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  • Health equity

To improve health equity, leaders must make it ‘the center of your strategy’


More health systems say they are aiming to close disparities in healthcare. Susan Garfield of EY outlines steps to help move the needle.

Susan Garfield has been working on health equity issues for 25 years.

“The issues aren’t new,” she says.

Susan Garfield of EY

Susan Garfield of EY

Nonetheless, Garfield, the U.S. chief public health officer at Ernst & Young (EY), says she is glad health equity issues are gaining more attention from healthcare leaders. Many of those issues have been vividly illustrated in the COVID-19 pandemic.

“COVID has brought the challenges of health equity and health disparities to the forefront,” she says. “It has shown the impact persistent health disparities and health inequities have.”

“It has always been a topic that is real and prevalent,” she says. “It has emerged as a priority for healthcare organizations.”

EY recently surveyed 500 healthcare leaders representing providers, payers, and life sciences on health equity. Nearly all of those leaders (98%) said their organizations had health equity strategies in place, and roughly four out of five (82%) said they had organization-wide strategies. EY noted participants in the survey had to have a role in health equity efforts, so it’s more likely participants are coming from organizations with established strategies.

Garfield talked about health equity efforts and measures healthcare leaders can take to close disparities. Many health systems have different ideas on strategies for health equity, and that’s a positive, she says.

“We are in a period of opportunity, learning and creating the foundation for additional and future collaborations,” Garfield says. “It’s not something we are going to reach by doing one single thing.”

Hospitals and health systems may be focused on issues such as transportation and connectivity, she says, while payers may be looking at affordability and access to care.

‘Put it at the center’

Healthcare leaders who are interested in improving equity in their communities must recognize that it should be an organization-wide effort.

“This is an issue that should be at the center of your strategy,” she says. “When you put it at the center, you can start to win on every front.”

Health systems that can move the needle on closing disparities can build deeper and more sustainable ties with their community. They will also improve their own reputation in their communities.

“Health equity at its utmost is an aspirational goal. But closing health disparities  and addressing the root causes along that continuum …… it is a meaningful way healthcare executives can change patient lives and improve their communities,” Garfield says.

In the EY survey, health leaders most commonly pointed to the lack of understanding of what health equity actually entails as the biggest barrier they are facing.

More organizations are appointing a chief health equity officer to lead efforts in closing disparities. More than half (58%) of the leaders surveyed by EY said their organizations have a chief health equity officer.

Some organizations have given those responsibilities to members of their executive team. But Garfield said she was “thrilled” to see many organizations investing in health equity officers.

“It is certainly helpful in any big transformation like a health equity activation to have someone in charge … It’s not necessary but it’s really an accelerator and can help organizations reach their goals more effectively,” Garfield says.

Investments are critical

Healthcare leaders can empower health equity officers by working with other senior leaders to be aligned around key goals. Leaders should be in agreement on what equity efforts are going to entail, and organizations need to develop data analytics infrastructure to support those initiatives.

While a majority of organizations say they have strategies to close disparities, many health systems don’t have specific budgets for health equity programs, according to a study by Accenture and HIMSS Market Research released last year.

Garfield suggests that organizations who aim to make progress must budget for those equity initiatives.

“Budgets and investments are really critical to support these leaders,” she says.

“Investment needs to be tied to those efforts, so organizations can see ROI, communities see the value, and there’s an incentive to continue the investment,” Garfield says.

Healthcare organizations must engage with their communities to understand key issues that are driving disparities. Virtually all of those surveyed (99%) said they recognized the need to work with members of the community and secure their involvement in health equity efforts.

“No one should think in isolation from the people that they are trying to serve,” Garfield says.

Data challenges

Healthcare organizations need data to close disparities. While hospitals and health systems have enormous amounts of information on their patients, many don’t have the ability to analyze that data to see where disparities are emerging, such as procedures where members of minority groups may have worse outcomes, Garfield says.

“Most organizations don’t have the analytic infrastructure to take that data and address the root causes of healthcare disparities,” she says.

A hospital may know that the Hispanic community lags other groups in cancer treatments, but the organization may not know what to do with that information, she says. Getting more data can help with interventions.

Less than half (47%) of healthcare organizations say they have reliable health equity data, according to the EY survey. Systems that don’t have the capacity to analyze their data could consider finding partners “to build out capabilities they don’t have internally,” Garfield says.

The EY survey also found 10% of payers said they aren’t collecting and examining data to track disparities in their populations.

Improve diversity

Systems that are aiming to close disparities in minority groups must make every effort to improve the diversity of their own organizations, Garfield says.

“Embedding diversity, equity and inclusion efforts is critical on many levels,” she says.

“It also supports your health equity initiatives.”

A diverse clinician workforce can help improve interactions with communities, Garfield says.

Garfield notes the lack of diversity in the physician workforce. Only 6.9% of doctors identified as Hispanic, while 5.7% identified as Black or African American, according to data from the Association of American Medical Colleges. Much of the challenge is a pipeline issue.

Still, healthcare organizations must make every effort to improve diversity in order to make gains on closing disparities, Garfield says.

Healthcare organizations must recognize that the effort to improve health equity is a long road.

“This is a big challenge that's going to take a long time, a lot of commitment, a lot of collaboration,” Garfield says.

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