Healthcare leaders on addressing structural inequity

Structural racism continues to have a corrosive effect on the U.S. healthcare system. People of color experience higher rates of conditions such as diabetes, hypertension, obesity, asthma and heart disease when compared with their white counterparts, according to the Centers for Disease Control and Prevention.

But we should never accept these outcomes as inevitable. While progress has been made, healthcare providers, payers, purchasers and other organizations have plenty of opportunities to further dismantle bias, discrimination and structural racism.

A good place to start is at the top. Given that 79% of hospital and health system board members are white, according to a 2022 American Hospital Association survey, leaders should commit to creating boards that reflect the demographics of those their organizations serve and insist on a governance structure more reflective of all stakeholders. This will allow us to better understand communities’ needs and create systems that can help ensure everyone gets the care and attention they require.

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Organizations must be a lot more accountable to groups most impacted by health inequities. By using tools such as Community Health Needs Assessments as benchmarks, we can measure and report the results of care and other services provided. We can also measure the impact of investments made in those communities.

Payers also need to identify and measure inequities and develop plans to address them. In late 2020, SCAN Health Plan dug into its data and discovered alarming racial and ethnic disparities regarding medication adherence. The organization committed financial and staff resources to reducing those gaps and tied manager bonuses to achieving successful results. As a result, SCAN Health Plan reduced the adherence gap by 35%, the equivalent of roughly 700 more Black and Hispanic members taking their medications as prescribed. All health organizations could follow this example, holding leaders more accountable for reducing disparities and improving outcomes.

In addition, payers need to create and implement value-based payment and risk adjustment structures that center on equity and reward systems for narrowing disparities. They also need to reduce incentives to “cherry pick” healthy patients and decrease unnecessary tests and procedures.

Disparities are most often reflected in access to care. For example, barriers such as a lack of language comprehension and transportation unavailability frequently keep lower-income populations from receiving nearby care. Health systems and other provider organizations should invest in partnerships, programs and technologies that address such challenges and educate communities about available services. The main goal should be to increase access for the uninsured and those who use public insurance programs.

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Academic medicine, likewise, has a role to play in knocking down barriers for clinicians in training. Academic medical centers should prioritize making learning environments safe, inclusive and diverse. Medical education needs to commit more resources to mentoring young, diverse leaders and training aspiring clinicians on how to identify and eliminate bias and discrimination in direct patient care.

Health services researchers have a critical role to play in decreasing racial and health inequities too, since scientists across disciplines help identify evidence-based approaches to this issue. They can advance the understanding of social drivers and environmental influences that create disparities and then study those inequities to ensure historically marginalized populations are fairly represented in medical research and clinical trials.

We’re not naïve. We know that what we have outlined still represents a profound shift for many health systems, hospitals and health plans. But with a clearly defined roadmap, it’s possible to create a more equitable, accessible and affordable health system that truly serves the needs of all Americans. 

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