Health inequities have risen to the top of healthcare leaders' agendas, and organizations across the country are trying to determine the most effective ways to tackle one of the key issues: barriers to care access.
During a March webinar hosted by Becker's Hospital Review and sponsored by Vituity, health system leaders discussed tangible ways to address those barriers. Panelists were:
- Reginald Eadie, MD, president and chief executive officer, Trinity Health of New England
- Devdutta Sangvai, MD, vice president of population health management, Duke University Health System
- Imamu Tomlinson, MD, MBA, chief executive officer, Vituity, and president, Vituity Cares Foundation
Four key takeaways:
- Health disparities are preventable and reversible. Health disparities are preventable differences in burden of disease and opportunities to achieve optimal health, driven largely by social and economic inequalities. "Sixty percent of the outcome of one's health is determined solely by their ZIP code. This underscores the fact that healthcare disparities are preventable, reversible and there's something that could be done quickly about them," Dr. Eadie said.
- To reduce barriers, send provider teams into communities. While health insurance cost is a major barrier to care, there are less well-understood social drivers of health — such as housing, transportation and food insecurity — that deter access. "The first step in addressing barriers is understanding what those barriers are at the ZIP code level," Dr. Sangvai said. He described how Duke Health, a three-hospital health system in North Carolina, is taking on those challenges by sending providers into communities that have housing difficulties to facilitate check-in appointments.
Trinity Health, a five-hospital system based in Hartford, Conn., follows a similar approach by enabling line-level physicians who "breathe and understand those communities" to go in and engage with patients at the individual level. To propagate this way of working across the health system, Dr. Tomlinson said healthcare models need to abandon their traditional orientation of making hospitals and providers at the center of care delivery and instead become more efficient and accessible for the people they serve. "We need to blow all those [models] up and engage in disruptive ways where we're uncomfortable, because it isn't about us," he said. - To increase trust and operationalize patient-centric models, invest in care redesign. Reforming the current provider-centric system will be costly and will decrease short-term margins for providers and hospitals, but in the long term it will benefit them. Regarding telehealth, which enjoyed an unprecedented boost during the pandemic and may seem like an efficient way to bring care closer to patients, the speakers cautioned against over-relying on technology. Dr. Eadie said that only about a quarter of Americans can use telehealth because of broadband issues or because they lack the necessary hardware. Pinning too much hope on telehealth can deepen existing access challenges. “While we’ve seen a boom in technology, virtual health, and really creative ways to engage patients, I've also seen a lot of patients get left behind,” said Dr. Tomlinson. Vituity has responded by finding ways to meet patients where, when, and how they need help. For example, their street medicine programs provide medical care to unhoused people at shelters and encampments.
- Policymakers can advance system reform by applying a wider lens and bolder regulations. Individual providers who serve disadvantaged communities are often disadvantaged themselves, and policymakers ought to refocus conversations about health equity to include those providers. Lawmakers also ought to look more closely at price transparency issues and develop anti-steering policies that discourage monopolistic behaviors, which further marginalize vulnerable populations.
To enable real, local innovation, policymakers should create greater regulatory freedom for health systems that work with such communities. "If I were to ask policymakers anything, it's to let us go to where the work is happening and get the advice of those doing the work rather than argue on a high-level scale that doesn't get to where the people need that care," Dr. Tomlinson said.
Watch the full replay of this webinar here. To register for upcoming webinars, click here.