For health care systems, tackling health inequities requires not only close attention to plans of care and how services are delivered—it also requires challenging the assumption that every person will experience the same health benefits. It then becomes a priority to identify people who experience differential health outcomes as well as the reasons for these disparities.
This challenge was the focus of the third meeting of UHF’s Quality and Equity Task Force on April 17. The group of 24 New York City-area health care experts formed in 2022 to develop ways to integrate equity into efforts to improve health care quality.
Meeting attendees emphasized that health care services must be tailored to address such social barriers to health as substandard housing, economic insecurity, and racism—and the communities most burdened by them. Providers must also determine where services can best be delivered for each patient, be it in a hospital, a community setting, a mobile service, or at home, and then coordinate care across all services. The goal: person-centered, unbiased, and culturally aware care for all.
Participants discussed accountability and measurement, recognizing that providers need to be able to determine the effectiveness of specific services and actions. To achieve health equity, race-based algorithms should either be eliminated or designed to undo structural racism, the participants agreed. “Make sure it isn't an attempt to go race-blind, but an attempt instead to be race-conscious,” said Eric Wei, MD, Senior Vice President and Chief Quality Officer at NYC Health + Hospitals.
Several examples of programs designed with an equity lens were highlighted at the meeting. The New York State Cancer Services Program, for example, addresses the significant barriers to access people who receive community-based cancer screening may face should they screen positive. Health care systems can collaborate with the Cancer Services program, which offers further cancer diagnostic services and referrals to oncology services at no cost to state residents who are low-income, uninsured, or underinsured.
Dr. Wei spoke about several outreach efforts at NYC Health + Hospitals that are designed to reach underserved populations. The NYC Care program, administered by the public hospital system, guarantees low-cost and no-cost services to New Yorkers who do not qualify for, or cannot afford, health insurance. Some 300,000 people are currently enrolled, including undocumented immigrants who often do not have access to health care.
Health + Hospitals also uses mobile units “that meet patients where they are,” he said, primarily to treat homeless patients with complex needs. To better serve the LGBTQ+ community, Health + Hospitals has set up seven Pride Health Centers that offer gender-affirming health care. Providers in these centers have received extensive training to provide culturally responsive care.
The task force members ended the meeting by discussing the value of collaboration in taking on issues of health equity. They agreed that a framework on integrating equity in their organizations’ quality priorities is needed, and that lessons learned need to be widely shared so that changes can benefit communities at large. Most critically, the individual patient’s point of view must be incorporated into any efforts to improve health equity.
The Bridging Quality and Equity task force is managed by UHF’s Quality Institute and supported by the Donald A. Pels Charitable Trust. Its next meeting will be held in July and will focus on embedding equity into “clinical services and delivery.”