Health Equity Predictions: 2023 Year in Review
At the beginning of 2023, we highlighted health equity predictions for the year provided by more than a dozen influential health equity leaders. For the final Under the Same Sky discussion of 2023, Abner Mason, founder and CEO of SameSky Health, met with Chris Gibbons, MD, MPH, founder and CEO of The Greystone Group, Inc. During this event, Abner and Chris reviewed the 2023 predictions, broke them into five different categories, and discussed where the industry is at, as well as where it needs to go to advance health equity. View the recording.
Cross-sector partnerships and collaboration:
Our experts predicted that in 2023 we would see more efforts around health equity nationally, that health equity would become center stage in the healthcare system, and there would be more cross-sector collaborative engagement in order for these efforts to occur. Chris and Abner both agreed that the efforts were there, but probably didn’t go as far as many would’ve hoped.
President Biden’s executive order on advancing racial equity did a lot to push efforts for these predictions at the federal level. Part of that executive order called for every single federal agency to establish programs and find ways to advance racial equity. Chris shared that a positive example that came from this mandate was a new $45 billion initiative within the Department of Commerce to ensure that everyone has access to high-speed broadband, no matter where they live. He noted that these federal efforts even trickled down to the state level where states like Massachusetts just passed an innovative 1115 waiver for the Medicaid population that is embedded in equity. Clearly more is happening than ever before, however true cross-sector collaboration is difficult to accomplish and will continue to take time.
“We have been doing work with health plan members helping to identify social determinants of health issues. What we are finding is that there are a significant number of people, not just in the Medicaid programs, but also Medicare Advantage, Medicare, and even exchange and commercial populations, who have food insecurity. Just because a person has a job doesn’t mean they don’t have to worry about how they are going to feed their family or themselves. For some reason we have a hard time connecting people with resources, like food assistance programs, that are available for their use…we’ve got to figure it out. That shouldn’t be the case.””
Role of key stakeholders:
Our thought leaders predicted that in 2023, stakeholders were going to be called on to make tighter connections to the business case for health equity and continue to incorporate services into the benefits ecosystem for employers. Chris believed that these predictions came true but could also be misleading if we aren’t careful.
“If you’re using the business case as the primary reason for doing something, then I’m not sure you’re really as vested as you could be because the business case from a strictly economic perspective isn’t always there, particularly in the beginning…There are other realities that we have to consider. These predictions are true but oftentimes more used as challenges rather than opportunities to facilitate equity.””
Abner noted that many health plans are looking for cost savings and a lot of them are looking for it within health equity initiatives because they are new, and aren’t always creating short-term return-on-investments (ROIs). He mentioned that we need to collectively figure out how to make the case for health equity investments and programs if there’s not a short-term ROI.
Adoption of hybrid care models:
What happened between 2019 and 2023 to change the use of technology in healthcare? Chris mentioned that there was no new evidence or technology that came in 2019 that we couldn’t have been using before the pandemic. In fact, other industries had started using this technology way before 2019, and it was the healthcare system that was resisting the change. Hybrid care is here because COVID-19 forced us to change.
However, Chris believes that the current predominant view of hybrid care doesn’t go nearly far enough because it is just incorporating telehealth and the in-person care that we’ve already been using. He imagines the full potential that technology has on the healthcare industry goes far beyond telehealth and the future of healthcare will be wherever you are.
Quality measures ties to advancing health equity:
Abner feels strongly that one of the biggest challenges we have in our country to create more equity in the healthcare system is that we haven’t collected data, and we haven’t been able to put metrics around disparities. If you can’t measure disparities, then it’s hard to talk meaningfully about them, and certainly difficult to address them. Going into 2023, Abner wanted the healthcare industry to do something we hadn’t done yet, which was to start to measure, to collect data, and then stratify that data. He believed that we could use this data to incentivize parts of the healthcare system to do better.
We have started to see this happening in major ways, even faster than Abner anticipated. In California, they have recently put into place strong incentives for health plans to identify disparities and will even penalize plans that don’t meet certain benchmarks. Quality measures have to be tied to closing disparity gaps. The whole healthcare system will shift and advance health equity when we reward good results.
Moving the needle on the idea of health equity:
Chris credits the current administration for embedding health equity in society more than ever before, however he thinks it’s still early in the game. Health equity and systemic changes are very sensitive to external pressures, and there are always changes coming down the road that could directly affect healthcare. The outcomes of these changes, such as the Supreme Court’s pull back on affirmative action, take time to unfold before we know how it will impact the healthcare industry.
We are making progress to advance health equity and help it become more ingrained in society, but the battle isn’t won just yet. For instance, what should we expect if a different administration wins the election in 2024? Chris imagines there may not be the same level of investment or commitment if the current party doesn’t win again in 2024. However, he realizes there is still some obligation to these ideals on both sides of the aisle, and sometimes it’s just differences of opinion in how to go about it, which can actually be helpful. Chris thinks that market-based approaches can have a strong impact on health equity, so if that is the case, then we should seize the opportunity because we cannot continue to devise programs that are not economically sustainable.
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