Driving health equity takes patient perspective, data, better access to care, and a keen understanding of SDOH

Achieving health equity takes awareness and collaboration, said Dr. Neema Stephens, national medical director for Health Equity at Evernorth, during a panel discussion that she moderated at this year’s Evernorth Outcomes event in Orlando, Florida.

“Health equity is a top priority for Evernorth because we're here to solve health care's biggest challenges, and I think we can all agree that health equity is one of them,” Dr. Stephens told the audience. “We invite you all to be a part of the solution.”

Dr. Neema Stephens convenes a panel of experts to discuss ways to drive health equity outcomes.

Access to care Is a key challenge in driving health equity

Abigail Johnston, a patient advocate, writer and lawyer, was among the panelists and shared her personal story of being diagnosed with stage four metastatic breast cancer in 2017. She pointed to the fact that the American health care system is complicated and difficult to navigate, with everything from finding doctors to getting bills paid oftentimes becoming overwhelming obstacles for patients.

Abigail Johnston highlights the importance of patient inclusion, sharing her perspective on patient challenges related to health equity. 

“When you're diagnosed with a very serious illness, like a terminal cancer diagnosis, you are not able to process things in the same way,” Johnston said. “I had a neuropsychological evaluation done about a year after I finished chemotherapy, and it demonstrated a 20 point IQ loss. I was struggling.”

And for those who do get care, it is difficult to get the right level of care. She highlighted about 80% of people with metastatic breast cancer are seen by doctors in a community health setting. “These doctors are often generalists that treat every form of cancer, and those who are terminal need the care of academic centers and specialists to stay alive,” she said. “Many people can’t access the experts they need.”

Root causes and Social Determinants of Health

Madhuri Jha, vice president of Science, Equity and Integration at ETR, highlighted that when we think about disparities, we have to take a step beyond what we traditionally see as medical interventions, and focus on areas like housing, food security, and hygiene. She reflected on her time as a mental health mobile provider during the peak of the COVID-19 pandemic in New York City, providing wraparound services to patients who were homeless, socially isolated, or rapidly released from prison facilities. Jha called out the long standing history of political and social policies that have put certain groups at a disadvantage.

Madhuri Jha discusses the root causes of health inequity and the role of social determinants of health.

She emphasized the role that everyone in the health system has to play to reduce these root inequities. “Everybody deserves dignity, privacy, and a trusting provider they feel that they can talk to, that represents their experience or at least takes a moment to understand,” she said.

Jha expanded to spotlight the importance of communication — for example, explaining benefits to people in a clear way and providing services in languages that people speak. She highlighted that there is a very small percentage of physicians that speak Spanish, although we know we have millions of Spanish-speaking Americans in need of care. And on the psychiatry side, less than 5% of psychiatrists speak Spanish.

Provider perspective and access to primary care

The panel discussed the importance of rethinking the approach to patient care, specifically through the lens of access to care for historically underrepresented groups. Dr. Clive Fields, co-founder and chief medical officer at VillageMD, shared his perspective as an industry leader in primary care.

Dr. Clive Fields discusses the importance of access to primary care in driving health equity.

“We can't address any of the health inequities that we're going to discuss today without creating access to primary care,” said Dr. Fields. He noted that, in his experience over the past 30 years, the system has focused heavily on driving specialized care to small populations of people, instead of focusing on expanding access to primary care to treat the most common causes of death like complications from diabetes, hypertension, or heart failure.

He shared that VillageMD is committed to opening up 50% of new offices in underrepresented communities to help reduce inequity, because the most common interaction that a patient has with the health care system is through a primary care visit. “If you can bring primary care and access to prescriptions to communities without it, you've got a chance to start to close the equity gap,” he said.

The power of telling stories using data

The panelists also explored and expanded on the opportunities and power of data. Jha, speaking from her experience as an epidemiologist, underscored the importance of translating health data into stories.

“In my world, data is often how I work with policymakers or legislators to guide their policies,” she said. “If they don't have the data capture of the burden of someone's wellness in a certain ZIP code or district, they cannot advocate for the investment.”

For example, she shared one body of work she partnered on with the Morehouse School of Medicine, where they were able to use public data sets to quantify the potential savings to the health care system if mental health care was more equitable. The number was striking: $287 billion — and the data proved to be a powerful tool to advocate for health equity and influence decision makers. Data can also be dangerous, cautioned Jha. It’s dangerous to classify an entire community or demographic to be at risk for a certain condition — you risk disregarding the different strengths and attributes of that community. Rather, we must use data to look at the entire ecosystem to see both the positive and negative, she said.

Johnston added that it is important to empower patients to understand the context of data, to ensure their voice is captured. From a patient perspective there are qualitative experiences that must be taken into account. A person is not a data point, she said, adding that their life experience, the people that depend on them, and their culture cannot be captured in a traditional data set.

“I get pulled into surveys all the time. I get handed an iPad to fill out a survey at so many of my appointments and I fill every single one out,” said Johnston. “But not a lot of people are like me because they don't know why it’s so important. They don't know why it's important to share that they didn't have gas for their car to come to an appointment, they didn't have childcare so they missed their chemotherapy session, or they couldn't get to radiation therapy because they didn't have transportation.” She challenged the audience to empower patients in order to capture better, richer data and understand the full story.

Best practices for building a health equity strategy

The panelists shared best practices for leaders who want to build a health equity strategy.

For Dr. Fields, the first step is recognizing that inequities exist and we all are part of the problem, as well as the solution. It is vital to check privilege at the door, and approach each interaction with empathy, understanding that everyone’s experiences are different and unique. As important as data and technology, it’s crucial that health care stays human, he said. The most valuable thing that a person can have is a trusted relationship with a health care professional. People with these relationships live happier, longer lives and spend a lot less on health care.

For Johnston, the key to developing a health equity strategy is engaging and involving patients early and often. Reflecting on her own experience, she noted that there were many touchpoints in her patient journey where she could have been better informed about her risk for cancer, specifically the opportunity for genetic testing during fertility treatments. She noted that her insurance company has had to spend over $3 million to treat her cancer over the past six years, and if the health care system had been better equipped to inform her of her risk, she may have had the opportunity to take preventive measures — resulting in significant cost savings for the system.

Jha added that is it crucial to examine the representation of your own organization, pointing to many studies that show that many organizations in the health care system have a lack of representation in senior management. She expanded to say that the very act of placing health equity at the forefront of conversation and business strategy is an important first step. We must champion equity instead of treating it as a checkbox.