Addressing social determinants of health and expanding efforts to reduce health disparities is the number one priority of provider strategic planners. As we've explored in a previous post, there are two paths forward for the future of health equity. This has health care leaders at a crossroads. And the decisions that each organization makes will set the course for health equity. There are two possible futures:

1. The industry continues to designate health equity as solely a mission imperative, staying the current course.
2. The industry solidifies health equity as a transformative business imperative, in addition to a mission mandate. This directly ties health equity performance to an organization's bottom line.

No matter which path is right for your organization, every health care organization can still make a meaningful difference in advancing equity. What each organization does depends on where it sits in the industry.

Life sciences manufacturers

Recruit and retain a diverse team of staff to build and design products

According to the National Science Foundation, just 11% of scientists and engineers were Black or Hispanic in 2015 despite comprising 31% of the population. In order to create inclusive products that are effective across a broad range of attributes, including race, it's necessary to have a diverse team of people designing and building them. Life sciences manufacturers can recruit and retain a diverse team by:

• Engage the people of color and women that are already on your team to ensure that they feel comfortable and included in your workspace.
• Seek out diverse candidates by attending job fairs and networking events geared towards communities of color.
• Be patient and proactive, keep trying different strategies for recruiting diverse candidates and build on what works.

Form partnerships to drive clinical trial diversity

Diverse participation in clinical trials is necessary to learn about the safety and efficacy of medical products in diverse populations. Increasing clinical trial diversity requires a multi-stakeholder approach to align incentives with the needs of specific populations and reduce barriers to enhance participation. Life sciences organizations should employ strategies including:

• Partner with community agencies to engage communities your organization may not otherwise have access to and identify barriers to recruitment.
• Build trust with patients by investing in community-based clinical trial sites.
• Incorporate technology to facilitate hybrid and decentralized clinical trial design to access more diverse patients.
• Offer incentives that align with the populations you aim to recruit.

Leverage real-world evidence (RWE) to identify disparities

Technological advances allow us to collect more robust patient data. Think proactively about utilizing data beyond claims and clinical data and increase focus on social determinants of health data. Life sciences manufacturers can use RWE to amplify social determinants of health data and help guide better treatment options for marginalized populations.

Hospitals and health systems

Utilize status as anchor institutions to meet unmet economic needs in your communities

Hospital's responsibilities have expanded to include the environmental and social impact of their work, such as providing nonclinical services in local communities. All organizations can implement "anchor institution" strategies such as:

• Hire people from your locality, ensuring you are truly inclusive in your recruitment process.
• Purchase goods from local suppliers when you can.
• Donate services or supplies to match demand in the most vulnerable communities.
• Invest in educational campaigns that improve the health and wellbeing of the local population.

Serve with cultural humility

In the past, many organizations have used the cultural competency model to strengthen health equity efforts. But this model often causes more harm by perpetuating stereotypes about specific identity groups.

Organizations should instead strive for cultural humility. The cultural humility model encourages humbleness from both the institution and the individual. They listen to and learn from people's lived experiences.

Shift to value-based care

Health plans and provider organizations under risk already understand that mitigating disparate outcomes will reduce total cost of care. But with CMS hinting at mandatory value-based payment models down the road, all provider organizations should plan to build key capabilities that will allow them to succeed under downside risk models, such as changing workflows to screen for social needs or segmenting patients based on risk level. 

Commitment to value-based care includes actions such as:

• Break down silos and collaborating with stakeholders across the industry.
• Refocus conversations on core goals of improving quality and reducing costs to make progress faster.
• Shift the culture of their organization to elevate accompanying priorities like strategy-aligned compensation and community health.

Health plans

Establish and implement health equity standards and metrics

In order to create an immediate and sustained business case for equity, plans are adding a financial incentive. Provider organizations are now being held accountable for delivering equitable care by weaving equity into quality metrics.

Just as providers already receive payment bumps for meeting certain quality metrics and penalties for falling short, providers in these new contracts will now also be accountable for any gaps between demographic groups.

Ensure equitable patient outcomes

Although health plans don't interact with patients in a clinical setting, they can still work to improve equitable patient outcomes. This can be done by providing coverage for social care as part of benefits packages, and segmenting initiatives to focus on underserved populations.

Identify elements of benefit design that contribute to disparate outcomes and access

Pharmacy deserts, neighborhoods with few or no pharmacies, limit patients' pharmacy options. This causes patients to receive medications from non-preferred pharmacies, often paying more out of pocket. By working closely with pharmacy benefit managers (PBMs), payers can eliminate or reduce copays for treatments proven to deliver patient-centered outcomes and improve care.

Digital health

Utilize AI to recognize and address bias

In recent years, AI in healthcare has received much deserved scrutiny over the potential negative consequences of biased algorithms. But bias in AI is dependent on the design of the model, the data inputs, and the use case. When researchers and developers operate with the understanding that structural inequities and racial stereotypes impart bias on many of the actions and datasets used in medicine today, they can build AI tools that help to mitigate this bias instead of exacerbating it.

Each sector has a responsibility to act to advance health equity. No matter where you sit in the industry, you can advance equity goals by ensuring you bring as much strategic rigor to health equity as any other initiative. Allocate ample resources to equity efforts, while embedding equity into all parts of the organization. Advocate for policies that mitigate existing disparities and create new solutions to support equity. No one person or organization can tackle this challenge alone. Partnerships, transparency, and communication are necessary to advance equity.