Overcoming Barriers to Health Equity

Physicians are often frustrated when systemic barriers prevent them from providing high quality care to all of their patients. But there are steps every physician can take to overcome these barriers and ensure health equity.

This was one of the messages from the panel’s presentation, “The Balancing Act: Addressing Social Drivers of Health in Practice” at the American College of Physicians’ 2022 Internal Medicine meeting April 27-29.

“The things we have control over are ourselves, our care team, and to some extent our model of care,” said Sarah Candler, MD, MPP, FACP, director of academic relations at Iora Health at Houston.

Candler suggested doctors start by examining their own biases, as evidenced by the people they hire and the disparities in outcomes among their patients. “There is evidence to show that if your care team reflects your patient population, you will achieve better outcomes,” she said. She also urged primary care residency programs to expose trainees to a variety of practice settings, including private, academic and community practices, and those using value-based payment structures. “If they only know about the paid service, they will never see that there is another way to practice medicine,” she says.

Additionally, suggested primary care physicians and practices establish preceptorships with medical schools so that students can gain experience in the field and view primary care as a relationship-based specialty.

Joshua Liao, MD, FACP, associate chair for health systems at the University of Washington School of Medicine, noted that payment models vary as they address the social determinants of health. Fee-for-service addresses this at best indirectly, through payments for clinical acuity and payments to safety net organizations. “My feeling is that these are generally not sufficient to meet the needs of the social drivers of health,” he said.

Some quality and value-based payment models take into account the social determinants of patient health through risk adjustment, Liao said, but this is often insufficient due to incomplete information on social factors of health. patients. “It’s hard to adjust properly if you don’t have that data,” he noted.

Moreover, he said, models that make practices accountable for the costs of care have been shown to discourage them from caring for patients from racial and ethnic minorities, as they often have complex needs whose care is more expensive.

Liao suggested that a better approach is to adapt to risks based on the emerging concept of social need levels. “If we wait for every practice in every community to get all the data needed (to fine-tune risk), we’ll have a long time to wait,” he said.

Liao noted that the concept of area-level data will be part of Medicare’s ACO REACH program scheduled to be introduced in early 2023. It will identify patients living in areas of high social need, where factors have an identifiable impact on health outcomes. , and links them directly to financial benchmarks.

“That means doctors are paid more to care for people in those areas,” he explained. “It means we’re moving in a direction that recognizes that the social and lived environment matters, and we need to take that into account in how we compensate clinicians.”

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