Hacking health equity: Strategies for 2024 and beyond

Social determinants of health provide insight into health disparities; are digital solutions a possible solution to level the field in healthcare?

This article is part of the December 2023 COVERstory.

There’s been a decade of evidence accumulated about the importance of social factors in affecting care outcomes. Both providers and payers have mounds of evidence showing that different economic circumstances cause variations in outcomes for those in different socioeconomic groups. 

It’s important to level the playing field, especially as the country tries to deal with reining in overall healthcare spending. It’s widely known that those who can’t access healthcare on a consistent basis are more likely to suffer acute illnesses, chronic conditions and complications, which are more difficult to manage and constrain overall costs. 

To move more of the country to value-based care, it will be crucial to improve health equity, a necessity that’s reflected as the most recent addition to the Quintuple Aim. Here are some key priorities that health organizations will be pursuing to improve health equity in 2024. 

Assessing social determinants of health and acting on them

Increasing attention has been paid to the social determinants of health, such as access to healthcare, transportation, fresh food, social support structures and other non-medical factors. 

But just realizing the impact of SDOHs isn’t enough. Organizations are struggling to deal with the data and then be able to exchange information on patients throughout the continuum of care so that action can be taken to ameliorate the challenges. 

EHRs, which serve as repositories for clinical information, now are being called on to contain a wider range of health information. Some of that is already in progress, with the Office of the National Coordinator for Health Information Technology supporting the incorporation of that information into EHRs, as well as looking to facilitate the exchange of the information. In addition, the second version of the United States Core Data for Interoperability (USCDI) include data elements and classes such as SDOH, sexual orientation and gender identity “and many other health-equity related data elements to help improve healthcare needs.” 

Also, with the 2023 IPPS Final Rule, the Center for Medicare and Medicaid Services (CMS) introduced two new measures as part of the Inpatient Quality Reporting (IQR) Program – they are SDOH-1, screening for social drivers of health. and SDOH-2, screening positive rate for social drivers of health. 

Still data exchange and coordination across the continuum – especially with organizations that are community service providers or not connected via traditional healthcare records systems – is a work in progress. Health information exchanges and Qualified Health Information Networks (QHINs) will look to improve connectivity and data exchange to communicate patients’ non-medical needs that can affect their health. 

Many see EHRs as playing a key role in bridging the gaps that stand in the way of health equity. As organizations seek to more fully shift to value-based care reimbursement, progress in addressing SDOHs in 2024 will be crucial. 

Digital health can level the playing field

The use of apps and virtual healthcare services can help healthcare organizations reach out to needy populations inexpensively, providing a way to get services to patients earlier in their episodes, which can help to reduce the severity of illness and improve odds for quicker recoveries. 

As most of the U.S. population has access to smartphones and related mobile apps, organizations can provide access to more services to those who otherwise might be challenged to get easy access to care. 

Reaching out to populations that don’t speak English natively

As the U.S. population continues to diversify, healthcare organizations must deal with various populations that know little or no English. Communicating medical information back and forth remains a challenge that impacts health equity. 

One of the observations of the COVID-19 pandemic is its disproportionate effects on minority groups. Language barriers are a significant obstacle to achieving positive health outcomes – they can lead to miscommunication between patients and medical professionals, reduce patient satisfaction, and have adverse effects on healthcare quality and patient safety. Almost one in 11 Americans have limited English proficiency, and that makes it difficult for English-speaking clinicians to communicate information without easy access to translation services. 

Technology as a second language

While technology can help organizations reach out to needy populations, implementing it on the consumer end isn’t always easy. Healthcare organizations increasingly are wrestling with how to support populations, particularly those that don’t speak English or are not technologically savvy. 

Some technology tools are difficult to implement. Internet connectivity is not always consistent, particularly in areas with poor cellular coverage or in rural areas. Consumers lose or forget user names and passwords, and that sometimes locks them out of accessing care. Devices or smartphones break down or stop working after system updates. Who supports consumer users during these breakdowns is not necessarily clear – IT departments are stretched thin supporting internal needs and don’t have the bandwidth to handle outside users. Providing sufficient consumer support will increase in importance as more care and communication is provided remotely. 

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