Aligned incentives, community investment are key for achieving health equity
Over the past several decades, the healthcare industry has spent increasingly more time, effort, and resources on the quest for health equity. Defined as “the state in which everyone has a fair and just opportunity to attain their highest level of health,” health equity is only attainable if healthcare leaders identify, acknowledge, and proactively address the conscious and unconscious biases that lead to disparities in the current system.
Naturally, this is easier said than done. Deeply rooted systemic challenges are everywhere, from chronic provider shortages in historically underserved communities to hidden flaws in artificial intelligence algorithms that disadvantage certain populations.
Dr. Margaret-Mary Wilson, the incoming Chief Medical Officer at UnitedHealthcare Group, has witnessed many of these disparities first hand.
During a medical career spanning three continents, she has seen patients die from treatable illnesses due to lack of access to resources the rest of the world takes for granted. She has also come to learn that highly structured, well-resourced health systems aren’t always equitable ones, she explained in a Q&A at ViVE 2022 in Miami Beach.
“Even mature health systems with strong regulations and clinical guidelines can produce pretty severe abrasion and detrimental complexity,” Wilson said. “In the US particularly, we experience significant variation in provider practice, inefficiency, and complexity that drive up the total cost of care for everyone. There is severe abrasion for patients, for providers, for payers, and for caregivers.”
“Healthcare can be simple. It can be less complex; it can be affordable. It should be and can be equitable. It’s all a question of how we come together and align around meaningful incentives to drive measurable value.”
Aligning incentives to achieve equity and value
The first step is creating a shared definition of “value,” Wilson said.
“Value for you is not necessarily the same as value for me,” she noted. “If our healthcare systems are really meant to work, we have to align around incentives that drive meaningful value as defined by – and for – the patient.”
For providers, that realignment will involve some degree of financial risk-bearing, she cautioned. Value-based care models that use reimbursement as a level for accountability and continuous improvement are the way of the future.
As the largest health insurance company in the United States, UnitedHealthcare has enormous influence in the provider market, and the company is using that clout to encourage the growth of value-based care. Many value-based care models actively incent providers to address the drivers of unequal outcomes in socioeconomically disadvantaged populations.
“If we’re able to get our provider partners to adopt a value-based approach, it’s going to build momentum in that alignment and move in the right direction for lower costs and improved outcomes across all segments of society,” Wilson said.
Working with communities to invest in better health
Incentives for providers are only one component of success, she continued. The second area is around investing directly in communities to tackle known disparities.
“Maternal health is a good example,” she said. “When Black mothers are dying at three to four times the rates of their white counterparts, something needs to be done. Women shouldn’t be dying from a normal part of life. Pregnancy is not a disease.”
Relatively low-cost, community-based initiatives to reduce avoidable mortality have brought immediate results. The company connected postpartum mothers in Hawaii, Ohio, and Michigan with community-based organizations and public health services.
Between 2018 and 2019, the program reduced disparities in timely postpartum care for Black women by more than 40 percent in Michigan and Hawaii. In one Ohio county known for high rates of substance abuse and poverty, disparities in care access decreased by more than 80 percent.
Rallying industry leaders to achieve equitable health outcomes
Payers, providers, patients, and regulators will need to work together to solve the problems of health disparities, Wilson asserted.
“Each stakeholder needs to think about what niche they can occupy and best bring together their capabilities to drive change,” she said. “It’s going to take all of us committing to understand that everyone, regardless of their socioeconomic group, is entitled to quality, affordable, accessible care.”
“It will take all of us working together to solve this problem, but we must help people live healthier lives and help healthcare systems work better for everyone.”
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Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry. Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.