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Health equity is having a moment. The words, ‘ health equity,’ seem ubiquitous from podium to pen, emerging in mission statements, white papers, policy documents, speeches and blog posts. Nevertheless, the two-year lovefest with these buzzwords is slow to usher in tangible shifts in outcomes-oriented actions, innovation and access for people who most need the support. The action steps following health equity commitments seem to focus primarily on collecting and analyzing data about health inequities. Data collection is Priority 1 in the new CMS Health Equity Framework. NCQA prioritizes health equity-related data collection rather than specific actions and health outcomes that might advance health equity. Nevertheless, every healthcare service and delivery organization has actionable information needed to begin addressing health inequity. Why wait for more data?
Maybe advancing health equity to improve outcomes is too daunting. Does a lack of consensus on measuring it sow confusion? Is it too overwhelming? Or is calling for more data as the first action a scapegoat?
The holy grail for any data-driven program or intervention is to operate with complete information and clean data that are standardized, harmonized and collected consistently. This utopia rarely exists across the health ecosystem or even within a health system. The absence of complete information should not impede decisions and efforts to address health equity in a way that improves patient experiences and outcomes.
Furthermore, a wealth of data characterizing health disparities and inequities is available. These data have appeared in peer-reviewed publications, CDC MMWRs, and national policy briefs for decades. Twenty years ago, the National Academy of Medicine convened a panel of experts to outline the evidence for longstanding care and treatment disparities. The report could credibly bear today’s date.
How do we move forward? Every organization collects demographic data. Zip code combined with service mappings by zip code can be a powerful proxy for understanding where and how inequity presents. Beyond demographics, payer and healthcare systems are replete with data ripe for exploration. What can be learned from the epidemiological and clinical data available? Is this information being collated to provide a clear picture of patterns and missed opportunities to improve care and outcomes? What data are quality committees poring over? Who has high morbidity? Who is dying and why? Is someone in the organization routinely talking directly to those who appear in these analyses? If not, why not?
Maternal health outcomes and disparities are timely examples reflecting the urgency to act on available data. This issue ebbs and flows in the US. Despite our awareness of the problem, I have encountered organizations that have yet to thoroughly review historical and current maternal health data to understand the social and clinical drivers of these outcomes. This includes quantifying outcomes by conditions and correlating this information with environmental and clinical factors or exploring the clinical progression of patients with high morbidity and poor outcomes. Existing data can elucidate important information to guide action without waiting to implement new data collection processes.
Achieving health equity will change our healthcare culture and we should be honest about our desire for such changes. A few years ago, I needed a colonoscopy before my employer-based insurance lapsed, but the next available appointment was three months out. I called a friend, who called a friend, and less than a week later, I was in the colonoscopy suite. How does this scenario align or misalign with how we think about advancing health equity? In pursuit of health equity, is this acceptable? Are we ready for the change we seek or does focusing on data collection further delay our progress?
There’s a saying, ‘perfect is the enemy of the good.’ If we believe our healthcare system is unjust, we have to change. If each organization selects one structural issue to address and measure progress, a few years from now we will look back and be proud of what we accomplished by acting upon the data in front of us rather than waiting.
We have a graveyard of buzzwords and data left in the wake of waves of new and recycled trends and priorities. Will this become the fate of health equity? For the millions of people with inadequate access to the health and preventive services they need to be healthy, I certainly hope not.
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