Is Improving Health Equity Still Possible?

The key to health equity may be more of a “where” than a “who.” With CMS removing race, ethnicity, and language from their Medicare data feeds, identification of specific health needs becomes more difficult on an individual level. Thinking more on a population level, meeting needs and ensuring equity is still quite possible.

In the City of Boston, as an example, you can use data freely available from the U.S. Census Bureau and the Commonwealth of Massachusetts to create a heat map of food insecurity. If you’re focusing on reducing the incidence and improving outcomes for Type 2 Diabetes, it’s where it’s hot that counts.

Example map of food insecurity in Boston, MA. Redder areas have higher levels of food insecurity.

The next step is combining the “where” with a “who,” using data that identifies people who have been diagnosed with diabetes or a risk factor and any related outcome data that’s available. If you’re a health plan, it can be found in your Quality Management system or even member-level HEDIS® or Medicare Stars results. If you’re a health care delivery system, it will likely be a quality module attached to the EMR but sometimes needs some kind of custom extract. On the pharmaceutical end, it’s who was dispensed medicaitons for glycemic control and markers for adherence. Yes, this is the hardest step.

From there you can see where the areas of food insecurity intersect with the population of people with or at risk for diabetes and their outcomes. They are the people at highest need of services, lacking consistent access to healthy food.

With budgets tight and grants less available, it is important to ensure that any program for improving health is as targeted as possible to a person’s specific needs. Even without individual identifiers, data sources exist that can show the racial, ethnic, and linguistic breakdown of an area. You can add sources that show income, transportation, availability of nearby fresh food, education, and age. The more closely you look, the better you can see the specific barriers that the people you have found will need to overcome.

Addressing people’s specific needs for health care seems like common sense but it takes quite a bit of work to get there. There is no one-size-fits-all program. It may fit most, but there are groups who need something different. Once you have an idea who, where, and why, you can finally address what is they need that others may not. That is the true meaning of health equity – ensuring that all people have the same chance to be healthy, even when it takes some extra help to get there for some people.

What is the program that improves equity? An analysis of the specific barriers found in data helps to determine what might be needed. In this example, nutrition assistance programs are likely to be able to help. Before starting a new program, there is one final step. Make sure to ask some of your target people how it might help them. They may have thoughts.

I'd love to help achieve your health equity goals and I'm always available to answer questions. You can get in contact with me at inquiry@kwbellconsulting.com.