Health Equity: 'First and Foremost, It Is a Moral Imperative'

Accenture consultants present a framework for addressing health equity that has three core areas that every healthcare organization can embrace.

A new report from Accenture provides guidance on how healthcare organizations can address health equity.

Health equity has emerged as a pressing issue in U.S. healthcare during the coronavirus pandemic. In particular, there have been COVID-19 health disparities for many racial and ethnic groups that have been at higher risk of getting sick and experiencing relatively high mortality rates.

Healthcare organizations have an obligation to address health equity, a co-author of the Accenture report told HealthLeaders. "First and foremost, it is a moral imperative. If we were able to reduce the disparity in infant mortality, we could save the lives of thousands of Black infants. This is a justice and a moral imperative," says Ankoor Shah, MD, principal director of consulting and health equity lead at Accenture.

Addressing health equity is also a good business practice, he says. "There is a business growth and sustainability opportunity as well by advancing health equity. There is an opportunity to increase revenue and decrease costs; and those who are addressing health equity and reinventing themselves now will be a market leader in the future."

There are five causes of health inequities, according to the report: implicit bias, fear and lack of trust, access barriers, uneven quality and experience, and racism in research and development of clinical practices.

The report presents a framework for addressing health equity that has three core areas that every healthcare organization can embrace.

1. Mitigate bias in data analytics and algorithms

Clinical algorithms play an essential role in the digital systems at healthcare organizations; they are intended to boost accuracy and efficiency, but they have the potential to worsen healthcare disparities, the report says. "The most cited example is the large commercial health decision algorithm that used healthcare costs as a proxy for health needs, which inappropriately led to Black and African American patients being labeled as 'healthier' than equally sick white patients. To advance health equity, data analytics and algorithms must be inclusive, fair, accountable, transparent, and easily explainable."

Data analytics and algorithms can improve care, but they come with risks for health equity, Shah says. "If datasets have biases in them, then we could expand disparities. What that means is we often have incomplete datasets. If we do not have a dataset that has the true demographics for race, ethnicity, and language, then we purchase a third-party dataset to fill in those gaps, we run the risk of having a poor baseline dataset that we are applying analytics to, which can lead us astray and cause disparities to widen further."

2. Design inclusive products and services

Health equity should be a prominent factor from the beginning of product and service design, the report says. "Inclusive design methods enable and draw on the full spectrum of human diversity and individual experiences to create solutions. This does not mean that a single product or solution meets every person's needs. Instead, it means designing different ways for people to receive the same access, experience, and outcomes while having a sense of belonging. Considering health equity at this stage encourages better practices, greater accessibility, and a more inclusive healthcare environment, which drives value for people and ecosystem participants."

Focusing on inclusion builds patient trust in healthcare organizations, Shah says. "In our report, we mention that there are 7 of 10 Black Americans who say they are treated unfairly by the healthcare system. So, how can we reimagine healthcare's delivery to have trust? That is through an inclusive mindset—it is through an inclusive lens for how we develop products and how we deliver services."

3. Create sustainable structural change

Structural change is essential to make long-term progress in addressing health equity, the report says. "Racism and implicit biases are embedded throughout the ecosystem. Addressing institutional policies such as inclusive hiring practices, the types of partnerships created, and how participants execute clinical treatment and tools will have far-reaching effects on the sustainability of the healthcare ecosystem. Additionally, engraining equity as a core tenant of participants' foundation will aid in normalizing these activities across the ecosystem."

Shah cites the example of a health plan that tied executive compensation and incentives to reducing racial health disparities among its members. "What this does is uses structures we have in place to tie strategy to execution—to tie financial rewards to actually delivering what your business is intended to deliver and tie to health equity. You are changing the whole organizational mindset and the mechanics within it to drive advancing health equity."

Related: Institute for Healthcare Improvement Boosts Health Equity Efforts