Health systems say equity is a goal. Not many are budgeting for it.

Many healthcare executives say they recognize the importance of improving health equity, but most aren’t dedicating a specific budget for that goal.

Virtually all health executives surveyed (93%) said health equity initiatives are important, according to a study by Accenture and HIMSS Market Research. About 9 out of 10 (89%) said they considered health equity a core part of their business.

Ankoor Shah of Accenture

Yet only about one in three (36%) said they had specifically budgeted money to address health equity. An additional 25% of executives said they planned to have a health equity budget in the future.

Health equity has been a topic of intense interest, particularly amidst the COVID-19 pandemic. It’s significant that so many executives recognize health equity is a priority, said Ankoor Shah, principal director and health equity lead at Accenture.

“We wouldn’t be having the same conversation 10 years ago,” Shah said in an interview with Chief Healthcare Executive. “It is top of mind for C-suite executives.”

At the same time, he said, “How do we connect health equity to the core business?”

If health equity is a goal for healthcare systems, they need to dedicate a budget for that purpose, Shah suggested.

• Related story: HHS, CMS leaders talk about health equity, sharing data

Healthcare executives need to see the value in improving health outcomes from patients in minority groups from an economic perspective.

“Health equity drives enormous value for an organization,” Shah said. “It’s the right thing to do but it’s good for business.”

“You’re going to improve overall health outcomes,” Shah said. “You are going to reduce costs as well. By having the right care at the right time, it will improve provider satisfaction. That is hitting every aspect of the value chain.”

The value of technology

Technology can help healthcare systems identify those inequities and determine if Black or Latino patients, for example, are having worse outcomes than other patients with similar illnesses or procedures.

In Ohio, Accenture worked with the state to address high infant mortality, which is particularly high among Black babies. Using machine learning, Accenture helped identify mothers who were at higher risk of their child dying within the first year of life. Those mothers were able to get more support services, Shah said.

Technology can also help to reveal bias in medical training and treatment. Black patients were more likely to have negative descriptors in their electronic health records than white patients, according to a recent study in Health Affairs.

“We can understand our problems quicker so we can act on it,” Shah said.

Services such as telehealth can also help address equity concerns. Telehealth can offer patients an easier option to see doctors without having to miss time at work or for those who don’t live near a provider.

But Shah said it’s important for healthcare organizations employing services such as telehealth to have equity in mind. A recent federal study showed some disparities in telehealth: Black and Hispanic residents had less access to video telehealth services.

If health systems don’t consider equity as they deploy new technology, Shah said, “You’re going to see technology as a divider.”

“The way to use technology is to have intentionality. And ensure that it’s designed in a human-centered way.”

• Related story: Using telehealth to improve access and equity

Broad commitment

Hospitals and healthcare systems need to understand that improving health equity should be a goal for everybody in the organization.

Shah said healthcare leaders should ask: “How do we integrate this into every business unit in the organization?”

“Everyone has a role,” Shah said. “Step one is making it a priority.”

More healthcare organizations have appointed chief diversity officers and health equity officers recently, and Shah said those are important steps.

Hospitals need to identify leaders who can guide organizations through the process, he said. They also need the full backing of the top executives of the organization to make meaningful change.

“That kind of senior leadership is an investment,” he said.

Start small

Health equity is an enormous problem. But shah suggested a different approach from simply aiming to solve health equity for a city, region or state. “That’s a big boulder and it’s almost overwhelming,” he said.

“Instead, we can say, ‘How do I ensure I'm providing care equitably?”

Hospitals and healthcare systems need to gather data to understand disparities on access, outcomes, quality and the patient experience, Shah said.

“I still think the number one question is understanding your problem,” he said.

When health systems gain a better picture of disparities, then they can begin working on solutions.

“When we focus on outcomes, access and quality, it’s how do we implement programs and policies and how can we do it in a way that’s frictionless?”

“This is where technology can play an incredible role,” he said.

Healthcare organizations, even smaller hospitals and systems, could start by looking at 30-day readmissions. They could collect data and see if there are certain groups that are more likely to be readmitted to the hospital a short time after being discharged.

“Look at who is coming back,” Shah said. “What are the key drivers? Is there a disparity? Then you can look at quality-of-care processes.”

“You can start small,” Shah said of looking at 30-day admissions. “What’s interesting about this example, the value is improving patient experience, provider experience, but also cost. You’re going to reduce your 30-day readmissions. If you take a health equity approach, you can understand the problem.”

Work with the community

Healthcare systems can’t just go it alone on health equity. They need to work with their communities to get a better understanding of their needs, including issues to access they may not have considered.

Northwell Health has been expanding its community outreach in its efforts to improve health equity, including establishing an office of community and population health.

Jennifer Mieres, Northwell’s chief diversity and inclusion officer, told Chief Healthcare Executive in a Februay interview that engaging the community has been a key part of their efforts. She said a health equity task force went on a listening tour with community members. “They gave us honest feedback about how they felt,” Mieres said.

It’s imperative to involve the community as health systems consider new services and new technology, Shah said.

“Stop talking about people and start talking with people,” he said.