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Charting the Path to Health Equity: Steps for Providers

Mary Caffrey
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.
Califf worries what will happen to healthcare for the poor if Medicaid funds are handed off to states with fewer rules. However, from his experience, he pointed to several concrete actions that health systems could take:
  • Realize that much of what happens in the next 4 years will happen at the local level. Healthcare needs to be made part of the local community agenda, over a period of time.
  • Get active in the politics of healthcare legislation. Health systems are major employers in their communities and have clout with elected officials, he said. And, “Opinion about a likely impact is improved by empirical evidence,” he said.
  • Keep doing research, and put measurement systems in place. This will help overcome the tendency to put community clinics only in places with high reimbursement rates, instead of the places where they are most needed.
  • Support the other “determinants of health,” such as local education systems.
  • Medicaid block grants may come, but this “will force the health system to do something different,” Califf said, such as experimenting with digital health. People want healthcare that is “close, connected, and accountable.”
  • Stick with the basics, like improving patients’ blood pressure and cholesterol, and getting people to cut salt and stop smoking. “The biggest issue in the long run is prevention,” Califf said.
 
Kimberlydawn Wisdom, MD, MS, senior vice president of Community Health & Equity at the Henry Ford Health System in Detroit, offered a host outreach examples, such as using retired professional athletes to engage men in their health and using an $850,000 grant to publish a series of research papers on diabetes. One of the current challenges is an alarming rate of infant mortality.
 
The biggest issue, she said, is that health systems can’t just be dedicated to serving the poor when funds are available. “Grants come and go,” she said. “Health systems have to be in it for the long haul,” she said.
 
Other speakers discussed deploying of data to pinpoint areas of need, and to harness health data for research. Kevin Campbell, MD, a specialist on heart disorders who appears frequently on television, spoke about the use of technology, including social media, to help patients improve their health. Data are everywhere, he said. “We have to just figure out how to use it intelligently.”

A speaker from CDC, Wayne H. Giles, MD, MS, highlighted a new data initiative called 500 Cities, which aims to bring health data down to the census tract level in the most populated areas.

Echoing Califf’s talk at ACC in 2016, Campbell said, “FDA must be making better use of big data, to lower the cost of getting important therapies, and getting therapies to the patients who need it.”

Ileana Pina, MD, said health systems need to change the way they think about “cultural competence,” and they need to have a process to make honest assessments about their ability to treat patients from various backgrounds. Many in medicine will agree that health equity is a problem but not their problem—she pointed to data that found 34% agreed there were disparities, but only 12% felt it was a problem at their institution and 5% said they were doing it.

Once an institution has a plan, Pina said, “You’ve got to put it into action. You’ve got to abide by it,” she said. “It can’t be, OK, I’ll check it next year.”


 
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