Making real progress on health inequities

Nine out of ten hospital executives name health equity among their core business priorities. However, funding, reimbursement, and pandemic-related disruption remain major barriers to implementation.

During Becker's 2023 Annual Meeting, Vituity CEO Imamu Tomlinson, MD, MBA, joined a panel of health system leaders to discuss steps hospitals can take to increase care quality, equity, and patient engagement. Here are his top three takeaways from that discussion: 

1. Cost remains the number one barrier to care, and the situation is likely to worsen. While coverage rates are currently at record highs, that era is coming to an end. Millions of people who became ineligible for Medicaid during the pandemic are now being removed from that program. Many will not be able to afford replacement coverage.

At the same time, drug companies have dramatically raised prices on many common drugs, increasing patients’ out-of-pocket expenses. And many patients are struggling to pay for their basic needs due to inflation and cuts to assistance programs like CHIP and SNAP.

“Cost intersects with systemic discrimination and therefore affects some patients more than others,” Tomlinson says. “Patients of color earn less than white workers in the same jobs, have fewer opportunities to accrue and transmit generational wealth, are less likely to own a home, and have fewer opportunities to borrow money at affordable interest rates.”

2. Telehealth may seem like a solution to these challenges, but it creates barriers of its own. “On one hand, the expansion of virtual care is one of the best innovations to come out of the pandemic,” Tomlinson says. “It really does improve access and convenience for a lot of people. However, virtual care isn’t a magic bullet for healthcare justice.”

He points out that overreliance on virtual care can worsen health disparities by deepening the digital divide: “High-speed internet access has become a social determinant of health — and it’s leaving the most vulnerable behind.”

As of 2019, one in four Medicare beneficiaries lacked access to a high-speed internet connection at home. Older people and people of color were among those least likely to have access. “As we expand our virtual care programs — which will benefit many — we also need to keep in mind these less connected populations,” Tomlinson says.

So how can healthcare meet these needs? Tomlinson says it all starts with preserving access to in-person services: "Healthcare will follow the omnichannel model of banking, travel, retail, and many other industries.”

3. Physicians must be part of the solution. “Often, your best resources for care delivery innovation are right in front of you,” Tomlinson says. “They’re your front-line providers — the doctors, advanced providers, and nurses who care for patients every day.”

He points out that clinicians are well-positioned to understand the needs of the community and where the gaps are. Often, they can already visualize solutions to the problems that keep executives awake at night.

Tomlinson also calls for more diversity at all levels of the healthcare workforce. “The connection between clinicians and patients is strengthened even further when our provider teams reflect the communities we serve,” he says. “This is why it’s important to hire locally when possible.”

While representation alone won’t end health disparities, Tomlinson points to research that suggests patients achieve better outcomes when they have access to physicians who look like them. “It’s also crucial to equip all clinicians with the skills to provide culturally competent care — and to hold them accountable for doing so,” he says.


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