Imagine an asthmatic child experiencing an episode, but he does not have an inhaler. His parents face one or more of the following: financial hardships, inability to take time off from work to bring him to the doctor, lack of transportation, language barriers.
As a result, care will be delayed. By the time this child is seen, perhaps his asthma has worsened. This means more tests and appointments than would have been necessary had he been seen shortly after the episode, or better yet, simply had an inhaler.
This is health inequity.
Health equity is crucial to the success of both patients and providers in 2023. This concept aims to ensure that every individual, regardless of their background or circumstances, has a fair opportunity to achieve optimal health outcomes.
A zip code shouldn’t determine whether a person has access to the care they need.
What is Health Equity?
Health equity is defined by the World Health Organization (WHO) as “the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically.”
When certain groups are denied accessibility, not only do they miss out on quality care, it causes the system to lose money. Healthcare providers play an essential role in bridging the gap between disparate health experiences and fostering a more inclusive environment for all patients.
Who is Affected by Health Disparities?
These inequities fall heavily along racial, geographical, and socioeconomic lines. Americans of color, LGBTQI, in rural areas, and of lower income are all less likely to have equitable access to care.
For example, “Black Americans have higher rates of diabetes, hypertension, and heart disease than other racial groups, and Black children have a 500% higher death rate from asthma when compared to White children,” according to the Harvard School of Public Health.
Health Equity and the Healthcare System
When healthcare issues remain untreated, they can spread and generate further complications, or co-morbidities, thus leading to the need for additional care and increased costs. In fact, “$93 billion in excess medical costs per year are due to these disparities.”
Think back to our asthmatic child. Delaying care means more tests, possibly additional health issues that could have been avoided. These costs don’t just affect the boy and his family, they also impact the healthcare system. “Minimizing these inequities by 2050 could erase more than $150 billion in unnecessary medical care.” (Kellogg Foundation)
Josh Liao, MD, Enterprise Medical Director for Payment Strategy at UW Medicine, notes that when you’re part of the healthcare mechanism, you need to examine the whole body, all the “interconnected parts of systems.”
How care is paid for, he points out during The Modern Patient Experience podcast, drives the right or wrong behaviors. Unfortunately, equity is not often one of the lenses through which payment incentives are measured or implemented.
The traditional payment model in the U.S. healthcare system, fee-for-service (FFS) care has incentivized the system to work off of the theory that more care is better care. Payment is made for each individual unit of care. In this system, providers are very silo-ed; receiving care in this manner can be challenging for patients with multiple health conditions and those who have trouble advocating for their care. It is easy to see how disparities are exacerbated under this model: FFS care requires multiple appointments and incurs more costs.
Recently the system has been moving towards a value based payment (VBP), in which payment is to keep the patient healthy. This transitional care model has been championed by CMS and pioneered in certain state Medicaid programs, such as MassHealth. Value based care provides the opportunity to more seriously examine health disparities and outcomes.
Patient Financial Experience and Health Equity
You may wonder how the topic of health equity affects the revenue cycle and financial models. Healthcare discrepancies are not simply unjust. They’re also bad for business.
Revenue cycle professionals have a unique opportunity when it comes to promoting health equity.
Financial hardship and medical debt place enormous strains on patients, and disproportionately on marginalized communities. Patients delay seeking care for fear of the high medical costs. According to the U.S. Department of Health and Human Services, “uninsured adults are less likely to receive preventive services for chronic conditions such as diabetes, cancer, and cardiovascular disease.” Additionally, patients lacking a primary care provider are less likely to get needed care.
In 2022, The Commonwealth Fund conducted their Biennial Health Insurance Survey to evaluate Americans’ health insurance coverage. “Forty-six percent of respondents said they had skipped or delayed care because of the cost and half (49%) said they would be unable to pay for an unexpected $1,000 medical bill within 30 days, including 68 percent of adults with low income, 69 percent of Black adults, and 63 percent of Latinx/Hispanic adults.”
As Dr. Liao notes, these teams work with payer data that “provides a lens into where the gaps and inequities are.” The information RCM teams extract from this data should help inform future initiatives and decision making.
A great example of this is when the AdventHealth RCM team used emergency room visit data combined with a patient’s preferred speaking language and whether or not they had a PCP in order to connect those patients with a local provider from a similar cultural background.
Addressing Inequities in the Healthcare Delivery Model
How do we address these inequities? Dr. Liao suggested a few steps he thinks we should take moving forward.
Intention
Dr. Liao goes back to this word again and again. “Intention always proceeds implementation.” It will be impossible to improve inequities across all demographics at once. As we identify policies that will alleviate inequities for certain demographics, we should take action. Perfect is the enemy of good, as they say.
The whole health of an individual
Community, food security, housing, etc, are all factors that make up the whole person. Thanks to a NYU Langone Health study, we know that a person’s zip code can say more about their life expectancy than their genes or gender. (NYU) “Healthcare is hyperlocal”, says Dr. Liao. Partnering with food banks, getting vouchers for city buses, etc. It is important to think outside the box. After all, “lack of access to reliable transportation results in 41% more excess days in the hospital.” (HealthCare IT Today)
Containing costs and assessing payment models
Are the fee-for-service models working? How are providers being incentivized? What is the quality of the dollar being spent? Dr. Liao points out that payment is a very powerful motivator for care. The way we pay affects which programs we implement and choose. More clarity around standards and delivery will reduce inequity moving forward.
Finding ways to encode equity into cost
Dr. Liao discusses joint replacement surgeries and the general push amongst the medical community to move away from them; providers often consider these procedures overused. It’s imperative to look at the patient population that one is capturing in that assessment, however. People of Color chronically underuse joint replacement procedures; these services are already underutilized in certain communities, and now we are talking about suppressing the access even further.
Looking Forward
Addressing health inequity is not a quick or easy fix, but initiatives focused on eliminating disparities and bettering health outcomes are being embraced every day. AccessOne’s dedication to addressing both patient outcomes and the financial health of the system is an innovative approach to improving the healthcare landscape.
