Setting a Game Plan for Equity in Healthcare

Karen Dale is the market president of AmeriHealth Caritas District of Columbia, and the chief diversity, equity, and inclusion officer for the AmeriHealth Caritas Family of Companies. Guided by the organization’s mission and values, Karen collaborated with stakeholders in her healthcare community to develop and implement innovative, person-centered strategies—including using telemedicine to aid in the management of chronic diseases, peer-to-peer outreach using community health workers, and the rollout of a multifaceted member engagement approach.

Prior to joining AmeriHealth Caritas, Karen served as executive vice president of Health Care Management at DC Chartered Health Plan Inc., where she led strategic initiatives to address critical challenges faced by its members. She also serves as a Board Member for Volunteers of America.

In an interview with Healthcare Tech Outlook magazine, Karen sheds light on the significance of equity in healthcare, and how technology can help achieve it.

What is the current state of healthcare equity in the US?

My 30-plus years of health care industry experience have given me great appreciation for and understanding of the interdependent dynamics that need to be aligned to achieve health equity. There have been discussions about equity in the last few years, perhaps more than ever. This is the right time in health care to align people, policies, and structures in a culturally responsive way.

To attain better healthcare equity, we need a payment system that supports providers, especially small and mid-sized providers, so they can afford to initiate activities that relate to health equity. Many times, small and mid-sized providers do not have the resources to hire someone like a community health worker, who can conduct an assessment to identify health related social needs and provide needed care coordination.

Alternative payment models are a pathway to equity. These models provide a framework beyond visit-by-visit reimbursement, which supports health care providers in delivering improved health outcomes and person-centered care. Those healthcare providers that improve their performance on certain measures receive additional payments that allow them to make investments in technology, and new innovative care models to enhance their practices.

I am extremely hopeful about organizations such as the National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS) investing in the development of payment models to improve health outcomes and equity.

What kind of technologies do you think can facilitate equity in healthcare?

I believe that technology enables; it does not replace human touch or engagement. It enables people to be connected to what they need quickly and reduces the barriers hindering them. Today’s innovations hold a lot of promise as they can be used proactively and specifically to design interventions by leveraging data.

For instance, conducting a zip code analysis to identify people whose diabetes is not well controlled provides valuable data to design specific interventions for them. Interventions for people living in that zip code may include addressing food insecurity by delivering meals or connecting them to a food bank. In addition, ensuring transportation to medical appointments, and that primary care providers are located in their zip code, would improve access. 

However, I also caution people that quantitative data is not sufficient to design the appropriate interventions. Conversations with patients or members creates a deeper understanding of their health-related social risk factors (e.g. housing or food insecurity, health literacy, translation services).

Technologies such as health information exchanges can also be a good investment for states and jurisdictions. Health information exchanges streamline information about healthcare services. The storage and democratization of data at the point of care gives providers detailed information at their fingertips so they ask patients fewer, focused questions that improves the patient experience.

By leveraging technology, healthcare organizations can enable patient/member self-service via platforms that allow them to log in to a portal or an app to connect with different providers. Technology can act as a social networking site or forum for people who have little time to visit a provider in person. Patient/members can access what they need, get referred, and utilize available resources that might take longer to avail when done in person.

What are projects or initiatives that you have taken to bring equity in healthcare?

There is a preponderance of research that demonstrates how decades of racism and other inequities in our country’s healthcare delivery system creates disparate health outcomes for Black, indigenous, people of color. To address this, we have focused on training providers about diversity, equity and inclusion and encourage our providers to give respectful care. Recognizing that our communities include people of different races, and ethnicities, who speak different languages, and face unique communication barriers, we ensure translation services at all points of care. In addition, we educate our providers to be more aware of the specific needs related to their patient’s gender identity, and sexual orientation. Our aim is to have an inclusive healthcare delivery system where the diverse and intersecting identities of people belonging to traditionally marginalized communities are embraced instead of stigmatized which often contributes to poor health outcomes. 

One avenue to assess the success of our provider education is member surveys. We utilize an emoji campaign to get feedback on provider visits and found that the use of emojis greatly increased our survey response rate. The feedback received allows us to analyze which communities have more complaints, and discover members who may have faced discrimination. Last year we received more than 2,000survey responses, and nearly 80% of respondents indicated they were very satisfied with their provider visit.

What would be the single piece of advice that you could impart to an aspiring professional in your field?

I would encourage any professional to keep the goal of achieving health equity top of mind. Understand the concept deeply, and listen to diverse voices and perspectives, with a focus on underrepresented communities, in order to understand the needs of the population being served. Analyze both quantitative and qualitative data. Focus on innovative approaches such as technology solutions, and payment models that promote health equity by improving health outcomes.

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