Outlook 2023: Health equity will likely solidify as a key business strategy

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By Jay Bhatt, D.O., Managing Director of the Deloitte Health Equity Institute and the Deloitte Center for Health Solutions, Deloitte Services, LP,

I live in downtown Chicago. Each day—during my 30-minute walk (or drive) to the office—I pass through several neighborhoods where life expectancies can vary depending on historical discriminatory policies (e.g., zoning, redlining) and limited investments in the community. These neighborhoods are a reminder of how this city was built and how racism and segregation remain deeply embedded in some of its streets, neighborhoods, and institutions.

Decisions that were made many years ago may continue to impact the health of people who live in certain communities today. However, as we head into 2023, I am optimistic that these long-standing systemic and structural issues are receiving more attention and action.

When it comes to health, well-being, and opportunity, the deck is often stacked against people who live in systemically marginalized communities. All the clinical work done to prevent disease and treat illness won’t result in the intended outcomes if individuals return to the same environment that might have contributed to their illness. It can be frustrating to see a patient return to the doctor’s office or emergency room with an avoidable health issue that was caused by, or worsened by, their environment or unmet social needs.

The US health care system is often hindered by racism, bias, and structural flaws—including gaps in access, quality, affordability, and insurance coverage—that prevent health care from being equitable. Health inequities account for about $320 billion a year in avoidable health care spending in the US. If left unaddressed, health spending tied to inequities is on track to top $1 trillion by 2040, according to our actuarial estimates (see US health care can't afford health inequities).

• Access: Someone who lives in a rural environment is five times more likely to face challenges in finding a primary care physician compared to urban/suburban residents.1 Moreover, while 13% of the US population is Black, just 5% of physicians are Black.2 Some people are more comfortable seeking care from someone of the same race or ethnicity.
• Affordability: About 2.2 million people with incomes below the federal poverty level do not qualify for either their state’s Medicaid program or federal subsidies that can be used to buy health coverage through a public insurance exchange. Moreover, access to quality care is often limited for the more than 80 million people who rely on Medicaid.3
• Insurance coverage: Racially and ethnically diverse people make up about half of the nation’s 30 million uninsured.4

Health equity goes beyond equal access

Health equity is about much more than ensuring equal access to quality care. We define health equity as the ability to fulfill our human potential in all aspects of health and well-being. Since its inception in 2021, The U.S. Deloitte Health Equity Institute (DHEI) has been working with cross-sector collaborators to make health in our society more equitable. We believe that advancing health equity is both a moral and business imperative. Every organization, across every industry, has a role to play in making health more equitable within their organizations, in the communities they serve, and across ecosystems.

In 2022, I was encouraged to see an unprecedented focus on health inequities, which gives me hope that we are on the right path. Many organizations, employers, and government agencies have acknowledged that health equity is not a side game, and they are beginning to integrate it into their growth, financial, operational, and quality strategies. In 2023, I expect three primary levers—equitable communities, innovation, and key decision makers—will be used to remove barriers and push health equity further ahead:

Lever #1. Equitable communities: Many health systems are working to build more equitable communities by strengthening their long-standing partnerships with community-based organizations (CBOs), government agencies, financial institutions, locally owned businesses, and philanthropic foundations (see Advancing health equity through community-based ecosystems). The DHEI is working with a wide range of organizations including United Way5, the Morehouse School of Medicine6, CommonSpirit Health, the Robin Hood Foundation, and UnidosUS.7 Together, we are addressing issues that include equitable vaccine access, mental health, and issues related to women and children’s health. Our work has reinforced the idea that we need to scale what works and bring organizations together in communities to address place-based change. In 2023, I expect there will be even more work on investing in communities, and the voice of lived experience will become even stronger in shaping an equitable future because health equity is everyone’s business.

New and more convenient places where people can access care will likely continue to emerge in communities in 2023. Alternative sites of care could help ensure that health care services are available to patients when and where they need it. This could be in non-traditional clinical locations and outside of typical office hours. Many health care organizations have been trying to offer alternative sites of care in response to consumers and to reduce health care deserts in the communities they serve. According to our research, retail clinics, virtual health, and community health centers could bridge care delivery gaps for populations that have been historically underserved (see Advancing health through alternative sites of care). In 2023, I suspect there will be more community-based alternative sites of care.

Lever #2. Innovation: I expect technology and innovation will continue to help to reduce, and in some cases could help eliminate, gaps that make it difficult for some people to access quality health care. For example, nearly two-thirds of the health consumers we surveyed—across all races/ethnicities—said they would use virtual visits for preventive care (see Tapping virtual health’s potential). Moreover, nearly three in four Medicaid beneficiaries said they would use virtual health (apps or virtual visits) for mental health services.

Another key area to drive innovation is investment in the social entrepreneurship ecosystem to help create new, transformative approaches to address health equity.

Social entrepreneurs—racially and ethnically diverse people, women, and people from rural communities—could become more involved in leading change and bring their incredible ideas to the forefront. I also expect to see more resources and programs to upskill and develop workers from historically underserved and vulnerable communities.

Data and data analytics will continue to be a critical tool in advancing health equity. But that means that even more attention should be focused on the potential for algorithmic bias (see Rethinking when and how to use race appropriately in care delivery). Organizations should consider establishing AI governance to help ensure that data is used appropriately and doesn’t inadvertently widen inequities (see Erasing bias in emerging technologies). For example, we worked with March of Dimes to develop a data dashboard to help visualize maternity care deserts and other social and environmental factors. This not only helped us identify care deficits, but it also revealed community assets and opportunities for action. In the year ahead, I expect we will see even more sophisticated data dashboards and tools.

Lever #3. Key decision makers: Board members, CEOs, government and agency leaders, and other executives are usually well positioned to take on many of the big issues that influence health (e.g., health inequity, climate change, sustainability, and place-based inequities). In 2023, I expect we will see more collaboration among stakeholders and more investment and alignment around issues that cause health inequities. Our work with the Black Directors Health Equity Agenda suggests that there will be an even stronger emphasis on training diverse and inclusive leadership teams and boards. Leaders are expected to look closely at their leadership and board structures to help ensure that appropriate attention is being paid to health equity. Moreover, convergence among consumer, health, and technology industries will likely spur considerations on how strategic partnerships and mergers can enhance health equity or widen inequities. In 2023, policymakers might make more commitments to health equity. In November, for example, the Centers for Disease Control and Prevention committed to invest more than $3 billion in public health departments across the US.8 Modernizing the public health infrastructure will likely continue to be a focus for state governments and municipalities in 2023.

DHEI will increase investments in health equity in ’23

I expect DHEI will continue to be a catalyst for convening leaders and innovators, driving conversation around the business case for health equity, and supporting individuals, communities and organizations that are leading change. Since 2021, DHEI has invested over $15 million in more than 20 organizations to help them pull one or more of the three levers I highlighted above. In 2023, DHEI intends to continue those efforts to help organizations focus on many of the issues that contribute to health disparities.

All individuals should have the fair and just opportunity to fulfil their human potential in all aspects of health and wellbeing. This means that there are no differences in healthy years in a person’s life span, within and across communities.

Wishing you all happiness and good health in 2023!

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Endnotes:

1 About rural health care, The National Rural Health Association

2 Percentage of all active physicians by race/ethnicity, Association of American Medical Colleges

3 Closing the Medicaid coverage gap, Joint Economic Committee Democrats, January 20, 2022

4 Health insurance coverage in the United States, US Census Bureau, September 13, 2022

5 United Way Worldwide and Deloitte announce strategic collaboration, United Way, March 10, 2022

6 MSM receives $1.1 million from Deloitte Health Equity Institute to advance health equity, Morehouse School of Medicine, October 4, 2022

7 UnidosUS and Deloitte Health Equity Institute announce new collaboration, UnidosUS, November 30, 2022

8 An equity-focused CDC can address racial disparities in health and life, The Hill, December 7, 2022

This publication contains general information and predictions only and Deloitte is not, by means of this publication, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This publication is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional adviser.

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

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