To Achieve True Health Equity, We Need to Start Asking the Right Questions

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Advanced analytics tools that provide clinician enablement are essential to ensure we don’t just ask the right questions about how to reduce care disparities – we answer them, too.    


As the financial impact of value-based care combines with changing consumer attitudes and a tsunami of stresses from the COVID-19 pandemic, the question of health equity is on everyone’s mind. Reducing health disparities among traditionally underserved populations is now a business imperative as well as a moral one, prompting vigorous discussion over the equity, equality, and ethics of healthcare delivery in this new world.  

Just this past April, the Centers for Medicare & Medicaid Services (CMS) released the agency’s strategic vision – and health equity is at the core. Administrator Chiquita Brooks-LaSure said, “Health equity will be embedded within the DNA of CMS and serve as the lens through which we view all of our work. Our vision is clear and our goal is straightforward—we will not stop until every person has a fair and just opportunity to attain their optimal health.”   

It’s important to start this conversation by knowing the fundamental differences between equity and equality. While equality means that each person gets exactly the same resources, equity is about giving each individual exactly what they need to thrive within their unique circumstances. 

Naturally, equity is the more difficult goal to achieve, especially if we don’t fully understand the strengths, challenges, and opportunities of the people we are trying to support.   

This is often the case in healthcare. Despite the growing maturity of electronic health records and other digital tools, we have largely struggled to collect robust, meaningful data about the social determinants of health (SDOH) and other non-clinical factors that impact adherence, spending, and outcomes. 

Without an understanding of our populations, we cannot possibly ask the right questions about what they need. And we certainly can’t ensure that we are meeting people where they are along their individual health journey. 

If we want to advance our ability to create true health equity, we need to adopt the technologies and human-centered strategies that will allow us to collect the right data, ask appropriate questions, and work collaboratively to deliver the right services at the right time to the people who need them most.  


It’s Not the Genetic Code, it’s the ZIP Code 

Many factors contribute to disparities in health outcomes, and most of them have little to do with the actual clinical care provided to a patient. Between 60 and 80 percent of health outcomes are influenced by SDOH, including access to food, shelter, education, employment, and psychological and physical safety. 

Population health experts agree that a person’s ZIP Code can be an accurate proxy for their socio-economic vulnerability. Resources like the City Health Dashboard from NYU Langone Health and the CDC Social Vulnerability Index clearly illustrate the close ties between under-resourced neighborhoods and lower life expectancy.  

Life expectancy in the wealthiest areas can sometimes be decades more than in impoverished regions – and it should come as little surprise that the residents of these highly challenged communities are primarily Black, Hispanic, Asian American and Pacific Islander (AAPI), Native American, and other minority ethnic and racial groups.   

Unfortunately, this socioeconomic data doesn’t make it into clinical decision-making as often as it needs to. As a result, members who simply do not have the resources to access care, purchase their medications, or adhere to clinical instructions get stuck in a negative feedback loop that can ultimately lead to poor quality of life, higher overall spending, and worse overall outcomes. 


Leveraging Technology to Illuminate and Address Health Equity Concerns 

ZIP Codes and other geographic-based indices can give healthcare payers some valuable insight into which questions they should start asking, but the road to health equity cannot stop there.  To reach beyond one-size-fits-all “equality,” payers must create detailed, individualized portraits of each of their members and the specific issues they face. 

To collect, manage, and apply this information to the benefits they offer, payers particularly need sophisticated and flexible technology tools. 

For example, medication nonadherence can have many underlying non-clinical causes.  Affordability is often the first question. If a patient cannot afford a drug, they’ll prioritize other things. If it’s a choice between food or medication, or between food or the cost to get to the pharmacy – that’s a hurdle. 

There are a lot of moving pieces that cause medication nonadherence, of course – social determinants of health such as food insecurity, access to care, and pharmacy deserts all add to the burden. Members face additional problems, such as securing transportation to a pharmacy or reading and understanding the instructions, that can also contribute to being labeled “non-compliant.” 

A digital pharmacy solution tailored to high-risk members with SDOH concerns can help to identify and manage these factors. With advanced predictive analytics and intuitive data-driven workflows, payers can generate holistic, tailored views of their members and apply socioeconomically appropriate engagement strategies that meet their unique needs. 

These may include switching to a more affordable generic medication, starting synchronized mail-order delivery directly to the home, or using in-home devices such as smart pill dispensers that makes it easier for members to self-manage their drug routines. 

Streamlining and automating medication adherence with a focus on overcoming SDOH barriers can empower members to improve their health while reducing costs and boosting performance scores for health plans.  


Solving for Health Equity Issues with People-Centered Services 

Because of the sensitive nature of SDOH challenges, payers cannot solely rely on technology to complete this work. They also need to leverage trained digital pharmacists who can breathe life into these data-driven insights, transforming black-and-white member information into supportive, ongoing relationships with people experiencing difficulties with medication adherence or accessing care in general. 

By using person-centered engagement strategies such as motivational interviewing and multiple touchpoints, digital pharmacy staff can build trust and rapport with members, make real-time referrals to resources in their communities, maximize the use of health plan benefits, and create lasting behavior change that may lead to better outcomes. 

The combination of powerful technology and the human touch is essential for making sure that we don’t just ask the right questions – we answer them, too.  Health equity is only attainable if payers, providers, pharmacists, technology developers, and community-based organizations come together to take concrete action on SDOH barriers and their downstream impacts on health outcomes. 

If we can better use technology to incorporate both clinical and non-clinical factors into care, then collaborate to create stronger infrastructure to address these concerns at scale, we will be able to support vulnerable communities and achieve meaningful health equity for traditionally disadvantaged populations. 

To learn more about data-driven strategies to educate patients, increase access to prescriptions and reduce the negative impacts of poor adherence, download our latest white paper.