Despite the best of efforts, population health strategy efforts don’t inherently translate to better care for everyone. Distribution of outcomes can vary wildly across demographics, including socioeconomic status, race and gender. In some cases, worsening or stagnant outcomes for one group could be masked by improvements across the board.
For health system leaders, this means your population health strategy should be intentionally refined to prioritize racial equity and other vital measures. Consider the following seven elements of an equity-focused population health strategy.
1. Map out your current approach to equity and population health
The question of health equity vs. population health is most clearly understood through the lens of social determinants of health (SDoH). As the nonmedical factors that influence outcomes, SDoH are increasingly being recognized as critical to addressing health inequities and structural racism within the healthcare system. They include:
- Economic status
- Education level (including health literacy)
- Healthcare access
- Environmental factors (such as neighborhood violence or industrial pollution)
- Social and community support
There is also growing support for considering communication as a SDoH, since clear communication can make or break patients’ understanding of their own health outcomes. This should catch the attention of health system leaders, since it’s one area where you can have the most opportunity to make a difference. Hospital leaders can foster health equity by supporting an empathetic environment where clinicians and hospital staff communicate respectfully and fairly with all patients, while acknowledging linguistic needs, cultural norms and varying literacy levels.
2. Assess how race impacts care
Creating a population health strategy that supports health equity requires acute awareness of the internal and external factors that might contribute to variation in care and negatively impact progress.
Hospitals can take significant steps in addressing health equity by looking inward. Leadership’s dedication to health equity, organizational culture of institutional racism and current provision of resources such as interpreters all matter when it comes to better serving the surrounding community. One potential starting point for some hospitals is inconsistent applications of race in pharmacogenomics testing recommendations. Your assessment can also include a review of your current educational materials, filtering for outdated, inaccurate or biased language and references.
Other potential areas of concern are medical textbooks, which are known to overlook the ways some conditions show up in non-white or darker-skinned patients. But this issue isn’t limited to educational materials. A 2021 study in the Journal of General Internal Medicine found that similar biases have also been found in providers' clinical notes on Black American patients, reflecting bias in physician perception of patient credibility.
Language in all healthcare interactions needs proactive guidance toward equity and inclusivity. This will require that hospital system leaders conduct a systematic review of bias and take active steps to facilitate change through population health initiatives.
3. Invest in data collection
Measuring your population health efforts is key to refining community partnerships and improving outcomes for your patients.
Data can be a powerful tool in documenting health inequities. You will need access to data on race, ethnicity and language, as well as:
- Income
- Immigration status
- Zip code or home area
- Sexual orientation
- Disability status
According to the Centers for Medicare and Medicaid Services (CMS), organizations should use this information to disaggregate data and identify existing disparities. This data can be used to stratify performance measures and highlight needs for housing, transportation or food.
The information you compile can also aid in connecting with resources that close gaps in healthcare outcomes, such as a food bank or parenting classes in a neighborhood where patients have those needs. CMS also recommends aligning your data categories with the standards and certified health information technology requirements of the Office of the National Coordinator for Health IT.
4. Practice informed, inclusive patient outreach
Successful population health relies on respectful, inclusive one-on-one patient communication. Fortunately, hospitals can access help managing these conversations. Rhonda Medows, MD, President of Population Health at Providence Health, suggests that hospitals can collaborate with community organizations and take steps like hiring community health workers or formalizing partnerships with organizations like Boys and Girls Clubs or community health centers.
This is also a time to acknowledge that some groups might rightfully be suspicious of public health efforts. This could be because of a generational understanding of medical racism and unethical research, such as the Tuskegee Syphilis study, or because of immigration status. To bridge these gaps, you will need to explore why individuals might be unwilling to take part in public health efforts such as vaccination or data-gathering.
5. Harness the latest evidence-based clinical information
Medical research is making progress in understanding the relationship between health equity and clinical practice — meaning that evidence-based clinical information will be critical to the success of your health equity efforts. For example, Native American, Black and Hispanic people are nearly twice as likely as their white counterparts to live with major, long-term conditions such as asthma or diabetes. This makes treatment more complex and intensifies the need for clarity in clinical decision-making.
To address this, consider evidence-based clinical decision support tools, which have been found to improve patient care through connecting clinicians, including physicians and nurses, with the latest research and best practices.
6. Prepare for healthcare hesitancy
COVID-19 vaccination is one of the most pressing areas of population health today. While hesitancy has been a challenge, success is possible.
People across every demographic doubt the scientific achievement and motives behind the rapid development of the vaccine. But Hispanic and Black Americans have seen higher rates of death and hospitalization from COVID-19 than white Americans. A Penn State study found that disparities in vaccination between Black and white adults could be attributed to anti-vaccine beliefs, with Black adults being consistently more vaccine hesitant.
But some outreach efforts have met with success. VA Connecticut Healthcare System (VACHS) launched a quality improvement project to improve vaccine uptake rates. It found that a population health approach to vaccine acceptance that used EHR-based tools could impact vaccination rates, including a statistically significant increase among vaccine-hesitant patients (24.1% vs. 13.6%). Their approach might be useful to other large healthcare systems interested in improving their vaccination rates using population health.
The Journal of Urban Health suggests addressing mistrust by:
- Validating the experience-based reasons patients might be hesitant
- Combating misinformation with culturally intelligent outreach
- Improving access through trusted and convenient vaccination sites such as barbershops, churches and other community locations.
7. Educate clinicians on inherent biases
Population health is an ongoing process. That means hospitals must be constantly working to help clinicians understand how they might be biased in ways that affect their patients.
Providers hold both implicit and explicit biases that manifest in the form of clinical decision-making, communication and institutionalized practices. By addressing these biases on an ongoing basis, your organization will not only be supporting staff in upholding a professional responsibility, but will also be taking positive steps to improve the health and wellness of your community.
Ongoing interventions can include training for identifying bias as well as instruction on the ways biases harm patients and perpetuate the health disparities that lead to negative outcomes. But healthcare work and learning environments are often the sources of these biases, either confirming or initiating them. Healthcare leaders might find the model proposed by the Annual Review of Public Health helpful in identifying necessary interventions.
As you refine your population health initiatives to provide the best care everywhere in your community, know that you already have access to the tools. Gathering data around social determinants of health can be instrumental in informing quality improvement and better patient outcomes.
Learn about solutions from Wolters Kluwer to support population health strategies and programs.
