By Lauren Riplinger, JD
Earlier this year, President Biden issued an Executive Order on “Ensuring an Equitable Pandemic Response and Recovery.” A key directive of the Executive Order was the establishment of a COVID-19 Health Equity Task Force whose purpose is to provide recommendations to the President to mitigate health inequities caused or exacerbated by the COVID-19 pandemic and to prevent such inequities in the future.
The COVID-19 pandemic has revealed and exacerbated existing health inequities in the US and beyond. Latino and Black Americans exposed to COVID-19 have experienced disproportionally higher infection and mortality rates.1 Higher hospitalization and mortality rates also reflect higher infection rates, higher rates of underlying health conditions and social and economic barriers to care.2 However, even after controlling for such factors, it does not fully explain the disparities in hospitalizations and death.3 This suggests that other factors such as policies that support structural racism and discrimination are negatively affecting outcomes.4
AHIMA’s mission of “empowering people to impact health” is rooted in our founder’s belief that great possibilities are achieved when we work together towards a common goal. This includes creating lasting change in the health of individuals around the globe. Few ways are more impactful in creating lasting change in the health of individuals than addressing health inequities. Consistent with our mission, public policy is an important tool to help reduce and eliminate health inequities in the face of the COVID-19 pandemic and in healthcare more broadly. More importantly, health information professionals have the knowledge and expertise to inform these ongoing public policy discussions.
This spring we convened a work group to help us think about what key public policy considerations should be addressed by policymakers to address health inequities. The work group discussed many of the challenges and opportunities related to health equity as well as a set recommendations to policymakers to address health inequities. In July, the AHIMA Board of Directors approved the public policy statement on health equity.
The public policy statement identifies six considerations for policymakers to address health inequities:
- Encourage the standardized collection of accurate and complete patient demographic and social determinants of health data in ways that are culturally competent to better understand the communities being served and their related needs. This includes supplementing demographic information with more granular collection of data regarding race, ethnicity, sexual orientation, gender identity, and intersex status using standardized categories to enable individuals to self-identify and increase the utility of the data for the entity collecting them.
- Guarantee the right for all to have access to affordable, high-quality health coverage, including addressing current coverage gaps to achieve comprehensive health coverage for all. This includes individuals with multiple chronic conditions, those experiencing challenges in access to care, and underinsured and uninsured individuals.
- Promote the leveraging of technology to analyze quality-of-care and outcomes using both patient demographics and clinical data to identify and address health disparities. This includes promoting the development, piloting, and testing of machine learning and artificial intelligence technologies and solutions that identify and address biases in the data and avoid exacerbating existing health disparities and inequities. Building health equity into program and system design should also be considered.
- Promote healthcare delivery and finance models and quality measures that focus on promotion and prevention strategies to reduce health inequities and disparities. This includes promoting delivery and finance models such as CMS’ CMMI Accountable Health Communities (AHC) Model that are designed to reward efforts to reduce health disparities and improve equity by addressing social determinants of health. Development and use of disparities-sensitive quality measures, including measures that assess whether interventions promote health equity, are also critical to reducing health disparities and inequities. Further evaluation of accounting for social risk factors in risk adjustment is also needed.
- Address human capital and educational needs of the healthcare workforce including how to consistently and accurately collect, use, and maintain patients’ demographic information in ways that are culturally sensitive. Investment in a diverse, culturally competent professional workforce is also needed to foster an inclusive approach to addressing health disparities and inequities.
- Identify and support efforts to overcome historical mistrust in healthcare institutions including encouraging strong patient-provider relationships, creating opportunities for community leaders to be engaged and part of the decision-making process, identifying and dismantling policies that support structural racism and discrimination, and fostering a commitment to improving the patient experience of marginalized communities.
Addressing health inequities will continue to be a priority for the current Administration and US Congress this year. Recently, the Office of Management and Budget (OMB), which is tasked with overseeing that the President’s policy, budget, management, and regulatory objectives are met, issued a Request for Information (RFI) to identify effective methods for assessing whether agency programs, services, and operations equitably serve all individuals and communities including those that have been historically underserved. The Centers for Medicare and Medicaid Services (CMS) have also issued several RFIs on health equity as well as part of the FY2022 Inpatient Prospective Payment proposed rule and the FY2022 Physician Fee Schedule proposed rule. AHIMA provided comments to both OMB and CMS, highlighting some of the key recommendations in AHIMA’s health equity public policy statement.
At ONC’s Annual Meeting in March, Dr. Marcella Nunez-Smith, Chair of the White House COVID-19 Health Equity Task Force noted, “[the data] is where we begin because we cannot fix what we cannot see, and we have to begin with visibility in the data.” Health information professionals have a critical role to play in helping to “see” and make sense of the data to address health inequities. As these policy discussions continue, AHIMA is excited to bring its members’ expertise to help address these critical issues.
Health Equity Public Policy Work Group
Maria Caban Alizondo, MOL, MLC, RHIT, FAHIMA, Director, Health Information Management Services, UCLA Health System (Board Member)
Carrie Elliott, Manager, HIM, Sacramento Native American Health Center
Lolita Jones, MSHS, RHIA, CCS, Medico-Social Coding Consultant, iQueryData.com
Lari Anne Kamei, MBA, RHIA, Assistant Director, Kaiser Permanente Hawaii
Lakesha Kinnerson, MPH, RHIA, CPHQ, Assistant Professor and HIM Coordinator, Samford University
Armando Quinones-Cruz, RN, BSN, CPC, CPHQ, Clinical Investigation Analyst, Optum Services/United Health Group
Corey Smith, PhD, Assistant Professor, University of North Dakota School of Medicine and Health Sciences
Vivian Thomas, RHIA, CHDA, CPHQ, CHPS, CDIP, CPHIMS, HF Surveyor/State Medical Records Consultant, California Department of Public Health Center for Healthcare Quality
- Hooper, Monica Webb et al. “COVID-19 and Racial/Ethnic Disparities.” JAMA 323 (24): 2466-2467. May 11, 2020. https://jamanetwork.com/journals/jama/fullarticle/2766098.
- Rubin-Miller, Lily et al. “COVID-19 Racial Disparities in Testing, Infection, Hospitalization, and Death: Analysis of Epic Patient Data.” Kaiser Family Foundation, September 16, 2020. https://www.kff.org/coronavirus-covid-19/issue-brief/covid-19-racial-disparities-testing-infection-hospitalization-death-analysis-epic-patient-data/.
Lauren Riplinger (Lauren.Riplinger@ahima.org) is vice president, policy and government affairs, at AHIMA.