Industry Perspectives: Health Equity

The COVID-19 pandemic has accentuated the need for technology to emerge and take center stage in efforts toward health equity for all. We asked thought leaders to share their perspectives on the next steps healthcare systems should take to positively impact health equity and the importance of adopting evolving technology.

Clifford Goldsmith, MD, Chief Medical Officer, Microsoft US Health and Life Sciences

What are some next steps the industry should take to positively impact health equity?

We need to focus on the root causes of health inequity. That means addressing the digital divide from both the broadband access and edge device perspectives and focusing on allyship with organizations to train, support and advance far more Black, Latinx and indigenous people as doctors, nurses and allied clinicians. It means focusing on wellness and not just care, and bringing health resources much closer to vulnerable, disadvantaged communities. We need to measure outcomes to clearly highlight health inequities, and we need to remove the pre-existing biases in our clinical instruments by eliminating the data divide. We also need to look at our own organizations to create an empathetic culture and awareness of health inequity.

What technology or innovation do you see having a significant impact on health equity?

AI technology that provides insights into the inequity in outcomes based around social influencers of health will be key to deciding where interventions can be most effective. Once the digital divide is bridged, transformative technologies that lower the cost and improve the quality of care will be important in improving health equity. Examples include virtual care, care coordination with remote monitoring, care in the home, and improved patient experience. Remote assistance can also help bring high-quality care to areas that are underserved.

In adopting evolving technologies and information systems, how can we ensure that we don't leave communities or specific populations behind?

“Nothing about me without me” is the guidepost for all our activities. We need to bring health resources closer to communities, and we need to involve local leaders and organizations in our approach to health and well-being. We also need to make sure that current studies are redone, and no study is conducted going forward without an equitable representation of specific populations in the datasets, i.e., eliminating the data divide.

How can we ensure that advances in technology do not reinforce implicit bias or perpetuate existing inequities due to race, ethnicity, gender identity/expression, age, religion, sexual orientation, disability, economic status, and other factors?

Bridging the digital divide is something we need to include in parallel as we introduce new digital solutions, e.g., virtual care. We also need to provide strong requirements that all research uses datasets that are representative of the population at large to generate unbiased insights into outcomes and health of a community, which can be monitored to show improvement in health equity as we advance our use of technology.

How can we encourage collaboration among stakeholders for improving health equity? Who are those necessary stakeholders?

We need to add a health equity perspective to all our goals and missions across the healthcare industry. We need to make sure that our support for health equity is not gratuitous but sustainable by aligning the work with our core objectives. We need win, win, win health equity based strategic alliances where for-profit organizations can sustain or improve financial viability; public or not-for-profit organizations can improve the health of people; and populations and local organizations can meet their specific goals for their community members. We need to create opportunities to discuss health equity through our professional organizations, conferences, blogs and articles.

What has the COVID-19 pandemic taught us about global health equity?

The COVID-19 pandemic has had a much greater impact on poorer and vulnerable populations across the globe. We have also seen that many poorer countries have been slower at putting measures in place to slow and stop the pandemic, e.g., masks, vaccines and testing. We know that ending the pandemic means making sure that every country in the world is implementing measures to stop the spread and mutation of the COVID-19 virus. Microsoft’s collaboration with the CDC through the Center for Global Health Innovation has helped us understand the importance of private-public alliances, vaccine equity using respected members of local communities, and the use of community health workers in those communities. These learnings around COVID-19 vaccine equity are applicable to the broader goal of health equity.

Scott Hampel, President, MedeAnalytics

What are some next steps the industry should take to positively impact health equity?

Healthcare organizations need to better leverage or improve their analytics posture for better identification of and insight into their shortcomings from a health equity perspective. 

I would like to see CMS incentivize more innovative home healthcare models targeting underserved populations within Medicaid and Medicare. These incentives should utilize holistic home healthcare models that include medical, social and behavioral support services. 

What technology or innovation do you see having a significant impact on health equity?

I think analytics is key to identifying opportunities for programmatic improvement in health equity. Using these insights, many technological innovations in care delivery―including telehealth, remote patient monitoring, and home healthcare innovations―can drive material improvement in addressing underserved populations. 

In adopting evolving technologies and information systems, how can we ensure that we don't leave communities or specific populations behind?

Start by segmenting the population using analytics across not only across medical and Rx claims, but also using social determinants of health, clinical data records and behavioral health records. Then, further segment the population across health-equity related variables like race, gender, income, education, location, etc. to see where we have the biggest care gaps and communities without adequate access to healthcare. Finally, develop targeted programs leveraging innovations in mobile healthcare, telehealth, remote patient monitoring, etc. to close these gaps. I think CMS needs to elevate incentives through their value-based programs with Medicaid and Medicare to further encourage healthcare organizations to plan and deliver these important programs. 

How can we ensure that advances in technology do not reinforce implicit bias or perpetuate existing inequities due to race, ethnicity, gender identity/expression, age, religion, sexual orientation, disability, economic status and other factors?

I think the industry has realized that health equity is not a “one and done” problem. It requires focus from leadership and highly skilled individuals to execute programs effectively, and to ensure that the programs aren’t landing in these pitfalls. In larger organizations, we’re seeing new titles like Chief Health Equity Officer. Regardless of organization size, we need named leaders who are responsible for designing, executing and improving these programs. They will want to benchmark programs against statistics to monitor for bias and inequity perpetuation. I also think that CMS and industry watchdogs like HIMSS, CHIME, AHIP and others need to help align upon and publish KPIs in this domain for healthcare organizations to better understand how to measure their performance. 

How can we encourage collaboration among stakeholders for improving health equity? Who are those necessary stakeholders?

Ensure transparency and data sharing with an easy-to-use platform that provides a single source of truth for identifying and addressing care disparities. We are working with some very innovative organizations today that are doing a great job of addressing underserved populations leveraging both analytics and innovative care delivery models/technologies. They combine traditional health delivery with home healthcare, community health programs, transportation services, mental health services, food services, etc. They use population health analytics, wearables, remote patient monitoring, etc., and they are having great results. Their Net Promoter Scores (NPS) and their STAR ratings are very high, and they have material reductions in high-cost care situations for their patients relative to industry. While there’s no one platform that can accomplish all of this, a robust analytics platform capable of providing insight across a wide variety of data sources is critical to succeed.  

What has the COVID-19 pandemic taught us about global health equity?

We have learned that we are far from enabling equal access to quality, cost-effective healthcare in the U.S. and across the globe. Many people in other countries are still waiting for access to their first COVID-19 vaccine—versus the multiple vaccination opportunities that have been made generally available here. In the U.S. and many countries, the “essential workers” have a higher propensity to be people of color, people near poverty levels, people with high degrees of comorbidities. Along with the elderly, they are some of most at-risk populations, yet they are on the front line of the pandemic. As a global healthcare community, we need to better leverage our substantial resources in the ways I described to improve the health of our underserved communities across the globe.  

Grace Hurley, Director of Business Development, MBX Systems

What are some next steps the healthcare industry should take to positively impact health equity?

Making healthcare options more affordable and accessible to all people. Designing automation into healthcare solutions with AI/ML and computer vision will reduce the costs for diagnostics, time spent on tedious tasks and human error, while improving accessibility to people in remote and underserved communities. 

What technology or innovation do you see having a significant impact on health equity?

AI in patient monitoring devices is going to be critical for capturing, analyzing and aiding medical decisions, and improving patient outcomes in remote and underserved communities. Telemedicine has really launched universal access to people, and the more data that can be captured remotely for analysis by healthcare professionals, the better they can provide care to everyone regardless of location.

In adopting evolving technologies and information systems, how can we ensure that we don't leave communities or specific populations behind?

Everyone in the industry needs to continuously work to build a distributed healthcare infrastructure focused on equality. Training and consciousness of inequities within our development teams will keep the issue at the forefront to prevent bias when implementing new technologies.

How can we ensure that advances in technology do not reinforce implicit bias or perpetuate existing inequities due to race, ethnicity, gender identity/expression, age, religion, sexual orientation, disability, economic status and other factors?

Maintaining security while analyzing data will safeguard patient information. Studies from any trending data will need to be properly assessed for algorithmic fairness by the healthcare community to ensure there are no disparities, especially for training machine learning applications. The industry also needs to double down on creating and implementing technology to prevent cyberattacks that leave patient data susceptible.

How can we encourage collaboration among stakeholders for improving health equity? Who are those necessary stakeholders?

We are all stakeholders when it comes to health equity. Ensuring the health of all our communities is what we are all working towards every day. Industry leaders need to take up the mantle and drive awareness and empathy throughout their organizations to find ways to bridge the gaps in access to health services. For example, in communities with restricted access to healthcare, AI applications can reduce the number of medical professionals needed to facilitate a variety of healthcare services provided to the community. 

What has the COVID-19 pandemic taught us about global health equity?

One of the primary lessons from the COVID-19 pandemic has been the lack of buffer capacity in our healthcare system, which hits our most disadvantaged communities the hardest. Finding ways to automate monitoring and patient care will not only be key to maximizing the time of our healthcare heroes, but it will also help in limiting their exposure, keeping them healthy, and on the front line caring for all our friends and family when needed.