COVID-19 has been called “the great equalizer” because no one is safe – regardless of privilege or power. While there is truth to this description (see here), the pandemic has also revealed a disproportionate impact on people of color due to deep-seated inequities in health care. On August 18, the CDC released data showing the significant disparity in hospitalizations and deaths by race – Blacks, Latinos and American Indians are experiencing hospitalizations at rates 4.5 to 5.5 times higher than non-Hispanic Whites, and Blacks are dying at more than two times the rate of non-Hispanic Whites.
For hospitals and health systems, the pandemic has only punctuated awareness of the need to address health equity and social determinants of health (SDoH), such as food insecurity, access to health care and housing. It has been well-established for many years that the impact of SDoH on patient outcomes is at 80 to 90 percent. In short, investments in excellent medical care will only take us but so far.
For cash-strapped hospitals (even more so due to the impact of the pandemic), it is understandable that SDoH initiatives can be a tough sell – a recent survey of 200 hospitals shared that the top two reasons were lack of money and an inability to prove it can make a profit. The traditional fee-for-service payment model doesn’t incentivize screening for social needs that affect outcomes – and only a quarter of hospitals and 16% of physician practices do. However, as health plans engage in more value-based payment programs (in 2018, 35.8% of total U.S. health care payments in 2018 were tied to alternative payment models), it becomes more financially attractive.
That’s not to say that hospitals haven’t been trying to do their part – research shows an investment of at least $2.5 billion in programs around SDoH by 57 U.S. health systems from 2017 to 2019. Of those 57 health systems, all were not-for-profit. We need to acknowledge the good work already being done (so we can learn from it!), but COVID-19 has shown that what we’re doing simply isn’t enough.
So, what’s the answer?
It takes a village. No, really. Hospitals and health systems are best positioned in communities to address SDoH and health equity issues, but that doesn’t mean they have to do it all – or all by themselves.
Now is the time for hospitals and health systems to step forward and own the role of “The Convener.” At Padilla, we define this role as:
The Convener: Organizations that step forward and bring disparate groups together to solve a common problem. Conveners must set aside their egos and put the cause before their own visibility – otherwise others won’t want to take up their mantle.
What does it look like to be a Convener in your community?
- It starts from the top (and permeates an organization’s culture) – leaders must champion health equity and incorporate equity considerations as they evaluate and articulate all decisions.
- It starts from within – identify and dismantle institutional racism within our own organizations.
- It starts by bringing the right people to the table – cultivate the expertise, resources and voices that need to be part of the conversation.
- It starts by building trust – listen, learn and stand beside others who are already at work in the community and identify shared values, interests and assets.
- It starts by creating synergies – we don’t have to do everything, but we can help make connections that matter.
Health inequality existed long before COVID-19, but the pandemic has magnified vulnerabilities in our health care system that cannot be ignored. Health outcomes are inextricably linked to social determinants of health, especially poverty, structural racism and discrimination. We can’t wait for alternative payment models to drive change. Health care communicators – your organization isn’t expected to do it all, but we are called to step forward as Conveners and use our unique vantage point in the community to help connect the dots for meaningful change.
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