What Is Health Equity & Why Should It Be Addressed? How Does Health Equity Impact Providers & Payors? How Can Providers & Payors Be Rewarded For Addressing Health Equity? How Can Health Equity Be Addressed Through Technology?

1. ADDRESSING HEALTH EQUITY & THE RISK IN
PROVIDING CARE
Communities are facing a crisis in healthcare. Patients are choosing to feed their families over purchasing essential
prescriptions for chronic diseases. Due to a lack of transportation, vulnerable and underprivileged demographics are
purchasing cheap, unhealthy non-perishables at convenience stores rather than health-conscious options at grocers
just a few miles away. Non-English-speaking patients are being discharged from hospitals only to return because
they did not understand the post-discharge instructions. These are just a few challenges faced daily in communities
suffering from low health equity.
In 2014, evidence-based research ranked the U.S. as last overall in comparison to 11 industrialized nations meas-
ured in quality, efficiency, access to care, equity and healthy living (Mahon, 2014). In September 2015, the Centers for
Medicare and Medicaid (CMS) Office of Minority Health released their equity plan for improving quality in Medicare.
The mission of this plan strategized the benefits of advancing health equity by improving quality of care within mi-
nority and other underserved Medicare beneficiaries (CMS.gov, 2015). This proposal was catalyzed by the Affordable
Care Act, Healthy People 2020 and other leading federal agencies driving nationwide health initiatives. Furthermore,
Medicare spending grew 4.2% to $705.9 billion in 2017, or 20% of total national health expenditure (CMS.gov, 2017).
This historical data coincides with other trends highlighting the use of excess funds and care being directed towards
disparities within specific populations and demographics. Influenced by modern healthcare’s transition from fee-for-
service to value-based purchasing reimbursement models, the risk in caring for populations suffering from health
disparities has grown exponentially.
What Is Health Equity & Why Should It Be Addressed?
Health equity pertains to the absence of avoidable, unjust, remedial disparities typically observed in minority and
disadvantaged populations. Low-income, limited education and employment status are characteristics that can jeop-
ardize the health of specific demographics. The cost of healthcare within a household can quickly become a burden
and drive families into poverty when there is a need to treat chronic diseases. Preventative care and healthy lifestyle
coaching are absent in poverty-stricken communities as they are, in most cases, unavailable in geographic areas with
high populations of underserved Medicare beneficiaries. Without this education and access to an environment pro-
moting awareness and encouraging evidence-based health practices, health complications are compounded, reduc-
ing the probability of positive outcomes. In addition, chronic conditions lead to a domino effect of care management
challenges that require complex teams of medical specialists to be in position to address severe levels of illnesses.
These are daily challenges faced by licensed medical professionals seeking to heal the fragile patients assigned to
their care.
How Does Health Equity Impact Providers & Payors?
Patients seeking medical help with multiple, uncontrolled comorbidities bring extra risk to health facilities. Juggling
chronic issues that have not been addressed become a care-management challenge and nightmare.
AUGUST 2019By Evan Osborne

2. Gaps in care, sometimes due to a language barrier and education level, develop and lead to further complications. A
cycle commences as vulnerable demographics suffering from chronic disparities return, seeking medical attention
for uncontrolled, high-risk morbidities, which can ultimately lead to death within a hospital. These cycles ding hospi-
tals with readmission penalties, negatively affect mortality rates and decrease national rankings of both providers
and payors involved.
Research shows populations facing health equity challenges suffer reduced lifespans. This lower life expectancy rais-
es the mortality risk of these patients seeking specialized and acute care over and over again. High acuity de-
mographics, such as homeless populations admitted into hospitals, also pose a risk to surrounding inpatients seek-
ing care. Healthy hygiene practices are either not followed or proper facilities are unavailable to address cleanliness.
In addition, vaccinations, or the lack thereof, can lead to asymptomatic carriers entering health facilities seeking a
clean, aseptic space.
In 2018, United Health (UH) began paying for their members’ housing (Japsen, 2018). This was catalyzed by a case
where one of their homeless members checked into an emergency department over 250 times and was readmitted
on 32 separate occasions in less than three years. UH was able to determine that the cost of rent was less than the
alternative, inpatient billing charges. In 2009, the Urban Institute in Washington, D.C. predicted that disparities alone
were going to cost health insurers $337 billion between 2009 and 2018, including $220 billion for Medicare
(Waidmann, 2009). Focusing efforts on addressing health disparities, and the challenges these patients face, will sig-
nificantly reduce the risk of return visits and readmissions, ultimately improving healthcare quality outcomes.
How Can Providers & Payors Be Rewarded For Addressing Health Equity?
Steps can and are being made to reward payors for addressing health disparities through statewide health exchang-
es, such as Covered California. Covered California incentivizes payors tending to health inequity challenges within
the member populations. Millions of dollars have been put on the table as bonuses paid out to health insurance
companies successfully aligning with mandated initiatives. In 2018, Blue Shield of California (BSC) responded by hir-
ing staff specifically to build and manage a program focused on health equity. The initial challenges this program
faced was acquiring data along with needed documentation to establish a baseline assessment on health equity
within health facilities serving BSC members. These growing pains are catalyzing the movement to capture data
providing actionable insight for decision-makers within the healthcare industry.
Through joint efforts between payors and providers, health equity can be addressed by way of quality collaboratives.
Quality collaboratives provide infrastructure for incentivized reporting, as well as leverage in-hospital contract nego-
tiations and health exchange incentivization programs. Putting dollars at-risk around measures specifically associat-
ed with addressing health equity is powerful. Incentivizing providers to report ethnic, race, sexual orientation and
socioeconomic metrics will lead to tangible solutions payors can use within their health equity programs.
The foremost step for health organizations to be rewarded in tackling challenges and risks associated with low
health equity is through documentation and risk-adjusting analysis. In 2016, the development of official coding
guidelines and the incorporation of the ICD-10-CM Z codes by CMS and Center for Disease Control’s (CDC) National
Healthcare Safety Network (NHSN), were steps in the right direction. Capturing key contributing factors, such as pov-
erty, race, geographic location and language are all attributes needed to understand patient populations. These ana-
lytical opportunities help paint a transparent picture of performance rates within healthcare facilities, addressing the
challenges low health equity can bring.
How Can Health Equity Be Addressed Through Technology?
According to Paula Dressel from the Race Matters Institute, “The route to achieving equity will not be accomplished
through treating everyone equally. It will be achieved by treating everyone justly according to their circumstances.”

3. In this new age of tech-driven healthcare practices, we have tools available that can level the playing field for provid-
ers and payors addressing the needs of those facing health disparities. A way technology is having a big impact is
through modified enhanced electronic health record (EHR) systems. Incorporating population health modules and
risk-adjusting, documentation improvement solutions will enhance provider practices to capture evidence of health
disparities leading to actionable insight. Furthermore, bridging the gap in quality reporting between health facilities,
payors and healthcare-regulating government agencies can be done by standardizing payor-provider data portals
and improving collaborative efforts with Health Information Exchanges (HIE). These joint endeavors will lead to ap-
propriate distributions of value-based revenue supported by increased case mix indices, improved mortality and se-
verity of illness reporting; all byproducts of clinical documentation improvement and meaningful use of data stand-
ards.
Giving credit where credit is due by accurately risk-adjusting socioeconomic disparities and vulnerable de-
mographics will pave the way in rewarding health organizations for their efforts in assisting communities to over-
come challenges associated with low health equity.
For further discussion, please contact Dacarba’s professionals below:
Evan Osborne is a Manager with Dacarba LLC, a subsidiary of Opportune LLP, specializing in the field of
healthcare quality. Evan has over 10 years of professional experience in direct patient care and hospital
systems with a deep background in quality improvement, oncology, project management and program
development. Evan earned Bachelor degrees in Biology at Western Oregon University and in Radiation
Therapy at Oregon Health & Science University. He later earned a Master’s degree in Public Health at the
University of Massachusetts, Amherst, and is currently completing a Doctor of Business Administration at
California Southern University.
eosborne@dacarba.com