Inequity and disparities in health care
Recent events highlighting the systemic racism in the US have heated up the dialogue on racial disparities, and while most of those conversations are not centered around the pandemic, the health care community has seen firsthand how racial inequity and disparities are driving the disproportionate effects of COVID-19 on minority communities.
The way the pandemic has played out in these communities is seen against “a long backdrop of health disparities,” noted Garth Graham, vice president of community health for CVS Health, speaking at AHIP Institute & Expo Online.
The major factors behind differences in COVID-19 mortality are housing, education and socioeconomic status, he said, noting that even before the pandemic, socioeconomic status was driving significant differences in mortality rates. In fact, it is the top factor in terms of disproportionate mortality related to heart disease – above medical history, lifestyle factors and baseline health status.
And now, while black people make up around 14% of the general US population, they account for 24% of the death rate across the country from COVID-19. In certain areas, those numbers are higher. For example, in Michigan, black people account for about 31% of COVID-19 cases and 40% of the state’s deaths from the pandemic.
What health plans can do
CVS Health is working to address these disparities and apply lessons from prior pandemics. This includes arming minority communities with the information they need to make empowered decisions.
“Social distancing can be harder when you have housing challenges,” Graham said, so it is even more essential that people in in housing-challenged communities understand the importance of mask-wearing.
Health plans should also partner with organizations, such as the National Medical Organization, that serve as a voice for minority groups and are actively involved in and understand the local community. “There are community partners at the national and local level who are a part of the solution, and how plans engage them is going to be important,” Graham said.
Along with national and local organizations, CVS Health is working on a strategic plan for testing, “because without testing we are unable to isolate the disease appropriately and understand where it’s spreading and the kinds of things people need to do to take action.”
Since May, CVS Health has established more than 1,000 US locations for COVID-19 testing, and 50% of those sites are in places with high social vulnerability, Graham said, adding that health plans should also consider leveraging partnerships with free clinics to provide testing.
Even before COVID-19, CVS Health was using a multifactorial platform to address SDOH, including investing in affordable housing, partnering with employers, and expanding social services by working to connect people with transportation and food. To directly tackle COVID-19 challenges, the company is investing in local communities to provide food security, improve access to care and address mental health.
While these needs were always present, COVID-19 has increased the urgency for health plans to level disparities in SDOH. “Now is the time for us to elevate this agenda as part of the solution,” Graham said. “AHIP has been part of pushing this for a long time as well. Right now, health plan leadership is crucial.”
Language barriers to care
One problem driving differences in the level of health care for some minority communities can be lack of access due to language barriers.
“Health care is where people go to get equity, and if we can’t provide it, then we’re not doing the work we should be doing,” said Anna Lynch, manager of member engagement at CareOregon, speaking at another AHIP Institute & Expo Online session. But equity is not possible when people can’t receive care in a language they understand.
CareOregon is working to make care accessible by incorporating a workshop on language and access issues in new-employee orientation and by bringing this training to health care providers and its community partner network.
Toc Soneoulay-Gillespie, social services manager for CareOregon, agrees that equity takes ongoing work, and she said training should be repeated annually, as it is just as important as training on HIPAA and safety policies and procedures.
For providers using an interpreter, they underscored the importance of speaking directly to the patient and having the interpreter translate that first-person message, rather than talking to the interpreter about the patient. Health plans can train their provider network to use an approach known as CIFE:
- Confidentiality: Providers should assure their patients that everything discussed will remain confidential.
- I Use First Person: Providers should explain to their patients that the interpreter will repeat exactly what is said by either the provider or the patient to support a genuine dialogue.
- Flow: Interpreters should manage the pace of the meeting by using a hand gesture to slow or pause the conversation as needed to ensure they can interpret every word.
- Everything: Providers should assure their patients that the interpreters will not summarize messages and will relay every word, including any side conversations, phone calls or intercom messages that can be heard in the space during the exam.
“I think we can all agree there are deep-rooted racial and structural inequality in our system,” said Soneoulay-Gillespie. “We’ve all got to do our part to come up with bold solutions ... not just talk about it. We’ve got to ensure everyone has meaningful access to health care.”