Making health equity part of the value of value-based care

Health disparities connected to race, ethnicity, gender, sexual orientation, gender identity and other factors historically linked to discrimination or exclusion contribute significantly to healthcare costs in America. They account for $93 billion in excess medical costs and $42 billion in lost productivity due to premature deaths.¹

Health equity is the elimination of unjust, avoidable and unnecessary barriers in health and healthcare. These barriers can be a result of a person’s background, where they live, the resources they have or systemic factors such as racism and discrimination.

Achieving health equity requires clinicians and health plans alike to address inequities themselves, as well as the root causes of them.

Value-based care positions practices to drive change through the integration of resources, infrastructure and programs designed to remove barriers. However, value-based models alone cannot do it.

Population-level factors, such as the physical, built, social, and policy environments, can have a greater impact on health outcomes than individual-level factors², therefore this is where sustainable, large-scale change must start, experts say.

Many clinician groups have begun work on addressing health equity within their own practices. In Phoenix, for example, Equality Health is focusing on cultural competency within its multi-disciplinary care management team.

“We equip providers to interact, communicate and treat patients in the most culturally competent manner possible,” says Sharla Fisher. “Our multi-disciplinary care management team is paired with external social and cultural engagement resources that ultimately drive positive outcomes at a lower cost.”

The cultural care focus begins with training that empowers clinicians and care teams to approach patients with an understanding of their respective cultural perspectives, both from clinical and non-clinical viewpoints. As a result, EH’s care management team successfully enrolls 75% of patients in its care management programs once making initial contact. The approach has resulted in lower hospital readmission rates for the practice’s attributed Humana membership— from 16.4% in 2020 to 9.5% in 2021.

Pennsylvania-based Delaware Valley Accountable Care Organization (DVACO) is targeting health disparities among its cardiac patients.

DVACO works with Philadelphia-area cardiologists to identify and eliminate racial disparities relative to access to the transcatheter aortic valve replacement procedure, a minimally invasive treatment for severe aortic stenosis associated with lower risk of complications and shorter hospital stays.

DVACO’s initial data suggests patients from predominantly black areas are less likely to access cutting-edge treatment than patients from predominantly white areas.

“We are trying to better understand why we are seeing this treatment more frequently among patients in predominantly white areas,” says Dr. Mark Angelo, interim CEO and president of DVACO. “Our analysts continue their in-depth exploration to examine disparities in aortic stenosis care more broadly and help cardiologists to develop solutions that eliminate these disparities.”

Sources

1. Nambi Ndugga et al., “Disparities in Health and Health Care: 5 Key Questions and Answers,” Kaiser Family Foundation, last accessed November 1, 2022, https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/.
2. “Paving the Road to Health Equity,” Centers for Disease Control and Prevention, last accessed November 1, 2022, https://www.cdc.gov/minorityhealth/publications/health_equity/index.html.
3. Scott Buzby, “TAVR tied to better in-patient outcomes vs. surgical AVR for bicuspid aortic stenosis,” Healio, last accessed November 1, 2022, https://www.healio.com/news/cardiac-vascular-intervention/20220203/tavr-tied-to-better-inhospital-outcomes-vs-surgical-avr-for-bicuspid-aortic-stenosis.