Data, research must aid efforts to improve public health, combat racism
Weaknesses in the nation’s response to the COVID-19 pandemic highlighted waste in system, inequalities in care, AMGA speakers note.
Data and analytics will play increasingly critical roles in enabling the shift to value-based care, with the pandemic showing the necessity of reducing wasteful spending and the consequences of racism in care delivery and internal operations.
The necessity for a sea change in healthcare became apparent during the pandemic, noted two keynote speakers at AMGA’s recent Innovation, Quality and Leadership Conference in Dallas.
AMGA, a trade association whose members include large and influential multispecialty medical groups and integrated systems of care, is increasing its focus on health equity in healthcare and opportunities to make changes that are sustainable and scalable for future success.
The COVID-19 pandemic highlighted disparities in care and weaknesses in the public health system, said David Nash, MD, founding dean emeritus and professor of health policy at the Jefferson College of Population Health. Nash co-authored “How Covid Crashed the System,” a book released this month.
Nash identified many shortcomings in the U.S. COVID-19 response, leading to the deaths of more than 1 million in the country so far, and an average of 400 a day on an ongoing basis.
Nash said he decided to write the book so that the painful lessons learned aren’t forgotten, a typical occurrence after national tragedies. “When the dying stops, the forgetting begins. Our job is to make sure that doesn’t happen, especially to honor the 5,000 healthcare workers who died,” he said.
“How can we measure improvement in population health or reductions in racism? How can we tie reimbursement to these measures?
Societal factors played into the disastrous U.S. response, with Nash saying that trust in leaders was low, resulting in a fragmented response across the population. Countries such as Australia had a unified response that its citizens believed in, he noted by contrast. “More important than their testing rate was that they were working together. The key take-home message was social solidarity and the ability to go beyond their individual needs.”
Poverty exacerbated COVID’s impact, as did racism and health factors such as obesity, Nash contended. But the nation’s system is focused on delivering healthcare services, and that needs to change. “Can we make the deep necessary structural changes to deliver health instead of healthcare services?” he asked.
Keys to making the change is improving transparency and accountability, particularly when it comes to ensuring that clinicians are relying on evidence-based protocols in making care decisions. Employers, which fund the majority of healthcare purchases, must demand more from providers. “No other country hooks up employment to health insurance,” he noted. “We need more involvement from employers to improve health.”
Wasteful, inefficient healthcare spending needs attention, but it is not easy to cut inefficient care, he said. “We think about waste in three buckets – individual waste, clinical waste in the form of errors and unnecessary testing, and operational waste. If we don’t pay people to address these problems, (change) won’t happen. We need to disconnect waste from income – (if you’re delivering care and getting paid) it doesn’t appear to be waste to you because it’s your income stream.”
Measuring the results of care delivery changes is difficult but necessary, he believes, “How can we measure improvement in population health or reductions in racism? How can we tie reimbursement to these measures? It’s important, because you’re only going to manage what you measure,” he said. “We need a national outcomes and transparency movement, because sunshine is the best disinfectant.”
New models of value-based care can play a role in reducing disparities, Nash believes. These new approaches can provide publicly reported health outcomes and serve as a transparency tool to drive change. “Coupling it with efforts to reduce disparities, it can create value-based care 2.0 that takes into account these issues,” he concluded.
Some pioneer organizations are taking concrete steps to reduce racism. In particular, RWJBarnabas in New Jersey is in the midst of a program to end racism as a social determinant, says DeAnna Minus-Vincent, executive vice president and chief social justice and accountability officer for the system, which serves nine counties in the state through 12 hospitals.
"There is chronic racism, asking people how they want to be treated."
African Americans have the shortest life expectancies in its service area, and minorities were especially impacted by the pandemic, she said. In 2020, the system declared itself an anti-racist organization and implemented measurable targets, with compensation systemwide being tied to achieving the goals. A board committee oversees the initiative, underscoring its organizational importance.
“We looked at every piece of data we could find, but most importantly patient and employee data,” she said. It conducted more than 150 focus groups, and had consumer and market surveys to feed data into its direction.
In addition to the 33 metrics by which it’s measuring progress, the organization is working to diversify its management structure with minorities as a second goal. Additionally, the system is migrating to a unified Epic electronic health records system that will better be able to incorporate patient information around social determinants of health, about which patients now are routinely asked.
The system is now in the midst of putting its scorecard into practice, and Minus-Vincent anticipates further change to combat racism in a subsequent phase.
“If we had to do it with human intervention, we could not get it done,” she said. ”We want data and technology to take care of the things that can be done in streamlined ways. We need to be culturally humble and ask people how they are being treated. There is chronic racism, asking people how they want to be treated. It’s not just the health system; we’re dealing with systemic issues that are beyond the control of healthcare.”