Why health equity is now a business imperative in cardiology

For health systems under value-based care payment initiatives, there a direct financial incentive to invest in programs that improve access and outcomes among underserved populations.

“It’s not just an economic imperative. I truly believe it’s a clinical imperative,” Itchhaporia said.

Building the business case to solve health inequities

Itchhaporia said health systems need better data on race, ethnicity, gender, demographics and patients’ social needs to identify disparities and develop targeted interventions. She also advocated for payment incentives that reward providers for reducing those disparities.

Value-based care could be particularly important because interventions that prevent emergency department visits, readmissions and other costly care can generate both better outcomes and financial savings.

She cited a Pennsylvania hospital pilot serving an underserved population with high emergency department utilization. By collecting information about patients’ social needs and connecting them with community-based organizations, the program reduced emergency department readmissions by 15% during its first year and saved $1 million, according to Itchhaporia.

“Those are great wins,” she said.

Community partnerships can also help health systems expand their reach without needing to build new infrastructure from scratch. Itchhaporia pointed to a Detroit program that used mobile vans during COVID-19 to provide screening and vaccinations in underserved neighborhoods. Existing relationships with community organizations subsequently helped the program transition toward providing basic care after the pandemic.

The model also involved negotiating lower costs for point-of-care testing and working with insurers, pharmacies and other partners. She said it demonstrated how community-based care can be structured as a financially viable service.

Incentives and innovation to solve health inequities

Itchhaporia said insurers are beginning to create financial incentives around equity. She cited a Massachusetts Blue Cross Blue Shield program that pays clinicians for quality improvements tied to racial and ethnic disparities.

Technology could provide another avenue for expanding access, although health systems must account for the digital divide, particularly in rural communities where broadband access may be limited.

The same principle applies to clinical research where better data is needed to understand issues in underserved communities. Itchhaporia said pharmaceutical and medical device companies can help increase diversity among researchers and clinical trial participants while working with community organizations to establish trust and improve enrollment.

Itchhaporia also noted that "health equity" as a phrase may end up being a barrier of sorts. There are some people who may not believe in the concept or think it deserves to be a priority. 

"People are concerned that the political headwinds are different, and I tell them maybe the language is different, but I don't think the underlying message of what we need to do to deliver care has changed at all," she said. "I don't think anyone, even politically, is going to say what we need to do is to deliver inequitable care. So we just need to change the language, but still move forward."

She even suggested coming up with a new name altogether for the idea.

“Maybe we don't call it health equity,” Itchhaporia said. “Maybe it's population health, because what we're looking at is a whole person.”

For cardiology organizations facing pressure to improve quality while controlling costs, the message is straightforward. Delivering care equitably may be not only the right thing to do, but increasingly the financially sound thing to do because of the costs and resources other required down the road.