Thursday, Aug 12, 2021

Health Equity: Four Pillars of Action

U. Michael Currie MPH, MBASr. Vice President & Chief Health Equity Officer, Optum & UnitedHealth Group

HLTH Foundation

Health equity is described as every person having an opportunity to achieve their optimal health — without unfair differences in their ability to access or receive care. In a healthy and just society, health disparities would not exist. Yet these considerable care disparities — connected to race, gender, socioeconomic status and sexual orientation — do exist from community to community. Coming together to address variation in health care outcomes for everyone and building a more modern, better-performing health care system overall will empower quality outcomes for everyone. And, doing so will confront health care inequities head on.


So how can we as an industry resolve health inequities? Identifying and acknowledging that disparities exist is a crucial first step. Further, meaningful change will include recognizing the impact of implicit bias on our thoughts and decisions to address health disparities. 


We must also acknowledge that this change will take time. Results may not occur until well past our tenure. But there are ways to achieve opportunities, build momentum and create a foundation for lasting impact.


Four pathways to equity

Across the UnitedHealth Group companies, our key metric for health equity is improving clinical outcomes. To organize our activity against this goal, we prioritized four pillars of action. These categories offer opportunities for results that lead to bold, long-term systemic change. Each pillar lends itself to measurable goals, so that leaders can build a business case to support the investment of resources needed to address each one. 

1. Leveraging data and emerging analytics to monitor and address disparities in care

Through community partnerships, it is possible to gather richer consumer data, ZIP code information and social isolation data. This will help to build a more comprehensive picture of all the factors that can impact people’s health. Healthcare organizations have already identified the populations with poor utilization or outcomes. Overlaying social determinants of health information can reveal the root causes. This will further concentrate efforts to overcome disparities and inequities, guide your partnerships and inform the financial rationale for your actions.

2. Delivering on personalized care based on individual needs

Root causes threaten an individual’s core safety and well-being and prevent them from achieving optimal health. These causes can include social determinants like economic factors as well as non-economic factors such as mistrust or disaffection for a healthcare system that does not match their individual needs. Personalizing for needs means offering care programs that people trust, can easily access and want to engage in. Any effort to learn more about the root causes that impact your populations will naturally lead out into the community; and community involvement will create a deeper understanding of what truly shapes the lives of people who live there.  

3. Improving the health of underserved communities

COVID-19 made the health inequity in our communities clear. Widespread and costly disparities were on display as the entire nation watched the tragic results. This cannot continue.

A powerful first step toward equitable care is to make health equity part of the organizational mission. This supports the mandate of looking at everything through an equity lens. Unconscious or implicit bias can be hard to spot, but poor clinical outcomes are obvious. The level of bias in health care is the same as in the general population and it will need to be addressed in everything from scheduling to surgery. It will be easier to integrate into your culture when it is an openly stated part of the mission.

Next, narrow in on the population whose clinical outcomes are falling below benchmark. Ask your leaders to look for the underlying causes and identify where demographic data may be incomplete or systems unable to collect it. Gather feedback from this population and see if their feelings about their health experience match staff perceptions. Doing this will reveal gaps that can be addressed. Finally, choose one area where you believe you can make the most clinical impact and focus resources there.


4. Promoting equity and diversity in the health workforce

A natural way to narrow in on health equity is to start with your own organizational culture and levels of diversity. Do you match the populations you serve? Can you ensure that employees are culturally competent to serve the community? Do they understand and respect the cultural norms, language and beliefs shared by your consumers? Building gender and racial diversity into the recruitment process and leadership succession plans are concrete ways to advance here.

Another consideration is inclusion. Even if you have diversity in your ranks, those in the minority may not feel like they have a voice at the table. Only leaders can create a respectful, welcoming environment that brings forward all voices. Research tells us that diverse companies are 35% more likely to outperform their peers. So, along with advancing health equity, those who enable a diverse, inclusive workforce are also building a more resilient, competitive organization.

The pandemic taught us many lessons in health care, and we can take heart in the courageous strides we made there. But our job is not yet finished. Health leaders have a critical role to play in advancing health equity. It is up to us to take the lead in addressing systemic issues and improving health outcomes for everyone.

Health equity can’t be addressed as a short-term fix. It will require the same passion and drive with which we pursue other growth strategies. It will require the same sense of urgency, sacrifice and cooperation required of us during the pandemic. And it will take formal, out-loud, organizational commitment.


To read more on health equity, click here.

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