This guest column by Greg Deavens, Independence Blue Cross president and CEO, originally appeared in The Philadelphia Tribune with the title, “Addressing health equity at the point of care,” on Sunday, November 27, 2022.
Despite having some of the top medical institutions in the country, Philadelphia consistently ranks last of Pennsylvania’s 67 counties in health outcomes. This alone is cause for alarm. But even more striking is that nearly one in four Black Philadelphians has avoided seeking care due to concerns about discrimination according to a Robert Wood Johnson report. And almost one-third have personally experienced it.
Systemic health inequities have left Black Philadelphians at far greater risk of poor health. In fact, minorities in Philadelphia rank lowest for three quarters of the measures that contribute to health outcomes. COVID-19 has only magnified and exposed these deeply rooted inequities that exist in our health care system.
I see the consequences of health inequities every day, as the President and CEO of Independence Blue Cross (Independence) and as a Black man I am fortunate to be in a position to influence change, and I am working with some of the foremost minds in our region who are committed to confronting this crisis. There are tangible steps we can take across the industry to improve health outcomes and ensure equitable health care for all:
- Enhancing access to health care: A person’s zip code has an unacceptable but undeniable impact on their health. According to Philadelphia Department of Health data, people in Philadelphia neighborhoods just five miles apart can face up to a 20-year difference in life expectancy. Ensuring that all Philadelphians, regardless of where they live, have convenient, affordable access to quality care is a critical step in enhancing health equity. We must emphasize that preventative care – annual physicals, vision and dental exams, timely cancer screenings and digital tools – can save lives. Ongoing chronic care and disease management are equally as important. Neighborhoods across Philadelphia need to be able to easily access primary care, specialty care, urgent care, and surgical centers. They must also be able to avail themselves of other health and wellness resources such as nutrition counseling, behavioral health services, and new technologies that allow for continuous and/or remote monitoring of conditions.
- Addressing Social Determinants of Health: The factors that impact community health go far beyond the doctor’s office. We must address the underlying social and environmental factors that make communities less healthy. These include things like inadequate housing and transportation, lack of healthy food access, lack of employment opportunities and more.
- Improving representation in clinical trials: Equity in outcomes and equity in research go hand-in-hand. To best serve their patients, providers need patient data that is representative of broader national demographics, including gender and race. Unfortunately, according to a 2021 Harvard Business Review article, people of color represent just two to 16 percent of patients in clinical trials. Until the issue of representation is addressed, providers are not fully equipped to provide equitable care to patients of color.
- Eliminating race-based medicine: Race is not a biological characteristic, yet clinical tools often use race as a variable, leading to inequitable care and poorer health outcomes for certain patients. At Independence, we are partnering with health systems in Greater Philadelphia to remove race as a variable in clinical decision-making across 15 specialties. One example is the elimination of race-based adjustments in eGFR – or estimated glomerular filtration rate – a measurement of kidney function. This longstanding systemic inaccuracy causes delays in needed kidney care and, ultimately, inequitable outcomes for Black patients. Another example is the use of pulmonary function/spirometry testing to assess lung conditions. Manufacturers of the testing machines often program race settings into the testing machines so operators do not necessarily know that lung function is being automatically adjusted. I am grateful that so many regional health systems are open to change, and we look forward to reporting on outcomes of this initiative.
- Empowering patients to self-advocate: It is our responsibility as an industry to empower Black patients to demand more from their providers: to self-advocate, ask for better explanations of treatment options and medications, and provide feedback when basic expectations are not met. Across the health care ecosystem, we must ensure patients have access to all available resources to improve health, such as disease management programs and advanced technology. At Independence Blue Cross, we are proud of our partnership with The Philadelphia Tribune called Our Community. Our Health. This public health campaign brings greater awareness to chronic health issues affecting the African American community, such as heart disease, diabetes, COVID-19, and maternal health. We’re working with The Tribune and community ambassadors who are providing accurate information and approachable solutions to improve health outcomes while encouraging healthy living.
- Enhancing diversity in medical professions: One way we can reinforce trust in the medical system – and hopefully improve care delivery and outcomes – is to ensure people of color have abundant access to providers whom they can relate to and who demonstrate cultural awareness. Startling data from the Association of American Medical Colleges found that just five percent of active physicians identified as Black or African American in 2018. This shortfall is an injustice to patients, and we must support and encourage young people to pursue careers in medical professions to improve representation in healthcare. Our Independence Blue Cross Foundation, for example, collaborates with Temple University’s College of Public Health and Department of Nursing to provide scholarships for students of color pursuing a degree in nursing.
It will take everyone in the health care ecosystem – payers like Independence, as well as providers, community organizations, educational institutions and even patients – to achieve health equity. At Independence, we prioritize working with organizations that share this commitment to health equity, while simultaneously looking for gaps that we can help to fill.
Eleven leading organizations joined forces earlier this year to launch Accelerate Health Equity, a regional initiative aiming to produce tangible improvement in health inequities and ultimately achieve measurable changes in health outcomes for Black and other BIPOC Philadelphians. Accelerate Health Equity is built to foster action and enable partner organizations to measure progress, scale what works, and create lasting change at the point of care. Together we are addressing many of the issues I outlined above.
Our Independence Blue Cross Foundation also launched the Institute for Health Equity this year. This five-year, $15 million commitment will focus on addressing the long-standing policies and practices that impede health equity. The initial focus areas are digital health, cultural awareness in medicine, and maternal health.
No matter who you are or where you live, you deserve the chance to be healthy. I am encouraged by the progress being made through these and other innovative initiatives in Greater Philadelphia. But there is always more work to be done. These problems are complex, but they’re not unsolvable, so long as we come together to address this crisis from every angle, show exactly where evidence-based interventions can make a difference, and institute smart, targeted, collaborative programs to narrow and eliminate inequities in care.