Health Equity has become a key priority for healthcare organizations, validated in the Becker’s/TruLite 2022 Benchmark Survey, and they are increasingly aware of the repercussions of inequities on patient health outcomes, incremental expenses and reduced revenues.
During Becker's Hospital Review's 13th Annual Meeting, in a session sponsored by TruLite Health, Alan Roga, MD, founder and CEO of TruLite Health, moderated a roundtable discussion about the state of Health Equity in Health system organizations, the lack of awareness and impact of clinical bias on patients, the economic impact of inequitable care and best practices for addressing bias and health inequities.
Five key insights were:
- Deployment of health equity programs is an institutional priority for provider organizations. According to TruLite's first annual health equity benchmark survey of over 100 hospital executives, this prioritization is driven mainly by a desire for improved patient care, brand recognition and financial performance.
- Achieving health equity is deterred by a misalignment between desired program elements and actual programs being deployed. TruLite's survey revealed that 55 percent of health equity programs focus on cultural bias training, whereas what clinicians and staff actually desire are more care coordination tools, analytics and clinical guidelines to support improved patient outcomes. "Cultural bias training is unlikely to give those," Dr. Roga said.
- Embedded clinical bias is a significant barrier to advancing health equity. While clinical bias is a challenging topic to surface, research validates that outcomes for diverse populations are worse across all conditions. Examples such as unequal pain management or the increasing maternal mortality rate for Black patients demonstrate this systemic issue.
Clinical bias may also be built into algorithms that power certain tools, such as pulse oximeters that underestimate oxygen levels in people with dark skin tones or scheduling tools that flag no-show rates as being higher in patients of lower socioeconomic status (in many cases used as a proxy for race) will trigger scheduling visits into a more congested time in the clinician’s calendar resulting in shorter visits and long wait times for patients.,
Clinical bias permeates the research ecosystem as well through clinical trials that lack diversity in recruitment and enrollment.
- Improving health equity can significantly increase financial performance. The annual cost of care for a Black or Latino patient with a chronic illness averages $5,300 more than the cost of care for a white patient, Dr. Roga said. This means that without addressing the health inequities driving this differential, an accountable care organization with 50,000 patient lives under management — about a third of which would likely be Black of Latino, reflecting the makeup of the U.S. population — would incur over $45 million in annual incremental costs.
"If you look at the entire U.S., this has over a trillion-dollar impact on our health system that is incumbent on us to start looking at addressing," Dr. Roga said.
- Best practices for addressing health inequities include employing clinicians from diverse backgrounds and going upstream. One participant from the Yale School of Medicine said their institution has begun "introducing" itself to high schools with large populations of minority students in order to spur increased interest in pursuing a career in medicine.
Another attendee noted that when working with foreign-born clinicians or trainees, it is useful to keep in mind that some countries have zero tolerance for individuals of non-conventional sexual orientation. Institutions must support staff members in overcoming such biases from a place of empathy, recognizing their attitudes may be due to cultural upbringing and not malice.
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