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BDO HEALTH EQUITY SURVEY RESULTSARE WE STARTING TO SEE MEANINGFUL ACTION?
October 5, 2021
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STEVEN SHILL, CPAPartner & National Leader, The BDO Center for Healthcare Excellence & [email protected]
Welcome
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Agendafor Today
What is Health Equity?
Survey Findings
What Comes Next
Key Steps For Providers
Q&A
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HERMAN WILLIAMS, MD
Managing Director & Chief Physician
Executive
JIM WATSON, MBA
PrincipalHealthcare Advisory
ELIZABETH KOELKER, MHA, FACHE
DirectorHealthcare Advisory
UGO OKPEWHO, FSA, MAAA
DirectorInsurance Advisory
VENSON WALLIN, CPA, CGMA
Managing Director National Healthcare
Compliance and Regulatory Leader
[email protected] [email protected] [email protected] [email protected] [email protected]
With You Today
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What Is Health Equity?
For the purposes of this survey, we define health equity as a strategy to ensure everyone has a fair and just opportunity to be as healthy as possible.
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In June and July 2021, HIMSS Market Intelligence surveyed 153 executives and senior leaders at healthcare organizations to understand the status of health equity strategies and initiatives in U.S. hospitals and health systems.
Survey respondents included:
About the Survey
14%Integrated delivery networks
42%Multi-hospital
systems
27%Stand-alone/
specialty hospitals
4%Ambulatory/outpatient practices
13%Academic
medical centers
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Respondent Profile
99%Executive LeadershipDiversity, Equity and Inclusion Leader
JOB FUNCTION61%
12%27%
C-Suite Exec EVP/SVP/VP/Head SystemDirector/Director
32%
68%
Decision Maker SignificantInvolvement/Influence
JOB ROLE
AMONG C-SUITE ONLY, ROLE IN HEALTH EQUITY INITIATIVES
28%
50%
22%
Urban Suburban Rural
LIVING AREA
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ESG: The Sustainability Dimensions
ENVIRONMENTAL Climate change Biodiversity Fresh water availability
Water pollution Air pollution Circular economy
BDOSUSTAINABILITY
GOVERNANCE Corporate Governance Stakeholder engagement Anti-corruption
Fair operating practices Risk and opportunity oversight Ethical behavior
SOCIAL Health and safety Diversity and equality Work-life balance
Sustainable innovation Corporate citizenship Consumers’ awareness
Waste management Resource availability
Products and services innovation Sustainable consumption Community involvement
Responsible lobbying
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Health Equity, ESG and Hospital Boards
Boards are taking an active approach to ensuring their organizations are prioritizing ESG and health equity.
While there are established reporting frameworks and standards for elements of ESG reporting, including the Sustainability Accounting Standards Board, Global Reporting Initiative, Task Force on Climate-Related Financial Disclosures and others, reporting standards for health equity are still lagging behind.
There are some steps an organization can take, such as receiving the Health Equity Accreditation from NCQA.
Work with your audit partner on key measures and financial reporting.
Boards and auditors alike should understand that additional reporting standards are necessary, and both can play a role in advocating for and determining those standards.
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Maturity of a Health Equity Strategy
Survey Findings
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Nearly 3-in-4 currently have a health equity strategy or plan to implement one within 12 months
37% 37%
13%9%
4%
Currently have a healthequity strategy
Planning to implementwithin 12 months
Planning to implementwithin 12-24 months
Planning to implementwithin 24+ months
Do not have plans toimplement a health equity
strategy
Which of the following best describes your organization’s health equity strategy?
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Plans AMCs IDNs Multi-Hospital Systems
Stand-Alone/ Specialty Hospitals
Ambulatory/ Outpatient Services
Currently have a health equity strategy 65% 43% 31% 27% 43%
Planning to implement within 12 months 30% 24% 50% 24% 43%
Planning to implement within 12-24 months 5% 19% 5% 27% 14%
Planning to implement within 24+ months - 14% 9% 12% -
Do not have plans to implement - - 5% 10% -
1-in-3 IDNs Plan to Implement a Strategy in 12-24 Months, or Even Longer
Which of the following best describes your organization’s health equity strategy?
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Those in Urban Areas are Significantly More Likely to Have aCurrent Strategy
Which of the following best describes your organization’s health equity strategy?
Plans Urban Suburban Rural
Currently have a health equity strategy 49% 38% 21%
Planning to implement within 12 months 39% 36% 32%
Planning to implement within 12-24 months 12% 10% 21%
Planning to implement within 24+ months - 12% 15%
Do not have plans to implement - 4% 12%
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Not-for-Profits are More Likely to have a Health Equity Strategy
39%
34%
13%
11%
3%
21%
52%
17%
3%
7%
Currently have a health equity strategy
Planning to implement within 12 months
Planning to implement within 12-24 months
Planning to implement within 24+ months
Do not have plans to implement
For-profit Not-for-profit
Which of the following best describes your organization’s health equity strategy?
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Top Reported Challenges to Reducing Health Disparities
59%Tracking
economic health
40%Payer issues and reimbursement
36%Tracking provider
performance
33%Identifying gaps in healthcare
disparity
36%Tracking patient
outcomes
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Healthcare Organizations Still Think Too Broadly About Health Equity
50%
49%
49%
43%
41%
28%
24%
14%
2%
Discuss health disparities related to diverse populations
Outline how unconscious bias can influence
Coach communication skills
Confirm how to meet diverse needs of patients
Gain a deeper understanding of diverse cultures
Train on demographics of our organization’s patient populations
Confirm how to address confidentiality concerns of diversepopulations
Review the positive contributions where diversity has madesignificant impact on society
Another Objective
What are the top 3 objectives when training employees on discussing health equity and/or health disparities?
While the number one objective for half of our respondents is related to diverse populations, less than a third focus on the organization’s patient populations.
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Metrics & Measurement
Survey Findings
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While QOC measures are the most common, there is still no industry standard on how and what healthcare organizations should be measuring to assess health equity.
How Organizations are Measuring Health Equity
62%
34%
22%14%
7%
QOC measures Communityengagement
Demographics Data collection Cost
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Management & Accountability
Survey Findings
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Who is accountable for health equity metrics at your organization?
CEO/Executive Teams are Most Often Accountable for Health Equity Metrics
76%
46%37%
27% 21% 16%5%
CEO/Executiveteam
Board Department heads CMO DE&I leaders Clinicians Others in theorganization
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Who is part of your health equity task force / council?
Although Only 16% of Clinicians are Accountable for Health Equity Metrics, They are 3x More Involved on a Task Force
67%
63%
41%
33%
28%
49%
42%
33%
25%
8%
3%
14%
Other C-Suite Executives
CEO
Board
CFO
DE&I leaders
Clinicians
Administrators
Community stakeholders
Patients
Government stakeholders
Others in the organization
We do not currently have a task force/council
4.05 average number of members on task force
Nearly 9-in-10 have a task force / council
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Investment & Partnership Strategies
Survey Findings
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Estimate the percent of your team’s/business unit’s investment when thinking of health equity for your organization. (Data labels under 4% not shown)
Where Health Equity Investments are Happening
5%
5%
10%
12%
12%
11%
32%
75%
54%
67%
72%
66%
64%
73%
58%
21%
37%
24%
16%
20%
21%
15%
10%
Community outreach
Telehealth
Diversity of leaders
Diversity of providers
New care delivery models
New partnerships
Payer engagement
Other
0% 1-19% 20-39% 40-59% 60-79% 80-100%
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In the next year, which of the following do you plan to pursue to help meet your health equity goals?
Nearly 7-in-10 plan to pursue a community outreach partnership
69%
39%
31%
22%
16%
6%
5%
3%
4%
Community outreach partnership
Healthcare partnership
Technology partnership
Research partnership
Government partnership
Acquisition
Merger
PE investment
Another pursuit
60%* of Academic medical centers v. 14%* amongst Ambulatory/Outpatient, 22% Stand-along/Specialty, 29% IDN and 31% Multi-hospital
*Small base sizes, insight is direction
2.06 average number of measurements selected
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69%
39%
31%
22%
16%
6%
5%
3%
4%
Community outreach partnership
Healthcare partnership
Technology partnership
Research partnership
Government partnership
Acquisition
Merger
PE investment
Another pursuit
In the next year, which of the following do you plan to pursue to help meet your health equity goals?
Goals can vary when looking at living areas, with those in an Urban area more focused on technology and research partnerships
34% amongst those living in an Urban area v. 23% for Suburban and 6% for Rural
44% amongst those living in an Urban area v. 21% for Rural and 29% for Suburban
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What Comes Next?
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The Role of Actuaries in Addressing Healthcare Disparities
Broader use of claims data to include codes for “social factors” such as race, ethnicity, food insecurity, housing instability, transportation difficulty, etc. Diving into this claims data will enable one to understand the population when designing programs, pricing, etc.• Multiple address changes may be a sign of housing instability• Payers/providers can have a higher focus on collaborating with
inner city community organizations and be engaged Adjust cost and quality metrics to “level the playing field” in value-
based or public reporting programs Outcomes measures can go beyond ROI to incorporate other factors
such as: improved health
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ESG and DE&I reporting standards will become more robust and expectations will be higher, impacting companies’ financial reporting responsibilities
An industry standard for health equity KPIs will develop over time
Key Takeaways
Health equity conversations will move beyond the boardroom to all levels of the organization, and eventually to the surrounding community
Health equity will shift from reactive (based on patient outcomes) to proactive (based on prevention and proactive health management)
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ACKNOWLEDGE Recognize structural racism and inequity in your organization openly and honestly
ASSESS Gather data to understand specific areas of inequity and disparate quality of care at your organization and among your patient population
ACCESS Identify access issues specific to your patient population, including technology, food, security and other social determinants of health
ACT Establish an enterprise-wide strategy to address short- and long-term needs, and put it into action
ANALYZE Establish benchmarks and track them in real time to monitor progress. Report out outcomes to stakeholders
Key Steps for Providers
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Q&A
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Thank You!
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BDO USA, LLP, a Delaware limited liability partnership, is the U.S. member of BDO International Limited, a UK company limited by guarantee, and forms part of the international BDO network of independent member firms. BDO is the brand name for the BDO network and for each of the BDO Member Firms.
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