On this Martin Luther King Day, I’d like to focus on Health Disparities and doing something about it. It is a topic that has been near and dear to me since I ran a Medicaid HMO in 1994 and had my eyes opened over the years. My disease management company, Specialty Disease Management Services (SDM) focused on Medicaid; working in 10 States covering 10 different diseases or conditions.
Back in the day, before I knew what Social Influencers (Determinants) of Health were I used to orient the staff at SDM with the following phrase:
People can’t focus on their health because their life gets in the way. Lets focus on that first, then we’ll focus on their health.
One of the first things we did before launching our community based model in each contracted state or area, was identifying all of the various resources in the communities. We used these lists to arrange transportation, help with housing, food, appointment scheduling, someone who could watch the other kids so a parent could get to an appointment, help with prescriptions, you name it.
In one state we arranged for the distribution of mattress covers for all asthmatics, which were generously donated by an organization. In another state, when transportation services were changed to require a prior authorization by the MD, which greatly impacted the members in our program for persons with Schizophrenia, our data quickly showed the deleterious effect of this change and upon seeing the data, the state gave those members a waiver.
We also learned about cultural issues, and the importance of understanding how culture impacted outcomes and how to better meet each person’s unique needs. Our programs were in inner cities, rural communities, on Native American/American Indian reservations, in the Mississippi Delta and the Texas Border, Seattle, WA to Buffalo, NY and North Dakota to Florida. We worked with people who spoke over 60 primary languages. We learned from our members and others and then we sought to help in appropriate ways. It was incredibly rewarding.
Today we have all sorts of efforts to focus on disparities healthcare, in health outcomes and in health. We now recognize the profound impact that Social Influencers of Health have on various populations. But recognizing these issues and the efforts we see today are just a start. There is tons of work to do from educating the healthcare system to changing their approach, to moving further upstream to the root causes of these disparities.
We each can play a role in helping to fix these issues:
- Politicians looking at policy approaches,
- Hospitals looking at healthcare utilization,
- Doctors looking at disparities in treatment,
- Community organizations looking to meet the needs of their community,
- IT companies pulling together and showing data in new and useful ways,
- Start-ups launching new technologies and programs,
- Many, many others who play a role and can assist, and finally
- Funding. Where do we get the funds to solve these problems?
As I’ve reiterated several times, I think the funds to solve many of these issues are locked up in our current healthcare system and I wrote about that in Running to the Ball: The Shiny Object of Social Determinants of Health.
In 2020 Gregg Masters and I decided to play a role with our resources and focus on these issues as highlighted by COVID, on PopHealth Week. You can catch these PopHealth Week episodes here:
Caraline Coats and Andrew Renda, MD
Steven J. Spann, MD, MBA and Tray Cockerell
Bridgette M. Brawner, PhD, APRN
Each of these guests were fantastic with great insights into the issues we face and some possible solutions.
Lets each strive in 2021 to make a difference with our unique talents and positions. As a group, we can have a profound impact on the inequality and injustice in healthcare and achieve the dream that Martin Luther King so eloquently laid out for us.