The cost of healthcare disparities has been long and deeply felt by patients and their families, but it wasn’t until the high rates of COVID-19-related hospitalizations and deaths among persons of color made headline news that the broader societal impacts of health disparities became more widely known. In response, health systems are prioritizing health equity and leveraging new tools and data to support their work.
At a physiological level, the presence of underlying chronic disease increases the risk presented by COVID-19. The incidence of chronic disease(s) is increasing among all Americans, but the prevalence is much higher among the poor, which includes a higher percentage of individuals of color compared to the overall White population.[1] Health inequities among communities of color are further exacerbated by structural and institutional racism, which experts say “harms health” because of negative factors in their physical, social, and economic environments and a propensity to develop maladaptive coping behaviors (e.g., smoking, alcohol, etc.)[2].
A Community-Level Issue
Increasing rates of chronic disease create a self-reinforcing cycle that threatens the well-being of entire communities (and the health systems that serve them). Individuals suffering from chronic disease have higher rates of absenteeism,[3] which limits their wealth building potential, the productivity of their employers and the tax base of their communities. This, in turn, increases poverty and the impact of the social determinants of health (SDOH) that contribute to higher rates of chronic disease. The combination of chronic disease (as an inflammatory condition) and the psychological stress of racism have been shown to cause physiological changes that raise the risk of contracting additional chronic diseases.[4]
Hospital performance is also tied to economic well-being. Research documents a correlation between the quantity and quality of local economic resources and the clinical performance of hospitals, which under value-based payment models, can also impact financial performance.[5] With chronic disease responsible for nearly 90% of national health expenditures,[6] it’s continued rise threatens our national economy and the ability to fund needed healthcare for the poor and aging. In other words, this is not just a social issue; it is an economic imperative. A 2021 Institute for Healthcare Improvement (IHI) study found that 58% of healthcare executives ranked health equity as one of their organization’s top three priorities, up from 25% in 2019.
The COVID-19 pandemic exposed the true costs, human and otherwise, of health disparities, as low income and minority populations suffered disproportionately from the virus. Blacks, Native Americans and Hispanics were 2% to 3.3% more likely to be hospitalized or die from the virus compared to non-Hispanic Whites, primarily because of a higher prevalence of underlying disease states (hypertension, obesity and Type II diabetes) caused by relative lack of access to the so-called social determinants of health: good paying jobs, healthy food, safe housing, and transportation, among others.
As with so many aspects of the pandemic, supply chain is front and center in the fight, which is playing out on their home turf, literally. Once again, supply chain is also getting noticed in the executive suite, as the boards of trustees for America’s hospitals prioritize health equity in preparation for taking on more risk for the populations they serve under value-based reimbursement programs. Here are few ways they are making a difference.
1. Bringing Diversity Home
Supply chain professionals have long sought to increase their spend with diverse suppliers, defined primarily as those that are women, minority, veteran, or LBGTQ-owned. That data is tracked and often used to support grant applications. More recently, transparency around that spend is being mandated. In California, for example, Assembly Bill 962 (AB 962) requires all hospitals meeting a certain threshold to report how much they spend with diverse suppliers each year.
But for many health systems, diversity is not enough. They want to make sure they are using their purchasing power to support the health and well-being of local communities where the patients they serve live. Spending in local communities has a multiplier effect. For example, investing in a local business supports job creation; in turn the wages for those employees generate local tax dollars and increase their ability to spend and generate wealth in their own communities.
By Karen Conway, vice president of healthcare value, GHX.
Karen Conway
The disruption wrought by COVID-19 is unmatched in recent history. While the lasting implications have yet to be fully understood, the limitations of the global healthcare supply chain have been exposed. While it is impossible to predict when another crisis will hit, there are steps healthcare organizations can take now to mitigate future risk.
1. Collaborate with Key Stakeholders on Continuity Plans
Excellent crisis management begins with pre-planning. Bring together key internal stakeholders, such as clinical, financial, risk management and operational leaders, as well as external contributors, including public health agencies, local government officials, distributors and manufacturers. Pre-planning builds relationships and trust as participants anticipate needs, identify necessary resources and develop contingency plans.
2. Create Evidence-Based Protocols for Supply Utilization with Clinicians
There is a growing body of evidence surrounding the safe and sustainable use of personal protective equipment (PPE) and other critical resources, including scenarios in which alternative products or protocols may be required when demand exceeds the capacity of traditional sources. This evidence can support advance work with clinicians to determine how and when to source comparable alternative products or implement conservation measures. Pre-planning will help reduce clinician stress when changes are required during times of crisis.
3. Recognize Risks Associated with Current Supply Chain Practices
COVID-19 has called into question reliance on Just-In-Time (JIT) inventory practices, which are pervasive across most supply chains as hospitals seek to reduce costs. JIT delivers products on an as needed basis in contrast to keeping large quantities on hand. This can increase risk when there are upstream supply disruptions or unanticipated spikes in demand. COVID-19 has led supply chain leaders to rethink the risks associated with JIT and consider how improved inventory visibility and demand planning across the supply chain can enhance the ability to respond quickly to avoid potential shortages.
As the comment period has come and gone (ended May 29, 2015) for meaningful use Stage 3, and as multiple organizations, like CHIME, and countless other individuals have taken the time to comment on the final rule, I thought it was a good time to ask the question: Does the meaningful use Stage 3 rule sail or sink?
Procuring responses to this question from a number of health IT insiders helps to identify some of the most pressing issues with the final stage of meaningful use, a topic that is almost second to none in regard to generating support or opposition from those in the sector.
The College of Healthcare Information Management Executives, in its comments on the rule, called federal plans for the third stage of meaningful use too ambitious and in need of several important changes, but still offered their support for a corresponding CMS proposal that would shorten meaningful use reporting in 2015 from a full year to any continuous 90-day period. In total, CHIME said meaningful use Stage 3 is “unworkable.”
“Were all requirements finalized as proposed, we doubt many providers could participate in 2018 successfully,” CHIME said. “And with so few providers having demonstrated Stage 2 capabilities, we question the underlying feasibility of many requirements and question the logic of building on deficient measures.”
Bennett Lauber
Bennett Lauber, chief experience officer, at The Usability People offered a slightly different take: “The MU3 program contains some well-needed enhancements to the Safety-enhanced design portion of the 2015 certification criteria. They have also proposed significant changes to the Safety-enhanced Design (aka usability) testing requirements. These new requirements might seem burdensome to some of the smaller EHR vendors, as they require 17 and not seven items to be usability tested and finally set a minimum number of participants for these studies and more. With everyone complaining about the (lack of) usability of healthcare software these additional requirements should be welcome as they force the vendors to perform real summative usability tests and as a result it eventually might actually save lives.
David Muntz
David Muntz, former principal deputy director of the ONC and current CIO of GetWellNetwork adds, “Getting to a common stage is a good thing, but there is still some concern expressed by those who are struggling with the move from Stage 1 and Stage 2 to the future state. The limit on adding new elements is a positive, though some of the thresholds that need to be met will be a concern to many, particularly those that require a provider to affect behaviors in the patients. Standardizing quality measures and adjusting the reporting period are good moves, but the possibility of requiring all vendors to have a complete set will delay release dates.
“The encouragement to add APIs for data exchange is a positive. More thought, however, is needed to the areas where open APIs can prove beneficial. Secure messaging is great, but the threshold for usage is really based on patient preference and may be a bit aggressive. The greatest disappointment was the continued use of specific features and functions without an alternative to deem features and functions based on a combination of appropriate process and outcome measures. A deeming approach would have given the users a great deal of latitude in how to implement features and functions that would have produced favorable outcome.”
