TEN TRANSFORMATIVE TRENDS 2021 Getting Real About Health Equity
More health systems and state governments are developing and sharing strategies to eliminate racial and ethnic disparities in healthcare By David Raths
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n the wake of the pandemic and racial justice movement of 2020, many health systems have created positions or task
forces related to health equity. But will this work be sustained and actually decrease the disturbing disparities in clinical outcomes? Some health system executives are
recognizing that paying lip service to equity is not good enough. “We are put- ting our money where our mouth is,” said Kevin Mahoney, CEO of the University of Pennsylvania Health System, speaking last October during a webinar put on by the Philadelphia-based university. “We built it into the pay of the top 600 executives at Penn Medicine. Our executive pay is tied to reducing maternal morbidity and mortality among Black and Brown populations and increasing colorectal screening among our Black population. If we don’t make those improvements, we don’t get paid. We know that incentives work. We are tired of talking about it. We are going to take dramatic action, but doing it by impacting the higher-paid people’s paycheck. I wish it didn’t have to come to that, but that is the way we know we can move the needle. I’ll be happy to report next year — I know we’ll have achieved these goals because we built them in.” Efforts like the one announced by Mahoney are still the exception to the rule. Marshall H. Chin, M.D., associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago, says there has been some fair criticism of healthcare provider organizations, payers and the government that they have done work to document disparities but very little to intervene to reduce disparities. (Chin co-chaired the National Quality Forum Disparities Standing Committee that rec- ommended how to achieve health equity through performance measurement and payment reform to the Centers for Medicare and Medicaid Services.) Provider organizations may do some- thing like cultural competency training, Chin says. “These things help, but it is dif- ferent than saying we are going to reduce our differences in outcomes between African-Americans and Whites in blood pressure, and then thinking about a very sophisticated, very explicit process to do that,” he explains. “You determine what your goal is, do a root cause analysis to
determine why there are differences, and then design the interventions to specifi cally address the drivers of those disparities and create an environment that enables physi- cians to do the right thing. That includes payments to incentivize these types of care transformations. People can do it out of the goodness of their heart in the short term, but for something to be sustainable — and that’s the goal here — there’s got to be a business case. And right now, there are not nearly enough examples from the perspective of individual healthcare organizations.”
Being transparent about equity metrics Aswita Tan-McGrory is director of the Disparities Solutions Center at Massachusetts General Hospital in Boston, which works to develop and broadly share strategies that advance policy and practice to eliminate racial and ethnic disparities in healthcare. She says one silver lining of the pandemic is that it affects everyone. “It is not just about a social determinant of health, like lack of housing. If we don’t fi x it, we’re
Aswita Tan-McGrory
all impacted, and none of us can move forward. So it really forced us to address why our healthcare system is not working for everyone,” she explains.
When the pandemic hit, health systems such as Mass General Brigham (part of Mass General Hospital) that had already begun work on equity and health dispari- ties were better able to re-evaluate what they were doing than ones that haven’t put much effort into this yet, Tan-McGrory says. “We have over 10 years of stratifying
our data by race, ethnicity, and language. So very quickly, we were able to leverage that to look and see who’s coming into our hospitals. And we did see over 50 percent of our patients are coming from diverse immi- grant communities and needed interpreters. But even as well set up as our system was, there were still a lot of gaps and lessons learned. There’s nothing that brings home the importance of integrating interpreters into our systems than having half of your fl oor needing an interpreter. The urgency didn’t have to be explained.” Mass General Brigham created the Disparities Solutions Center to help other healthcare organizations that want to address disparities. “When we started, we were probably one of the few centers that focused on the intersection of qual- ity and disparities and how healthcare organizations can address this, and then expand to a bigger scope to get leadership buy-in,” she says. “You have to consider social determinants of health, the historical events that have preceded us that have led to this distrust in our community, and open- ing the walls of our institutions to include community health.”
Mass General Brigham has been doing this work for more than 10 years and it has made its results publicly available. Some hospitals say they’re committed, but have not made the effort yet to collect accurate racial and ethnic data from patients or are reluctant to publicly share their dashboards, Tan-McGrory says. “We can do a lot of measurement, but eventually you have to do something about it, right? And doing
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