Health equity and technological innovation are top priorities for the healthcare industry – with new standards, technology and policy driving the way.

Despite innovations, a new study from the Yale School of Public Health finds the nation is losing ground on access to healthcare, with more barriers now than 20 years ago.

Dan Brillman, CEO of Unite Us, and Melissa Sherry, vice president of social care integration at Unite Us, offer Healthcare IT News readers insights into how these and other challenges are likely to be handled in 2023.

Unite Us is a technology company that builds coordinated care networks of health and social service providers. Using Unite Us technology, providers across sectors identify social care needs, send and receive secure electronic referrals, report on tangible outcomes, and transform payment models within a secure and collaborative ecosystem.

Sherry discusses top examples of health equity in action in 2022 and what more needs to be done to break down barriers to care. Brillman discusses the technology trends that will drive healthcare innovation in the new year.

Q: What are some top examples of health equity in action in 2022? What more needs to be done to break down barriers to care?

Melissa Sherry: Over the past decade, there has been a growing recognition that addressing social drivers of health is a key part of achieving health equity. However, recognizing that health equity is important and that we should work on addressing the root causes underlying inequity is not enough to engender change.

What I have been most excited about is the acceleration in the concrete steps that Centers for Medicare and Medicaid Services states and accreditation organizations are taking to inspire action in the space of health equity.

There are some really impactful innovations happening in healthcare, and a few that I am most excited about are state Medicaid waivers that push funding into community-based organizations providing social services; policies that expand the eligible health workforce to include community health workers and doulas; and new quality measures and regulations pushing health plans, hospitals and health systems to think more holistically about how they meet the needs of their populations.

The COVID-19 pandemic underscored the important role that community-based organizations play in helping people stay healthy, and emphasized how much work we have to do in achieving health equity in the U.S. At the same time, we are seeing state Medicaid programs taking novel approaches to tackling issues of health equity.

"One of the most glaring examples of health inequities in the United States is the difference in birth outcomes between Black and white birthing people: Black individuals are three times more likely to die from pregnancy-related causes."

Melissa Sherry, Unite Us

Historically, the discussion around improving health equity in Medicaid was mostly linked to Medicaid expansion and improving access to care. Today, we are seeing numerous Medicaid 1115 waivers focused on addressing some of the underlying root causes of health disparities: unaddressed, health-related social needs.

States like North Carolina, California, Massachusetts, Arizona and Oregon are now broadening the way Medicaid dollars can be spent to include funding for community-based social services.

This represents a fundamental shift in the role Medicaid has played in addressing health: Rather than its historical focus on clinical care alone, allowing Medicaid to pay for underlying, nonclinical drivers of health shifts Medicaid programs into a whole person-centered paradigm – and one more likely to move the needle on health inequities.

While there is debate around whether funding community-based services should be healthcare's responsibility, there is strong evidence supporting the notion that healthcare payers and providers cannot achieve their quality, cost and equity-related objectives without addressing underlying determinants of health.

Evaluation results from these Medicaid Waivers will determine whether funding social determinants of health can really move the needle on health and equity outcomes, but I am confident we will see all kinds of value emerge from these initiatives.

One thing to add on these Medicaid 1115 Waivers: We need to ensure new policies and regulations are implemented in a way that won't medicalize community-based organizations or unintentionally create disparities in access to social services within communities.

Ensuring both community-based organizations and healthcare entities have the tools they need to meaningfully collaborate in addressing health inequities will go a long way to help. Some states are funding infrastructure and implementation support within their Medicaid programs, which is a really great way to set healthcare entities and their community partners up for success.

Another state-by-state initiative that we all can look to for inspiration is the increasing availability of funding for community health workers, doulas and other nontraditional health workers as a critical part of healthcare teams.

Trust is a critical factor to healthcare engagement that is often overlooked but contributes significantly to health inequities by preventing individuals who don't trust healthcare providers from engaging with preventive care and chronic condition management.

Community health workers and other traditional health workers often represent the populations they serve in a way that clinical workforces may not, and their ability to engage with individuals from a place of trust and perhaps lived experience has many benefits. These extensions of the care team are pivotal to addressing social determinants of health and to helping individuals meaningfully engage with a health system they may not trust.

Medicaid reimburses community health workers in a number of states and is now expanding to cover doula care as well. One of the most glaring examples of health inequities in the United States is the difference in birth outcomes between Black and white birthing people: Black individuals are three times more likely to die from pregnancy-related causes.

Evidence has shown that working with a doula can improve rates of preterm birth, reduce C-sections and otherwise improve engagement with prenatal care in Medicaid populations. Almost half of the U.S. is working toward reimbursing doulas through Medicaid, and states like New Jersey, Minnesota, Oregon, Virginia and Florida are already leading the way in paying for doula care.

Further, early lessons learned in states like Oregon and Minnesota mean that doulas can operate outside of direct supervision by a physician and are being reimbursed high enough rates to incentivize individuals to participate in Medicaid arrangements.

I am really hopeful that this increasing funding for CHWs [community health workers] and doulas (a less expensive, but powerful workforce) will help us not only move the needle on health disparities, but also serve the broader public health and equity goals for our communities.

Another big development in healthcare is the emergence of new health disparity-related quality measures and reporting requirements for health plans, hospitals and health systems. CMS, as part of its health equity framework, is now mandating the collection and reporting of standardized fields for race, ethnicity, language, gender identity, sex, sexual orientation, disability status and SDOH.

These data will be used to better understand how programs and policies affect health inequities and health disparities, which will provide the nation with the data we need to better understand how we can meaningfully impact health equity.

Other accreditation and quality organizations are joining the push for better data and reporting around health disparities.

Quality and accreditation standards are pushing healthcare entities of all types to think about the role they can play in improving health equity with new requirements, like NCQA's new requirements that health plans stratify quality measures by race and ethnicity and require collection of SDOH data, and the Joint Commission's requirements that hospitals must appoint a leader to reduce disparities, collect data on sociodemographic characteristics, and develop and monitor action plans to improve disparities.

While I am really hopeful about the momentum we are seeing across healthcare to address health disparities and their underlying causes, there is much work left to do.

Identifying and addressing underlying social needs; funding new, trusted workforces and community-based services; and ensuring healthcare entities take an active role in measuring and addressing disparities are really important steps; but even taken together, they are not enough to solve the complex causes behind health inequities.

The causes of health disparities are multifaceted, and achieving improved equity will require an even broader approach that is inclusive of environmental, social, political and economic determinants as well. We need multiple sectors working together on these issues, and we need to continue collecting systematic, standardized data on social needs and demographics across sectors to use these data and trends to understand what is working and what isn't in moving the needle on health disparities.

Overall, healthcare is headed in a really positive direction when it comes to tackling health equity, and I am eager to see what we learn over the next few years as we get more standardized data and reporting to evaluate these efforts.

Q: You suggest interoperability will play a big role in healthcare innovation in 2023. How?

Daniel Brillman: Over the last decade, the incorporation of technology into health and human service delivery has brought greater efficiency and reporting of services. However, many organizations serve a patient over their lifetime without knowledge of the support others are providing.

That information is managed separately; those services are not linked together into one journey; and every organization serving a patient only has one small piece of the overall story. This has led to a duplication of efforts, siloed data on patient services, a patient telling their story repeatedly, and unfortunately, service providers having to figure out whether their patient ever received services outside their four walls.

This is why interoperability and connecting systems and services together (both health and social care) has become paramount to truly address people's needs holistically. It takes cross-sector collaboration, and that means sectors need to be able to communicate together to better serve the patient.

When it comes to technology in the healthcare space, interoperability should be a top priority – but it can look vastly different across sectors, which is part of the problem. In the medical industry, interoperability is maturing in some areas of medical information sharing (for example, through HIEs) and still nascent in others, like social care service information.

However, to best serve a patient in need, we need the full picture across sectors, which is why interoperability between organizations and their technologies, as well as standards to share that information, is becoming a main topic of discussion at all levels.

When it comes to bringing together medical and nonmedical information, that's one of the top priorities we're seeing. For example, the White House Conference on Hunger, Nutrition, and Health released its strategy, which includes a group of leading technologies and companies called Sync for Social Needs.

The Sync for Social Needs coalition will unite leading health technology companies and health systems, including the Department of Veterans Affairs, to standardize the sharing of patient data on social determinants of health, including food insecurity. The gravity project is also setting out to bring standards of how health and social care information is standardized and exchanged.

These initiatives show the importance of information sharing and the role interoperability will play for anyone developing or expanding their technology in the industry.

Q. You see social determinants of health, or SDOH, technology playing a bigger role in 2023. What will this look like?

Daniel Brillman: Social determinants of health – the conditions in the environments where people live, with whom and under what types of stress – can inform multiple interventions and ultimately lead to better health.

While the pandemic revealed the critical importance of understanding SDOH, this focus has extended beyond the pandemic and into technology as stakeholders across healthcare and government look for ways to better understand the social determinants of health and, most importantly, how to actually address those needs in the community.

More than we've ever seen, healthcare, government and social services are now working together to address a person's overall health – not just their medical care. Federal and state governments are adding requirements for the healthcare sector to identify and address nonmedical needs in a clinical setting.

States are introducing new payment structures that incorporate community-based organizations into the fold. This has led to the increased need for technology to help us identify populations' needs, service those needs by bringing together organizations across sectors, and support reimbursement to social care services.

Melissa shared some of the ways states are advancing health equity across the country, and SDOH technology is a necessary component to administer and track the progress of these interventions. In 2023, we'll see an increase in the adoption of technology that can not only identify SDOH needs, but can predict, analyze and report on its impact.

The narrative will shift from identifying those needs to the outcomes we're providing once we identify those needs. Increased awareness of cross-sector collaboration – bringing together all the services needed to support a person's health journey – and how the different sectors are leveraging this technology will dominate the conversation.

On top of that, SDOH technology needs to work for those across many sectors, including healthcare providers, payers, government entities and more. When those helping aren't aligned, people fall through the cracks.

Technologies that can bring standardized approaches for sectors to coordinate and work together securely are critical. Patients' needs are being identified quicker through SDOH technology now, and technologies that can bring sectors together to coordinate and communicate effectively will be best positioned to support the industry.

Q: The role of telemedicine is shifting. What are your predictions here for 2023?

Daniel Brillman: The rapid adoption of telehealth has driven necessary innovation across the healthcare industry and forced all of us to evaluate the ways care can be delivered. This has opened up necessary questioning across the industry around what care can look like, who delivers it, and where and how it's delivered.

It doesn't have to be within the four walls of a hospital or doctor's office anymore: It can be in our own homes or even in a church or library, and it can be done by a community health worker, a social worker for a community organization, or it all can be done online when no physical intervention is needed or in person.

These options empower patients with increased choices and reduce the burden on hospital systems.

I predict we'll continue to see creative ways to leverage telemedicine to address challenges facing the healthcare industry. Telehealth can reduce barriers to care and address health inequities, especially in rural communities with limited access to local providers.

With physician burnout, increased burden on providers, and hospital closures, we'll see telemedicine offering a necessary avenue to get patients the care they need with fewer resources and without sacrificing the patient experience.

While some will push on innovation as it relates to telemedicine, others may slow their investment depending on the allocation of resources and funding with economic uncertainty. One thing is for sure, though: Telemedicine isn't going anywhere in 2023, and it will continue to carve its place in the care continuum.

Follow Bill's HIT coverage on LinkedIn: Bill Siwicki
Email the writer: bsiwicki@himss.org
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