest in indicated expansions, we are able to drive wider and deeper impact.
Historically, it has been difficult to collect the demographic (REAL and SOGI) data needed to drive change. These categories need to be redefined in a way that recognizes race as a social construct, factoring in ethnicity, custom, culture, and history. When none of the existing categorizations represent the true essence of who we are, we tend to disengage and distrust. Organizations can start building trust now by examining their hiring practices. When there is diversity in the workforce (particularly leadership), people think more creatively and inclusively.
Roadmap to health equity
A roadmap to transforming healthcare and achieving health equity should include robust data analytics and digital health tools that enable:
1. Best practices illuminated by positive deviance
2. Clinical collaboration and integration
3. Participatory decision-making with patients
4. Alignment within the ecosystem
1 — Best practices illuminated by positive deviance
Innovation and transformation in healthcare are often measured by outcomes (e.g., being cured of a disease, or returning to optimal health). Through data analytics, researchers identify positive deviance, or “bright spots,” which are like shining a spotlight on an unexpected strategy to reach a desired outcome. Once a bright spot is found, new and creative solutions to problems are discovered. This allows patients to experience a happier and more effective journey and prevent adverse experiences.
In 2017, Stanford’s Clinical Excellence Research Center (CERC) identified 10 of these bright spots in primary care that “deliver higher quality care at a lower-than-average total cost” with better outcomes and higher patient and provider satisfaction. Sometimes, looking within is fruitful, and through deep data analytics and modeling, transformative solutions are illuminated. For example, high-value primary care practices created deeper patient relationships, leveraged decision support, aggressively closed care gaps, and offered more basic services, such as stress tests, in-house.[2]
One way to practically identify and apply “bright spots” is to create a pilot program in a healthcare center that serves an underserved community that demonstrates best practices:
Once the pilot is complete, perform an objective analysis that measures the outcomes of the pilot against both existing operations and the stated goals, to learn what worked well and what did not.
For example, a medical group could hire and retain front-line staff that has the cultural and language competencies reflective of their patient population. In conjunction, leadership could review the composition of the executive leadership team and of those who sit in the board room. When we bring diversity into the workforce and into leadership positions, we also bring diversity in talent, experience, and ways of working. In doing so, we broaden our perspectives and create forces that enable individuals to think more creatively and inclusively.
2 — Clinical collaboration and integration
For primary care to be highly effective (measured by better management of chronic diseases or lesser use of emergency services), it must be done through an integrated and collaborative approach. Every touchpoint on the healthcare journey should have access to the right data at the right time.
Primary care providers often function in this role of care coordinator yet do so with only partial patient data. Longitudinal medical records, on the other hand, give providers a complete picture of every patient, enabling them to make better decisions. Integration between different systems would create complete longitudinal medical records to support best practices of care.
In addition to collaborating for patient data, many HCLS organizations partner with non-profits that have a history of supporting underserved communities. As distrust of the health system is prevalent in these communities, partnership with reputable and dedicated people and organizations can strengthen impact and build goodwill.
Choose these partners carefully and ask yourself: Are they credible? Do they deliver on their promises? Do they have the complementary capabilities you need? Can they dedicate adequate time and resources? Most importantly, do they have the trust of the community you wish to serve?
3 — Participatory decision-making with patients
Patients, families, and caregivers want to meaningfully participate in healthcare decisions. Participatory decision-making (e.g., shared decision-making) gives patients, families, and caregivers the opportunity to provide additional, and often personal, data to their care teams. This addresses their desired to be part of the decision process and accounts for their unique needs and circumstances (e.g., SDOH). If used properly, this additional insight helps providers choose the right path, be guided toward best practices, and truly personalize medicine.
When clinicians take a patient-centered approach, they can meet a person where they are by engaging them as individuals — not as numbers or statistics. This honors each person’s unique health history, cultural background, literacy level, financial ability, and social circumstance. The patient experience can be personalized through patient-centered support programs such as patient navigators, which guide patients through the health care system or clinical trial process and help them overcome barriers to care. They serve as the connector between practitioners and the patient and are instrumental in bridging gaps between what happens in a clinical setting with what happens at home. By addressing language and cultural differences and sometimes deep-rooted distrust in the healthcare system, patient navigators build trust with patients and empower them to make better health care decisions, leading to better health outcomes, and taking us a few steps closer to health equity. Meaningful impact can be created by focusing on one patient — and one step — at a time.
4 — Alignment within the ecosystem
For our healthcare system to move towards accountable care where providers are paid for value (and thereby prioritizing human outcomes and other quality metrics), we must work toward an alignment of incentives between all stakeholders AND rethink the point of care (e.g., “hospital at home”). Imagine that healthcare is a stool with six wheels, like those found in clinical spaces. Without alignment of each wheel, our system of healthcare is literally unstable.
Link your organization’s efforts to improve health equity in a broader socioeconomic perspective. Addressing SDOH is often at the core of health equity work. In many instances, the delivery process of HCLS products and solutions cannot be set up for success unless upstream factors such as homelessness, food insecurity, domestic violence, loss/change of employment, and other socioeconomic factors are considered.
These issues are not necessarily the responsibility of your organization to solve, but by not acknowledging their presence, efforts to drive health equity fall short. Partner or collaborate with social services providers, whether in the public or private sector, so that the entire patient journey can be considered, and products and solutions can be delivered appropriately.
Hopefully, in the future we will be able to celebrate successes, large and small, in disrupting healthcare through data insights and digital health tools that drive affordability and inclusion. However, to fully achieve health equity, we must also influence systemic changes to address the social factors of health. Advancing health equity is an arduous, but deeply worthwhile journey. As champions of health equity, our call to action is to build a better future where every person has the same opportunity to achieve their best health, uninhibited by social, economic, or environmental circumstances. Slalom is ready to co-create that future with you.
Adam Barde is a Senior Principal at Slalom’s San Francisco office on the healthcare and life sciences team. Adam has focused on transforming the patient and provider experience for over 25 years. He received an MHA and an MS in Gerontology from the University of Southern California. Follow him on LinkedIn.
Vanessa Sam is a Principal in Slalom’s Business Advisory Services practice in San Francisco. Her specialty is in healthcare and life sciences, with a deep passion for improving patient experience and advancing health equity. Find her on LinkedIn.
John Wheelock is a Senior Principal in Slalom’s Business Advisory Services practice in San Francisco. He focuses on innovative ways to deliver healthcare and has most recently supported the California Department of Public Health on the COVID-19 Response. Find him on LinkedIn.
[1] Sinha C, Schryer-Roy AM. Digital health, gender and health equity: invisible imperatives. J Public Health (Oxf). 2018 Dec 1;40(suppl_2):ii1-ii5. doi: 10.1093/pubmed/fdy171. PMID: 30329082; PMCID: PMC6294032.
[2] Simon M, Choudhry NK, Frankfort J, Margolius D, Murphy J, Paita L, Wang T, Milstein A. Exploring Attributes of High-Value Primary Care. Ann Fam Med. 2017 Nov;15(6):529–534. doi: 10.1370/afm.2153. PMID: 29133491; PMCID: PMC5683864.
