Bending the Cost Curve of Healthcare Inequities: Investment in Primary Care, Communities, and Technology
By Blake Madden
Happy Thursday, Hospitalogists!
Today continues our recent string of guest posters as I’m out on paternity leave and I think you guys will enjoy this one from Equality Health’s CCO Dr. Michael Poku on where investment is needed to address inequalities.
Let’s dive in!
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Bending the Cost Curve of Healthcare Inequities: Investment in Primary Care, Communities, and Technology
By Michael Poku, M.D.
Black women are three times more likely to die from pregnancy-related causes compared to white women.
Throughout one’s life, individuals residing in disinvested communities face higher rates of chronic illness burden, heightened mortality rates, and reduced life expectancy%20higher%20amputation).
Additionally, suicide risk is three to six times greater for lesbian, gay, and bisexual adults than for heterosexual adults across every age group and race/ethnicity categories.
This reality not only raises moral concerns but also imposes an unjust financial burden on communities and our country.
The financial toll of healthcare inequities in the U.S. is unsustainable. Health inequities are defined as differences in health status or outcomes that are systematic, avoidable, unfair, and unjust. These inequities are brought about by the social, political, and economic conditions in which people are born, grow, live, work and age. These inequities, specifically the disparity of health status and health resources influenced by socioeconomic conditions, are overwhelming and growing exponentially.
According to a report by the National Institutes of Health’s (NIH) on Minority Health and Health Disparities, the financial burden of healthcare inequities stands at a staggering $451 billion, representing a 41% increase from previous expert estimates. In 2023, the NIH released a comprehensive report providing national and state-level estimates of the economic burden of health disparities categorized by race, ethnicity, and educational levels. The study revealed that the total burden of education-related health disparities for individuals with less than a college degree reached a remarkable $978 billion, which was approximately 5% of the U.S. GDP for that year, surpassing the annual growth rate of the U.S. economy, which stood at 2.9%.
Deloitte actuarial experts have gone further to project the trajectory of these expenses. Their analysis indicates that this spending could eclipse $1 trillion by 2040.
The Causes of Health Inequity and the Imperative to Act
These healthcare inequities predominantly manifest along lines of race, ethnicity, and socioeconomic status. They stem from underlying disparities in access to healthcare and community resources, along with the influence of social determinants of health (SDoH) and the structural and political determinants of health inequities. Structural racism, historical trauma, and implicit bias contribute to the inequities, which drive up healthcare costs and compromise population health.
As the U.S. health system moves toward value-based care (VBC) models and away from fee-for-service, we are seeing encouraging evidence of health equity gaps closing for both individuals and communities.
Eliminating inequities through VBC is not just a matter of public health; it has become an economic and social imperative. Independent primary care practices (PCPs) are seeing positive impacts through lower no-show rates, fewer ED visits or hospital stays, improved patient engagement, and better health outcomes. Healthcare organizations, regardless of size, can gain a competitive edge by addressing the root causes of inequities, resulting in improved community health, as well as enhanced margins and success under value-based payment models.
Bending the cost curve by leveraging VBC will require substantial investments in resources, especially technology such as patient-centered analytics and engagement solutions, smartly coupled with new clinical workflows and a socially competent approach to care that embraces cultural humility. Further, this transition extends beyond healthcare providers; it calls for fundamental changes ranging from grassroots community interventions to significant policy shifts that tackle SDoH and the underlying structural drivers of health inequities.
What’s Working, Where the Gaps Remain
Fiscally responsible health and human services organizations are implementing holistic approaches to deliver more equitable “whole person” care with the aim of improving population health and lowering overall cost of care. These entities proactively assess patients for SDoH needs, build socially competent care teams, and facilitate connections to community services. Furthermore, some are making direct investments in housing, nutrition access, transportation, and other initiatives to advance equity in community health. Additionally, some forward-thinking physicians are writing prescriptions for healthy, wholesome foods as part of their care strategies.
Geisinger was the first health system to join Kaiser Foundation Hospitals’ Risant Health to expand and accelerate the adoption of VBC and improve health inequities across the nation. Commendable examples of such initiatives exist at the primary care provider level as well.
Technology forms the bedrock of VBC and serves a pivotal role in identifying inequities through better data collection and analysis, which can generate actionable insights at the individual patient and community levels. These technology solutions can help guide resource allocation, evaluate impact, and drive the changes needed to narrow and eliminate health disparities. Though we’re at the forefront of expanded health tech and AI, human connections remain indispensable for establishing and building trust and effectively serving diverse populations in an equitable manner.
The Importance of Primary Care Practices (PCPs) in Bending the Cost Curve
Independent PCPs on the frontlines in disinvested communities are invaluable healthcare assets essential for promoting health equity and reshaping the trajectory of healthcare costs. Despite grappling with limited resources, those embracing team-based and value-based models are demonstrating success caring for complex patients and addressing health inequities daily.
They need more, continued support.
Historically and intentionally excluded communities are often home to some of the nation’s most complex patients, caught in a vicious cycle of increased burden. Complex patients have a whole host of chronic conditions exacerbated by structural, environmental, and access-related challenges. One’s health experience and life expectancy can differ drastically within the confines of a single city, and this is often significantly influenced by their place of residence.
Innovative healthcare providers are delving deeper into the root causes of inequities by examining a spectrum of societal and political factors. For instance, it’s impractical to promote certain forms of physical activity without considering if someone’s neighborhood offers a safe environment for a walk outdoors. Direct community investments in economic development, coupled with creative collaborations spanning multiple organizations, can pave the way for walkable areas, safe exercise spaces, and the introduction of more expansive health and wellness programs.
To eliminate health inequities and bend the cost curve, strategic investment is crucial. We must reinvest in our under-resourced communities and offer steadfast support to independent primary care providers and other health and human services stakeholders operating in these areas.
VBC and the Path Forward
A compelling illustration of community investment is the recently announced partnership between the NHL’s Arizona Coyotes and VBC leader, Equality Health. This partnership is dedicated to expanding access to health and well-being through the sport of hockey, particularly among Hispanic youth, and introducing local sports and physical education curriculum to youth groups that have been historically marginalized in the Phoenix metro area.
The battle against health inequity requires a multi-pronged approach, including strategic investments to support PCPs through both technology and human resources, as well as enriching the communities with limited resources. Only through these concerted efforts can we genuinely narrow and eliminate health disparities and enhance both individual and population health.
In a value-based arrangement that rewards positive outcomes, addressing healthcare inequities not only benefits the community’s health but also yields measurable improvements in the financial bottom line. As underscored by NIH projections, the U.S. simply cannot sustain the status quo. Thoughtful investments made today to close care gaps can generate significant medical, social, and economic returns in the long term.
About Dr. Michael Poku
Dr. Michael Poku is Chief Clinical Officer for Equality Health, a value-based care enabler with a Medicaid-first model uniquely equipped to address the needs of diverse and historically underserved populations. Equality Health partners with independent primary care practices delivering technology, tools, risk-based financial support, practice management consulting and community-based clinical supports to help these practices be successful in VBC. Through the Equality Health Foundation, the company invests in communities. Equality Health and its foundation envision a world of vibrant and inclusive communities where all individuals can live healthy lives. This bold vision cannot be accomplished alone, requiring extensive collaboration within local communities across the country to make a sustainable and transformative change—a movement for advancing health equity for all.
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