The American dream promises freedom, opportunity, and equality. When you look at the country’s healthcare system today, that promise seems daunting. We’re in the middle of the worst pandemic this country has seen in 100 years. Important questions are being raised about human rights and socioeconomic inequality. At the same time, the average life expectancy in America is lower than in many other economically developed countries.
The reality is that social factors play a pivotal role in both access to care and the quality of that care. And these social determinants of health have an outsized impact on our most vulnerable populations: the disabled, the disadvantaged, and the elderly.
Consider a patient’s zip code: limited access to affordable housing has created subpar living conditions with greater risks for disease for the residents of “Cancer Alley” – the low-income communities along the Mississippi River between Baton Rouge and New Orleans. Homes in this area are surrounded by the densest concentration of petrochemical plants in the country, and the region is seeing some of the country’s highest cancer rates. As a former New Orleans resident and Katrina evacuee, I find this reality particularly jarring, especially when contrasted with the economic recovery in many parts of these cities.
What about transportation? A patient’s ability to access a modern transportation system can be the difference between getting timely care or waiting until it is too late.
Even in this pandemic, CMS has reported that African American, American Indian, and Alaska Native Medicare beneficiaries are disproportionately affected by Covid-19. According to CMS, “this is due, in part, to the higher rates of chronic health conditions in these populations” and “Black beneficiaries continue to be hospitalized at higher rates than other racial and ethnic groups, with 670 hospitalizations per 100,000 beneficiaries.”
It has taken a public health emergency to bring a conversation about these disparities back to the forefront of healthcare. If we have learned anything this year, it is that we can do better. As healthcare leaders, we must ask ourselves: What will we continue to tolerate? How can we close these gaps in access to care, how can we ensure equal access to quality healthcare for all communities? And how can we promote a bipartisan perspective on healthcare legislation that will improve conditions for all patients?
I’d like to believe that we all want better healthcare for everyone. Why can’t we appeal to both the liberal passion for Medicaid expansion and the conservative support for increased competition through privatization? We are seeing this incredibly successful marriage of policies in the Managed Medicaid transformations occurring in states across the nation. They serve as a model of how the public and private sectors can work together to create a healthier nation for all of our citizens through value-based care reimbursement models, commitment to proactive care management, and healthy competition among managed care organizations (MCOs).
I believe that this year, the “Person of the Year” wears a stethoscope, scrubs, and a mask. But alongside the physicians and nurses, there are many other healthcare heroes, like drivers who deliver masks to your door, health aides who take care of your ailing neighbor, and caregivers who ensure the utilities have been paid.
These heroes look just like you and me, and they are a vital part of our communities. They give a voice to the chronically ill, the disadvantaged, and those living in challenging environments. Their goal is to help each person, regardless of their economic, demographic, or ethnic backgrounds, get the care they need by understanding and managing their unique set of circumstances.
For years, innovative health systems and health plans have invested in teams of care managers to help serve patients. These trained experts are a patient’s primary supports for managing health and navigating the healthcare system – from conducting at-home wellness checks to making sure that patients have the prescriptions they need. Care managers and their stories of success represent the power of proactive, on-going, and consistent, high-quality care.
Imagine a world where every patient has access to a care manager armed with comprehensive, real-time data and the tools to take action. When a father needs transportation for his child’s doctor visit because he doesn’t own a car, his care manager can schedule a ridesharing service along with the appropriate car seat. When a care manager notices a patient’s medications are running low through a connected medication adherence device, she can proactively order a prescription refill and delivery. For patients managing multiple chronic conditions, the care manager can ensure automated scheduled follow-up telemedicine calls and prevent unnecessary (and expensive) ER visits down the road.
MCOs, care managers, health aides, and caregivers, armed with the technological innovations of our time, have the ability to help reverse the inequalities in healthcare. They can move the system from “sick-care” to “proactive care” that reduces costs, improves outcomes, and keeps individuals out of the hospital. All of our incentives are aligned. It’s time to embrace the mission.
Let’s reimagine the American dream – one that makes healthcare services available in every community and every neighborhood. The events of 2020 have elevated the pressing need for a proactive healthcare movement. We need to take action. We need to detect issues before they become expensive hospitalizations, locate potential outbreaks while they are still localized, and put the technological infrastructure in place to make all of this seamless and effective.
When healthcare organizations arm themselves with the full spectrum of important information, including both clinical and social determinants of health, and start caring for the health of their patients and members in a more holistic, proactive way, we can close the gaps in healthcare and make life, liberty and the pursuit of happiness more accessible to all.