Charting the Path to Health Equity: Steps for Providers

Heart disease is America’s top killer, and people living in poverty are affected at higher rates. With that in mind, the American College of Cardiology devoted devoted a 3-part intensive to this issue at the 66th Scientific Session.
Published Online: March 20, 2017
Published By: Mary Caffrey
All medicine is not delivered equally, and this unfortunate truth finds its way into data on health disparities. The Affordable Care Act (ACA), through its focus on better quality care and accountable care organizations (ACOs), sought to create both financial rewards and punishments for providers with a focus on population health—the idea of measuring the care of everyone covered by the health system.
 
This call for quality for all—first described in the 2001 Institute of Medicine report, Crossing the Quality Chasm—asks health systems to pay attention to those things like diet, poverty, and job status that keep people from getting care or make chronic disease worse, called “social determinants of health.”
 
Heart disease is America’s top killer, and people living in poverty are affected at higher rates, according to the CDC. With that in mind, at its 66th Scientific Session the American College of Cardiology devoted a 3-part intensive, “Health Equity’s Long Journey: Are We There Yet?” to this issue. The final portion covered how providers and health systems can take action to promote health equity in their own communities.
 
Act Locally to Create Chan
Tulane University Professor of Medicine Keith C. Ferdinand, MD, led off the session with a video of a 33-year-old New Orleans jazz musician, whose initial complaint of stomach pain—and a diagnosis of gallstones—escalated into surgery and a host of complications, including congestive heart failure that cost more than $500,00 to treat. Delays in getting the young man enrolled in ACA did not help.
 
For Ferdinand, the young man’s case was the type that would typically cost hospitals like his to run in the red, but Medicaid expansion is allowing for more preventive care and bringing more stability to the institutions that serve the poor. Ferdinand expressed frustration that Louisiana’s former governor, Bobby Jindal, declined Medicaid expansion. After a late start under Governor John Bel Edwards, more than 378,000 people have enrolled in Medicaid expansion in Louisiana, already exceeding first-year estimates.
 
But Medicaid expansion—and indeed, the look of Medicaid itself—faces uncertainty as Congress debates replacing the ACA with the American Health Care Act, which calls for converting Medicaid to a per capita grant program, something that worries cardiologist Robert Califf, MD, the recently departed FDA commissioner who has returned to Duke University. “There’s no magic bullet,” to solving the problems of healthcare disparities, and just as the causes are many, the solutions must be, too.



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