Health disparities have been thrown under a harsh spotlight in the past year and a half as the COVID-19 pandemic disproportionately ravaged communities of color in the U.S.
Addressing those structural inequities has quickly emerged as a key topic of conversation at HIMSS21, with health IT leaders and executives on multiple panels offering perspectives on how to ameliorate the pervasive divides and how technology — if implemented thoughtfully — might be able to help.
Some of that work is already being done, experts say. But payers and providers need to move beyond lip service and make enterprisewide investments in equity, using comprehensive data in order to drive targeted interventions and partnerships within these communities to improve the quality of care for all.
"While there were some isolated innovation gains, what remains are persistent, systemic access to healthcare challenges, which continue to negatively impact our underserved communities," said Michael Petersen, chief clinical innovation officer at NTT DATA Services, at a Tuesday panel on disparities.
The industry needs to move beyond simply recognizing the problem in hashtags and marketing approaches, and instead bring "tangible, meaningful solutions that work toward building health equity, and most importantly, trust," Petersen said.
Pandemic sheds light on inequity
Disparities in medical access and outcomes are unfortunately not new in American healthcare, but slammed into the public consciousness in 2020 as the coronavirus hit underserved communities in the U.S. disproportionately hard.
People with low socioeconomic status, as well as Black, Indigenous and Latino individuals, all experienced higher rates of infections, hospitalizations and deaths from the virus.
That inequity was evident in the public health response as well. For example, at the beginning of the pandemic, many COVID-19 tests were being allocated to retail-based clinics, which are largely located in wealthy areas, said Terry Adirim, the acting head of healthcare for the Department of Defense, at a Monday panel on pandemic lessons.
In addition, significant racial gaps in receiving vaccinations remain, despite the ongoing push to inoculate a greater swath of the U.S. population as the delta variant contributes to surging COVID-19 cases.
Executives who spearhead health equity initiatives said at HIMSS that they'd previously felt pushed to the corner in their organizations, with limited ability to scale their projects. COVID-19 changed that by bringing the conversation around health disparities to the forefront and leading many groups to reprioritize equity projects. President Joe Biden has even made promoting health equity a key prong of his healthcare agenda.
"We had been working in a room in the dark. And COVID opened the door," said Ivor Horn, Google's director of health equity and inclusion, on Tuesday.
"You can't build on an imperfect foundation. The pandemic revealed the crack," Horn, who's worked to reduce disparities for 25 years, said.
Patching the crack
Addressing the systemic inequity highlighted by COVID-19 isn't possible without collecting comprehensive data, garnering executive buy-in and fostering industry collaboration, HIMSS attendees said.
The pandemic has been a "lesson in modesty" in highlighting the limits of the medical system's data, said Ran Balicer, CIO of Clalit Health Services, on Monday. "If you don't have a full view of your population and their needs ... then you have a problem of increasing inequity that you need to take into account."
Executives at HIMSS said systems need to make sure they have comprehensive data on their populations to ensure they can meet needs at the individual level through traditional care delivery, community partnerships and technological interventions.
"We have to have these conversations with technology at the center so data's no longer a struggle," said Denise Fair, the chief public health officer for the city of Detroit, on Tuesday.
Google, for example, is working to try to address the needs of every user, Horn said. Along with the search giant's health equity tracker, an initiative rolled out in May in tandem with the Morehouse School of Medicine, Google is focusing on ensuring the medical information on its sites is science-driven and readily available.
That includes vetting the medical facts that pop up at the top of its search engine through experts at Mayo Clinic, and the creation of YouTube Health, which targets evidence-based data to users searching for medical conditions on the video marketplace.
For the latter, Google even linked celebrities and entertainers with trusted voices in public health like Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, for COVID-19 PSAs on the site.
However, Horn noted Google could be doing more in "last-mile work," in supporting and working with community health groups and agencies. And any organizations looking to improve equity need to ensure they're being careful with technology and not accidentially exacerbating discrepancies in access.
"We are seeing those who are able to get access to care and those who are not," Patrice Harris, CEO of at-home testing company eMed, said Monday. "We will have to be intentional about the use of technology."
For example, of Detroit's some 700,000 residents, 40% of them don't have access to high-speed internet, and 20% don't have access to the internet at all, Fair said. As a result, the Detroit Health Department partnered with a mortgage firm to create a call center during COVID-19 to give Detroit residents access to educational resources and information about testing. The city also hired a director of digital inclusion to make sure public health platforms were designed with the end user in mind.
And beyond the technology, the city's health department partnered with trusted community voices like pastors and schools to roll out testing sites and disseminate information.
"We have to start thinking not just about this is how people want access to care, but how can we use digital tools to manage different populations and engage people in a different way," said Thomas Keisau, director of digital health for management consultancy The Chartis Group, on a Wednesday panel on the future of digital health. "There's a way to do that that enhances the economic proposition for the health system, too."
Organizational buy-in — which, in many cases, does largely depend upon proving the ROI — is fundamental, executives said.
"We're getting traction here ... but we're not aligned enough as a system," Ronald Copeland, the chief equity, inclusion and diversity officer for integrated health giant Kaiser Permanente, said Tuesday.
According to Copeland, pervasive inequities were never due to a lack of awareness, but due to a fragmentation of incentives across the sector. Until those incentives are aligned at the leadership level, even the greater transparency afforded by data and technology are unlikely to make a meaningful dent in medical disparities.
"If we just take technology and lay it on the chaos we have now, we'll just be disappointed," Copeland said.
Healthcare executives do say equity is a top priority for their organizations, with half of the CEOs surveyed by Deliotte early this year saying its among their top three organizational priorities this year, according to a recent report from the consultancy.
However, companies are at different stages of actually implementing equity and inclusion programs, with some reporting they've been focused on addressing disparities for years, and others just beginning to define what it means to their organization.
Of the 20 chief executives surveyed by Deliotte, 17 said they had a dedicated team or budget for health equity initiatives.
That top-level buy-in is important, but addressing health inequities needs to be a whole-enterprise mission, Copeland said, integrated into every facet of payer and provider goals. One strategy to achieve this could be to make health equity a formal dimension of quality improvement, a policy that's even recently been considered in federal payer programs under the Biden administration.
"There is no quality without equity," Copeland said.