[PART 1] Using Innovation in Healthcare to Address the Needs of the Underserved

Thoughts & Take-Aways from Health Data Management’s Panel Discussion

Using Innovation in Healthcare to Address the Needs of the Underserved

Thoughts & Take-Aways from Health Data Management’s Panel Discussion

Part 1 of a 2-part series

 

Recently, I had the privilege of participating in a panel discussion hosted by Health Data Management. The discussion focused on harnessing innovation to better address the diverse healthcare needs of underserved populations. While the discussion took us down several paths, it centered on answering five principle questions:

  1. What’s the definition of “underserved?”
  2. Why is it important to understand and address underserved populations?
  3. How can (or should) we address the underlying or contributing factors?
  4. Where should we look for innovations addressing equity and care of the underserved?
  5. What opportunities and challenges are introduced by technology?

At Enli, we work alongside many progressive, mission-driven healthcare organizations, including several Federally Qualified Health Centers, Community Health Centers, and Behavioral Health Organizations that focus on underserved populations. Through them, the logic and technology that we build finds meaning when put into action—helping to address needs, improve health and lower healthcare cost. I am passionate about achieving health equity and so want to take the recent panel discussion beyond the walls of the Boston conference center.

 

1) What is the definition of "underserved?”

The panel shared a broad perspective on the term “underserved.” The panelists cited the Health Resources and Services Administration (HRSA) overview of Medically Underserved Populations, which describes subgroups of people living in a defined geographic area that has an identified shortage of primary care health services.[i] Examples of medically underserved populations, include:

  • The homeless
  • Low-income individuals and families
  • Medicaid-eligible
  • Native Americans
  • Migrant farm workers

Certainly, mental health is another commonly identified underserved population. More than one-quarter of U.S. adults experience some type of behavioral health disorder each year. 

Maybe the most controversial idea was the notion that most of us could be categorized as underserved. While many Americans have access to healthcare services, most are not well-served by the existing delivery system. The danger of this sentiment, as accurate as it may be, is that it risks minimizing our focus on the truly disadvantaged. 

Instead, if we concentrate on designing an equitable healthcare system for the disadvantaged, the more fortunate among us will also benefit. For example, we have a customer that cares for a large LGBT population. In their effort to meet the needs of transgender patients, they have designed a system to accurately capture, record, and use patients’ names based upon an individual’s preference. It’s a small thing, but a design feature that would delight me. If an organization is going to expertly guide me through the most important (the health of me and my family), beautiful (birth of my children) and difficult (end of life) experiences, I want to know that they at least know my name.

Now, imagine a more sophisticated design feature where an individual’s personal goals are obtained and recorded, alongside a considered assessment of personal barriers to attaining those goals. A system that values and addresses goals and barriers sets up a completely different care team-patient interaction, which can be critical in relationship-building and closing equity gaps. Once again, the health and well-being of each of us would be better maintained in such a system. 

 

2) Why is it important to understand and address underserved populations?

Many of us intermittently wear the hat of clinician, administrator, and vendor. All of us are healthcare consumers and advocates. These settings and roles color our perspective. For me, it leads to the conclusion that there are three primary reasons why it’s so important to understand and address the needs of the underserved:

  • A sense of professional obligation and ethical responsibility. The American Medical Association defines the responsibilities of all physicians. In part, that definition reads: “All physicians should work to ensure that the needs of the poor in their communities are met. Caring for the poor should become a normal part of the physician’s overall service to patients.”[ii]  Most of us enter healthcare with the desire to help others in need—it’s a basic responsibility to care for our “neighbors.”
  • Everyone deserves access to quality care. It’s well understood that access to care is a prerequisite for prevention and management. Disparities in access exacerbate disparities in outcomes—improve access, improve population health. According to Healthy People 2020, access to healthcare is important for: (a) overall physical, social, and mental health status; (b) prevention of disease; (c) detection and treatment of illnesses; (d) quality of life; (e) preventable death; (f) life expectancy.[iii]  Access to primary care services, more specifically, is associated with improved health and lower cost.[iv],[v] Quality care, of course, requires more than access to good primary care. Providing quality care requires that every healthcare delivery system is underpinned by a learning system that implements meaningful measures, engages in thoughtful reflection of performance, and seeks to improve the quality of the services that are provided within—and across—organizational departments, as well as between healthcare partners.
  • The burden of healthcare costs is felt society-wide. Without proactive planning and health engagement, the healthcare is taxed by expensive unnecessary ER visits, hospitalizations, and drug therapies for conditions that might have been prevented or better managed. I lament the loss of funding for education, community infrastructure, and the other societal benefits that are robbed by the inefficiencies in healthcare. 

I hope these thoughts and reflections have offered some perspective, and that they might prove helpful to those of you who are spearheading initiatives to deliver care to our most vulnerable populations. Next week, I will turn my focus to questions 3 through 5, highlighted in the introduction above. If you’d like to be notified when the article becomes available, sign-up for the Enli blog.

Jacquelyn Hunt, PharmD, MS, Enli Chief Population Health Officer

 


[i] HRSA, https://bhw.hrsa.gov/shortage-designation/muap

[ii] AMA Journal of Ethics, http://journalofethics.ama-assn.org/2011/08/medu2-1108.html

[iii] Rural Health Information Hub, https://www.ruralhealthinfo.org/topics/healthcare-access

[iv]   Macinko J, Starfield B, Shi L. The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998. Health Serv Res. 2003;38:831-65.

[v]   Shi L, Macinko J, Starfield B, et al. The Relationship Between Primary Care, Income Inequality, and Mortality in US States, 1980–1995. J Am Board Fam Med. 2003;16:412-22.


J. Hunt, PharmD, MS