Can community-based ecosystems make health accessible/equitable?

Jen Radin, principal, Deloitte Consulting LLP

Hospitals, health systems, and health plans have long been at the heart of the health care ecosystem. But as consumers move closer to the center, trusted organizations in the community are beginning to play a more significant role in health care. Community-based health ecosystems can extend the reach of traditional health stakeholders, help instill trust, and break down barriers to ensure that everyone can achieve their full potential in all aspects of health and well-being.

The Deloitte Center for Health Solutions recently published a report, Advancing health equity through community-based ecosystems, which explores the collective impact these multi-organization ecosystems can have on the social, economic, and environmental factors that can make health less equitable. These drivers of health (also known as social determinants of health) affect up to 80% of health outcomes. They include the physical environment, access to healthy food, infrastructure, economy, wealth, employment, education, social connections, and safety. Community-based ecosystems could help address these drivers of health by providing insight into the lived experience of the population.

Along with health systems and health plans, a community-based ecosystem might include a wide range of non-traditional players such as churches, synagogues, mosques, YMCAs/YWCAs, food banks, urban gardens, and transportation companies.

Consider this example: Two years ago, a San Francisco-based self-driving car company teamed up with a local food bank to deliver meals to families in need. In March, Cruise (a subsidiary of General Motors) delivered its 2 millionth meal for Marin Food Bank.¹ The two organizations are part of a community-based health ecosystem that is helping to address one of the key drivers of health—access to healthy food.

Large technology and platform companies can also play an important role in community-based ecosystems. These hyper-scalers, for example, might have access to health analytics that can help identify health disparities that exist within certain communities. Many of our hyper-scaler clients are paying close attention to health equity.

Can CHNAs help improve health equity?

Community Health Needs Assessments (CHNAs), which were outlined in the 2010 Affordable Care Act (ACA), require tax-exempt hospitals and health systems to identify the health issues in a community, conduct quantitative analyses of those issues, appraise existing efforts to address them, and formulate a plan for future action. The provision (IRS Form 990) was created to help hospitals understand the needs of their communities. But CHNAs can be so much more than a tax document. They could be part of a health equity strategy. For example, EHRs, census data, and other information used to comply with the CHNA rule, could help guide a community health strategy. This information could also help identify local organizations that might be willing to participate in a community-based health ecosystem.

Who should lead community-based health ecosystems?

While 74% of health system leaders say improving health outcomes is a top goal of their organization’s strategy, most admit they aren’t doing enough to leverage partnerships with community-based organizations, according to Deloitte research. However, hospitals and health systems are likely well positioned to take the lead in convening community-based ecosystems. Within the organization, multiple executives could play important roles. Here’s a look at what some members of the leadership team might contribute:

• Chief executive officer: A CEO who is closely involved in the organization’s health-equity programs and strategies is essential for a health ecosystem to reach its potential. A community-based health ecosystem might not even be able to get off the ground without strong support from the top.
• Chief medical officer: Clinical leaders can help ensure that clinicians and support staff consistently provide culturally competent care, and that they ask patients questions regarding social drivers of health.
• Chief information officer: This executive could lead discussions about the importance of viewing clinical pathways through an equity lens and de-biasing clinical decision sets.
• Chief health equity officer/chief diversity and inclusion officer: In addition to establishing a health-equity strategy, this leader can help identify ecosystem collaborators and create the network to keep everyone connected.
• Human resources: The HR team might help to ensure that the hospital or health system has (or is building) a diverse and inclusive workforce. HR staff can also evaluate potential biases in hiring, promotions, and the overall succession process.
• Supply chain leaders: These leaders could focus on evaluating vendors and suppliers to make sure they have diverse and inclusive workforces.

As a society, we have built structures that are often inequitable, and we have created clinical pathways that tend to be racist, and gender biased (to put it bluntly). In doing so, we have created management systems that make it difficult for certain populations and individuals to access the care and services they need to maintain health. Building relationships with community organizations can not only provide greater insights into the lived experience of local populations, but also create a trusted network focused on the individual. This trusted network contributing a relevant set of services and capabilities could reduce disparities, improve equity and improve the health of community members. A greater number of health care organizations are realizing this halo effect and are seeking ways to deepen the integration of data, insights, healthcare delivery, and socioeconomic services.

Nothing in equity can be successful without trust. But trust can erode very quickly, and it takes time, sometimes years to build. We are learning that a health ecosystem, which revolves around an individual or a population and coordinates organizations in the community, can create powerful impact on raising health.

Endnote:

¹ Cruise self-driving cars deliver 2 millionth meal for San Francisco-Marin Food Bank, CBS News, Bay Area, March 22, 2022

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Deloitte shall not be responsible for any loss sustained by any person who relies on this publication.

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