HDG #003: Literally everything is a Health Equity issue

Read time: 7 minutes

Today I'm going to talk about why literally everything in healthcare is a health equity issue in some way.

"Health Equity" is probably healthcare's biggest buzzword of 2023 (after ChatGPT?), but it's often used semi-synonymously with population health, social determinants of health, network/community resource adequacy, DEI-related things, and outcomes disparity.

Sure.. Health Equity is about those things.. but it's also about a whole lot more.

Let’s be clear:

Health equity is not just about access to community services.

Health equity is not just about differences in outcomes.

Health equity is not just about the neighborhood you live in or the color of your skin.

Don't get me wrong: all of these are absolutely important.

But today I'm encouraging you to think more globally so that health equity goals aren't checked off as "done" after standing up one food pharmacy and launching one digital maternal health program.

As always, I like to take a systemic view and think about the people behind the data points.

Consider the following where you may not see the immediate tie back to Health Equity:

• Revenue Cycle Management Analysis:

  Provider drops the bills, payer pays the bills, rev cycle companies help make sure that all runs smoothly and doesn't get denied, patient share is being collected, write-off is reduced, etc.

  What does the data say about those who can't pay, or those we will possibly even send to collections? What does your data tell you about if these folks are uninsured or have weak insurance benefits, or might even qualify for financial assistance or forgiveness (Charity Care)? Are they people who have other medical debt, which by some estimates are 1 in 4 Americans, or 6 in 10 if you're low income. How does this vary by insurer, demographics, types of procedures or visits, etc.? Do we see it exacerbated in any of those areas?

  Would any of these findings point back to..

• Provider Directories:

  A recent HealthcareDive article called out how provider directories are still wildly inaccurate. This is where people go to find out which doc they should go to when they have an emergency, or procedure, etc.

  You might think, "they've been inaccurate forever" (which they kind of have..).

  Or that you can just call (which, unfortunately, takes a whole day so hopefully you have the time to devote..)

  Or that most of the information is on the website (despite it being unnavigable, and assuming you know the difference between a health system or medical group, or that you might only be able to return an ENT by searching the term "otolaryngologist" [?????] kind of thing..)

  Well, I think I've made my point here, and I haven't even talked about Surprise Billing yet, which is when people unknowingly receive care from an out-of-network provider or facility. This can (surprisingly) happen when you go to a facility that is in-network, but the contract physicians working there are actually out-of-network, for instance. It became such an issue that new regulation had to be passed.

  I didn’t even know what an otolaryngologist was..

• Provider Productivity:

  I was talking to a friend who oversees a large number of clinics across a large system. They can't take providers off the line for meetings/updates/any reason other than regulatory. Even then, they have to show a plan to make up for the lost "productivity."

  There have been lots of thought pieces written about how no human should be expected to operate at 100% utilization at work (here's one, and here's another healthcare-specific one, and here's a book about it for the services industry).

  But consider this: will your providers who are under the gun to not end up on your "low productivity" report going to:

  • answer all the questions patiently from someone who has lots of questions like me me me

  • take the time to explain to someone who doesn't speak English as a first language

  • document and diagnose as thoughtfully and robustly as Dr. Kapoor does on New Amsterdam (clearly reality TV)

  • Conversely, is that same someone who doesn't speak English as a first language going to confidently continue to ask, or try to ask, when they sense the shortness?

  • Is the question-asker going to? (well, I would, but I have no shame)

Lots of examples here, but this kind of maximum fee-for-service throughput and cascading impact tends to impacts.. you guessed it...

(FYI, but for another day.. people are still trying to agree upon how we even measure provider productivity)

I think (hope?) you get the point.

Until we nail this—and put our money where our mouths are—"Health Equity" will continue to be a buzzword for years to come.

But.. not to fret: data holds the key to solving this.

. . .

Actionable Idea of the Week:

As you go forward, I encourage you think to think about this issue as you're doing an analysis, creating new programs, or launching a new product/tool into the marketplace:

• Who is going to be most impacted? Who is going to be disproportionately impacted?

• Are they going to be most impacted because of some kind of inequity, disparity, disadvantage, privilege, assumed understanding, or limitation?

• How would you do it differently, knowing that?

• How can you design it so it "meets people where they're at?"

• Who are the data points falling through the cracks of your analysis, programs, or product/tool?

• How do you make it equally accessible? Customized or personalized?

What other challenges/issues are you tackling (seemingly-unrelated but lowkey related) that we can discuss in a future newsletter so that it gets visibility?

Hit reply and let me know.

See you next week!

-Stefany

P.S. If you’re unfamiliar with this meme or how it relates: it is based on the well-known Ancient Aliens meme, where host Giorgio A. Tsoukalos (pictured) believes “aliens” is the answer to literally every question asked. Here is the background and some great examples of the meme in action.

You’re welcome!

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