From Good Intentions to Good Business: Health Equity Gets Real

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The Big Story: Joint Commission tackles health equity with new accreditation standards

“Targeted interventions to detect and address differences in care among racial, ethnic and other historically marginalized groups should be integrated into providers’ quality improvement programs, alongside efforts to prevent healthcare-acquired infections, medication errors and workplace violence.”

What it Means for You

Relatively recently, CMS, U.S. News & World Report, Lown Institute and, just this week the Joint Commission have signaled that how your organization is addressing health equity will be part of their dashboard for measuring and comparing your performance.

The JC, for one, will be asking questions like, “Do you have a designated officer who owns your health equity strategy,” and “Are you screening patients for social determinants of health?”

Good questions with consequential answers.

The U.S. News rankings and Lown’s report are important reputational metrics, impacting the recruitment of top talent, grants, bragging rights in managed care negotiations, labor issues and more. Moreover, consumers themselves are increasingly interested in health equity metrics to inform their decisions about where to receive care. Of course, as credentialing and regulatory agencies, the JC and CMS can control the fate of healthcare providers large and small.

It’s a big push, long in the making. Energy has been building. According to a survey from the Institute for Healthcare Improvement in 2019, one quarter of U.S.-based healthcare leaders surveyed identified health equity as one of their organization’s top three strategic priorities. In 2021, that percentage doubled to 58%. We seem to have reached a critical mass, a turning point, a moment to activate that energy. Doing so is integral to our collective missions. These steps add operational and financial urgency to today’s social crisis.

They have the power to morph good intentions into a business imperative.

Practically, it’s a money issue, too, striking at a time when everyone is struggling with bottom lines:

• Obviously, there’s the financial incentive angle – both in reimbursement and in savings realized through healthier populations.
• Amid the ongoing scrutiny of whether tax-exempt organizations are providing adequate community benefit and earning their tax exemptions, ensuring equitable care is a boon to an organization’s reputation.
• Organizations are reeling from the high cost of labor and turnover. When it comes to recruiting and retaining staff, there’s quite the reputational and cultural advantage that comes from doing the right thing.

So then how do you tell your story about health equity and the work you’ll be doing to fulfill CMS and JC mandates?

First, consider that delivering healthcare equitably can’t be seen as a standalone initiative but must be baked into everything you do – and say – as an organization. Every patient who walks through your organization’s doors has unique needs that include, but go beyond, race, ethnicity, gender identity and socioeconomic status. Because at its core, the concept of equity is ensuring that everyone, regardless and in the context of their specific situation, receives the best possible care.

Second, build your health equity story. You’ve probably already started. Use the new CMS and JC metrics to ensure your story is hitting all the right marks. Communications has a vital role to play in moving provider organizations forward into a position that is both compliant and mission-fulfilling. Here’s how:

• Assess your plans – plural. Know what your organization has done, is doing and plans to do. Get into the weeds, looking at things like NELP protocols, language services, communications tools and channels. The JC will be looking at plans as part of its evaluation.
• Compile your plan – singular. It’s not just knowing where different projects and programs live, but bringing them together in a single, unified blueprint. Connect everything to your mission and strategy. Plans that live in isolation don’t survive.
• Collect the data. If you don’t know what’s happening, you can’t find the gaps, much less close them. Do you have a full demographic picture of the community you serve? Do you know where and how social determinants of health affect your patients? Are you following up with patients who miss appointments or fail to schedule follow-ups to understand why? These are all questions you, as a leader, have a chance to put in front of your clinical, ops and community outreach colleagues.
• Review your communications. Ask, from the perspective of your employees and your patient communities, “Are we communicating effectively?” Not just about your health equity initiatives, but about the things that help drive equity forward. Things like translation and free interpretation services, payment policies, ADA considerations… Check the language used in your materials to ensure it’s inclusive and culturally competent, including for your ESL and deaf or hard-of-hearing patients.
• Check in with Operations and IT. Is your EHR system up to date? Does it make it easy for clinicians to input the nuanced patient data necessary to deliver equitable care? In partnership with the tech team, solicit feedback from your physicians and staff on gaps and frustrations with your EHR that are causing friction in the pursuit of equity.
• Identify the leaders. Who is the face of this work, and are they equipped to speak to the myriad issues surrounding health equity? Beyond that primary spokesperson, the rest of your organization’s leaders at every level need to be informed about the work you’re doing and the requirements in place.
• Equip the leaders. Give them the resources and support to lead their diverse teams through this evolution. Even if your protocols are perfect, it’s your team who provides the experience. They need culturally competent training and education, plus an environment where clear communication and cultural competence is modeled.
• Educate patients. Patients might not check a box for race/ethnicity or gender identity on an intake form because it feels intrusive and unnecessary. It’s on the provider organization to explain that this information is what’s needed to help provide that individual with the best, most compassionate and appropriate care possible.
• Revise policies, then talk about them. As your leadership team pushes towards equity, the comms team will be right there, bringing the story of that progress to life.

This is a transformative moment in healthcare for so many reasons. A moment to manage and drive change through new practices, behaviors, processes and communications. Similar to the CMS rule on price transparency, these new pushes from CMS and the JC should serve as jumpstarts for providers to go all in on initiatives that will improve healthcare. When it comes to health equity, this activity may start out as a box-checking exercise. But this isn’t just about compliance. It’s time to flip the switch.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.