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Comprehensive Guide to Health Equity and How to Achieve It

Learn how CertifyOS helps underserved communities and improves health equity.

CertifyOS Health Equity guide

Health equity refers to the creation of a just system where everyone has the resources and opportunities to be healthy. While undeniably attractive, there’s still a long and challenging road ahead for creating health equity globally—due to underserved and historically ignored communities.

Let us explore health equity in detail to understand better the potential impacts it can have, both tangible and intangible, as well as the challenges we as a species face to achieve it.

What Is Health Equity?

Health equity has a lot to do with identifying and addressing the root causes behind health disparities within different communities—such as income inequality and lack of education.

Health equity is grounded in the principle that everyone, regardless of background, has a chance to live a healthy life. To visualize this, let’s use an example.

Remi lives in a safe neighborhood with all the essential access to fresh food and healthcare.

Meanwhile, Asa is living in impoverished conditions, with limited resources and a relatively unsafe (health-wise) environment.

Health equity is focused on creating a world that ensures both Remi and Asa have the opportunity to reach their full health capacity—irrespective of who they are or where they come from.

Thus, to make sure that the healthcare system is driven by health equity, we must first recognize and understand the underlying health disparities that create inequality. We should prioritize underserved communities and develop SMART (Specific, Measurable, Achievable, Realistic, and Timely) goals to achieve effective health equity strategies.

How Does the CMS Define Health Equity?

The Centers for Medicare & Medicaid Services (CMS) defines health equity as:

The attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.”

Health equity means that everyone in the world has the opportunity to live a healthy life, irrespective of their personal and communal characteristics.

How Social Determinants Create Health Disparities

Usually, health disparities occur when an underserved group, defined by characteristics like disability or race, faces preventable health issues more severely than other communities. These populations are often historically excluded from social and economic opportunities and face barriers to accessing healthcare.

As discussed in the example of Remi and Asa, their living conditions determine that there is a real disparity in their access to living a healthy life.

This isn’t random—these disparities result from multiple social, economic, and environmental factors. As a result, Asa has a higher chance of getting a chronic disease, has a lower life expectancy, and more limited access to healthcare services in comparison to Remi.

To understand health disparities on a macro level, picture Asa as representing an entire social group that faces the same disparities. The social group that Asa belongs to can be based on race, ethnicity, gender, sexual orientation, socioeconomic status, or geographic location. That means everyone in Asa’s group experiences the same challenges when it comes to healthcare and access.

Health disparities are a highly complex issue and often situational. So, every community might require a tailor-made fix that could involve:

  • Identifying health disparities
  • Setting SMART goals for addressing any disparities identified
  • Prioritizing underserved communities that have been historically ignored
  • Developing and implementing their community’s health equity plan
  • Determining the tools and resources required to implement changes
  • Monitoring and evaluating progress in addressing health disparities

The CMS Framework for Health Equity

CMS has established a prioritized five-point Framework for Health Equity by systematically removing health disparities while simultaneously promoting equitable health outcomes for underserved communities.

Priority 1: Expand the Collection, Reporting, and Analysis of Standardized Data

The healthcare system relies on data, which is crucial to serve patients in need effectively. As health disparities are nuanced, we must have an improved data collection and reporting system so that we can understand and address those unique disparities, removing bias, misinformation, or inaccuracies.

By taking a data-driven approach, we can come up with policies and interventions based on accurate information.

Priority 2: Assess Causes of Disparities Within CMS Programs and Address Inequities in Policies and Operations to Close Gaps

The second priority is understanding and focusing on the root causes of health disparities within CMS programs. To reduce these causes, we must first conduct a thorough audit of existing practices.

By doing so, we then have the necessary baseline from which to propose and implement changes that ensure the reception of equitable care for all, regardless of their status, race, or location.

Priority 3: Build Capacity of Healthcare Organizations and the Workforce to Reduce Health and Health Care Disparities

Two groups of the same community might differ in their need for healthcare, depending on the health disparity. One group might have more underlying health issues compared to the other. That’s why, to bridge the gap and answer to their increased demand, there must be more health professionals to attend to that specific group.

This requires building the capacity of healthcare organizations and their workforce to serve affected groups. We must train healthcare professionals in cultural competency, implicit bias, and social determinants of health to ensure we have enough skilled professionals available at all times for each of the groups in need.

Priority 4: Advance Language Access, Health Literacy, and the Provision of Culturally Tailored Services

As communities differ in their lifestyles, they also differ in health literacy, language access and openness to receiving healthcare.

According to estimates mentioned in a study from 2003, 88% of US adults had limited health literacy. The study also came to the conclusion that an improvement in health literacy for a community will automatically improve their health, reduction in healthcare services required and the costs that come along with it.

This could be done by disseminating health and safety information in an easy-to-understand, accessible, and actionable way.

There should be significant improvements in communication—so that patients can make informed decisions. This could involve using person-first language or visual aids.

It’s also extremely important to offer culturally tailored services to bridge the gaps between access to healthcare among different communities.

One way of incorporating culturally tailored services is by matching specialists to patients by race or ethnicity and implementing patient-involvement strategies that give patients more access.

Priority 5: Increase All Forms of Accessibility to Health Care Services and Coverage

Last but not least, we must increase accessibility to healthcare services and coverage for everyone, irrespective of what community they come from or what conditions they live in. We must reduce barriers such as transportation, financial constraints, and lack of information.

And that needs to happen legislatively, such as ADA (Americans With Disabilities Act) actually requires healthcare entities to offer equal and full access to people with disabilities.

Once identified, implementing strategies to ensure geographic coverage, reasonable cost of care, and access to information needed to make informed decisions can help bridge the gap between those who have sufficient healthcare and those who do not.

As per CMS:

“By increasing our understanding of the needs of those we serve, including social risk factors and changes in communities’ needs over time, CMS can leverage quality improvement and other tools to ensure all individuals have access to equitable care and coverage. “

What Are the Financial Impacts of Health Equity?

Communities live in different financial brackets, resulting in healthcare being affordable for some and prohibitively expensive for others.

Most people look at this from a different angle—focusing on how some communities might find it easy to get high-quality care while others have to give an arm and leg (no pun intended) to treat their fractured arm or leg.

However, we’ll ask you to look at it from another perspective—better health equity requires significant financial adjustments to our existing system. Let’s look at some examples to understand this better:

Reduced Healthcare Costs

If we cut down these disparities, it’s obvious that there will be substantial reductions in healthcare costs for the underserved community. Health inequities often result in higher rates of health conditions that require expensive treatments.

By reducing the cost of required care, we can at least help those who already have fewer resources get more affordable access to the care they need more than their neighboring, more affluent communities.

Moreover, there would be fewer emergency room visits and hospital admissions. Improved access to preventive care and better management of chronic conditions would dramatically reduce how much healthcare costs the community.

Improved Workforce Productivity

Health disparities put a dent in the overall productivity and economic output of workforces. Individuals living in marginalized communities with poor health, limited access to care, and fewer resources will more frequently require time off from work, delivering lower productivity due to illnesses, burnout, and mental and physical ailments.

Economic Growth and Stability

When a community gets access to better healthcare, it grows economically. Better health makes people more productive and makes the underserved community a bigger and better contributor to the overall social and economic growth of the collective. This leads to stability and financial fulfillment, further negating the need for expensive and excessive medical treatments.

What Are the Clinical Impacts of Health Equity?

Not only does health equity benefit communities from a financial perspective, but it also brings positive clinical impacts. Health equity improves individual health outcomes and broader public health metrics. Let’s see how.

Improved Health Outcomes

Achieving health equity leads to significant improvements in health outcomes across populations.

Community-driven equity initiatives can improve the management of diseases through better access to preventive care, regular monitoring, and timely treatment.

Increased Access to Preventive Services

Earlier screenings for cancers and infectious diseases, health education programs, and other preventive measures mean a healthier community.

Better Patient Engagement

Improving health equity also increases patient engagement and adherence to treatment plans when services are adequately delivered. This improves trust and communication between patients and doctors.

Why Has Health Equity Been So Difficult to Achieve?

Achieving health equity to date has been incredibly challenging. Here are a few reasons why.

No Health Insurance

Many overlooked populations lack health insurance. This has limited their access to preventive and necessary medical care.

Geographic Dispersion

Geographic differences further worsened this issue, with rural and economically disadvantaged urban areas lacking the needed healthcare facilities.

Bias

Moreover, implicit bias among healthcare providers leads to differences in treatment and quality of care. Minorities often receive lower-quality care and are less likely to undergo necessary medical procedures.

How Does Technology Help Increase Health Equity?

Technology has played a huge role in improving the healthcare industry as a whole. It has the potential to propel communities past obstacles and promote health equity universally. Here’s how.

Social Determinants of Health (SDOH) Data

SDOH includes factors like access to transportation, safe housing, and healthy food. This data is crucial in determining health outcomes because it helps us understand the lived experience of that particular community on paper.

Thus, integrating SDOH data into healthcare processes is immensely important for identifying the specific needs of vulnerable populations and providing comprehensive care. Inadequate data collection and documentation can slow down the effective use of SDOH data, making these gaps unbridgeable.

Artificial intelligence could be a useful tool here, helping us understand the broader context of a patient’s life. With AI, bias can easily be removed from the data processing, enabling us to make informed decisions and personalized care plans that address specific circumstances.

Prior Authorization Processes

Prior authorization can affect low-income patients, people of color, and those in underserved areas. These populations face barriers that lead to delayed or denied care and dangerous health outcomes.

AI can change the prior authorization process through intelligent authorization, personalized care pathways, and streamlined administrative processes. This approach aligns with CMS’ goals to advance health equity and improve health outcomes across diverse populations.

How Is Certify Working to Bring about Health Equity?

Certify aims to improve health equity by streamlining provider data management. This reduces the administrative burden for both healthcare providers and health systems. By using a single source of truth for data, Certify cuts down wait times for providers to join networks, ensuring patients have access to a wider range of qualified providers. This is highly important for underserved communities that may have fewer healthcare providers or face challenges finding in-network providers.

Additionally, Certify's accurate primary source data helps health systems identify qualified providers who are accepting new patients, further improving access to care for all.

Finally, by reducing frustration and inefficiency for both providers and patients, Certify is helping create a more positive healthcare experience for everyone.

To learn more about Certify, reach out to sales@certifyos.com to chat with a member of our team—or request a demo to see our platform in action.


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