This is the second post of a three-part series covering Modern Healthcare’s Social Determinants of Health Symposium, which was held virtually on August 11, 2022.
In discussing the impact health equity has on healthcare delivery, Rob MacArthur, MD, chief medical officer at the Commonwealth Care Alliance (CCA), highlighted findings from the World Health Organization, estimating that social determinants of health (SDOH) account for between 30 percent to 55 percent of all health outcomes. “The responsibility of the healthcare industry is changing, and each of us has to be a part of the change,” he said.
Failing to address concerns surrounding health equity impedes healthcare professionals’ aim to deliver high-quality care to their patients. According to Korvachei Hernandez, director of Community Health Services at CCA, “Social unmet needs become drivers of health.” Thus, utilizing every available tool to optimize care was a central theme for each panelist during the symposium’s “Healthy at Home: Innovative Strategies for Managing Health in a Housing Crisis” session. And, perhaps, data is the most efficient tool of all.
Leveraging Data to Address Health Disparities
Garth Graham, MD, MPH, FACC, director and global head of Healthcare and Public Health at Google/YouTube, described healthcare as a field that has been primed for an evolution. According to Dr. Graham, “The importance of technology is data consumption and analytics.” This sentiment was echoed by Nasim Afsar, MD, MBA, chief health officer, and Rebecca Winokur, MD, MPH, lead physician executive and medical director of Health Equity, at Oracle Cerner. “We must leverage technology and data insights to be able to address health disparities, to prevent bias in care delivery, and [to] ultimately improve the overall outcome in all communities,” Dr. Afsar said. Dr. Winokur then described three ways data should be leveraged:
Dr. Winokur also highlighted the success Roper St. Francis Healthcare in Charleston, S.C., achieved after applying these practices. The health system implemented a geospatial analysis tool that allowed staff to identify and address health disparities its Black patients with diabetes and hypertension experienced. The results of this analysis indicated that those patients’ homes tended to cluster around the churches in the same ZIP code. This prompted Roper St. Francis staff to partner with the churches’ leadership to develop solutions to the health problems that were being seen within their community.
The health system also recruited nurses who were members of these churches as a resource for patients. In turn, the initiative led to a 50 percent increase in the effective management of diabetes and hypertension among Black patients and a 30 percent increase in primary care visits. “We can use geospatial mapping, the electronic health record [EHR] data, and community social risk data to pinpoint where social risks exist across patient populations,” Dr. Winokur said. “This can help drive community health, population health, and care management strategies.”
Improving Access to Clinical Trials
According to Dr. Afsar, only about 20 percent of the work done in healthcare contributes to an individual’s health, adding that 40 percent of one’s health is due to socio-economic factors, 30 percent is tied to their health behaviors, and 10 percent is impacted by environmental influences. “Where you live matters to your health, your risks, and your outcomes just as much, if not more, as how you deliver and receive healthcare,” Dr. Afsar explained. “Your ZIP code matters more than your genetic code.”
Kathy Moses, MPH, senior fellow at the Center for Healthcare Strategies shared a similar belief, describing one’s geographic location as an SDOH. “Run a study in your organization of … missed appointments by ZIP code, and you are going to see that there is a ZIP code barrier,” said Ana McKee, MD, FACP, chief medical officer, executive vice president, and chief equity, diversity, and inclusion officer of The Joint Commission. These barriers have implications in the accessibility of clinical trials for patients with cancer. “Seventy percent of the U.S. population lives more than two hours away from an academic medical center,” Dr. Winokur said, adding that “only 3 percent of patients are able to participate in cancer trials.”
To target this nationwide barrier and change the landscape of oncology research as we know it today, the Association of Community Cancer Centers (ACCC) created the ACCC Community Oncology Research Institute (ACORI) in 2021, with a mission to establish clinical trials as a standard of care in treatment plans and to help achieve equitable cancer care delivery for all patients. Since ACORI’s inception, ACCC partnered with the American Society of Clinical Oncology to design and release the Just ASK™ Training Program to combat implicit bias in clinical trial enrollment efforts. This training is open to cancer care teams across the nation.
In pursuit of a similar objective, Oracle Cerner implemented its Learning Health Network—a nationwide collection of data from 80 diverse hospitals and health systems. “They share EHR data, which we call Cerner real-world data,” Dr. Winokur explained. “And that helps power clinical research and trials in more diverse care settings. It helps foster representation among data sets.”
ACCC 2022-2023 President’s Theme
Dr. Afsar wagers that the next 10 years will bring more change in healthcare than the previous 40 years. Technological advances will be at the forefront of that advancement. ACCC President Dr. David R. Penberthy recognizes this future through his 2022-2023 President’s Theme: “Leveraging Technology to Transform Cancer Care Delivery and the Patient Experience.”
You can find more resources from ACCC on how cancer care and the patient experience is being transformed through technology and data on the ACCC website, including real-world examples from ACCC members across the nation.
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