Health Equity is becoming a New Regulatory Reality | Deloitte US has been saved
By Jay Bhatt, D.O., managing director of the Deloitte Health Equity Institute and the Deloitte Center for Health Solutions, Deloitte Services, LP, and Josh Lee, National Health Equity Practice leader, Deloitte Consulting, LLP
Accrediting bodies, federal regulatory agencies, states, trade associations, and the White House are pushing health equity to the forefront. A raft of regulations, rules, and standards makes it clear that health equity should be considered as a key part of every health organization’s business strategy.
For example, the US Food and Drug Administration (FDA) recently said it will soon require researchers and companies seeking approval for late-stage clinical trials to submit a plan that ensures diversity among trial participants.1 (See our report, Enhancing diversity in clinical trials.) Here is a look at a few health equity initiatives being driven by other federal agencies, accrediting bodies, and trade groups:
The Joint Commission: The Joint Commission recently introduced a new leadership standard (LD.04.03.08) that focuses on health equity. The new rule, which went into effect on January 1, requires accredited hospitals, health systems, and other organizations to collect race and ethnicity information from patients. It also adds new requirements to help prevent discrimination among individuals who work in ambulatory and behavioral health care settings. Beginning July 1, that new standard will be elevated to a National Patient Safety Goal. This places health equity on par with other hospital safety issues such as surgical errors and hospital-acquired infections.2 This is the latest indication reinforcing that patient safety and health equity are two sides of the same coin. A spokesperson told us that surveyors have already received two training sessions to help them evaluate compliance with the new standards. Resource documents have also been developed for surveyors to establish a meaningful, consistent survey process, she said.
The Department of Health and Human Services (HHS): Last summer, HHS issued a Notice of Proposed Rulemaking to reinterpret and strengthen Section 1557 of the Affordable Care Act (ACA). The provision prohibits discrimination on the basis of race, ethnicity, sex, age or disability in health programs or activities that receive federal financial assistance.3
Centers for Medicare and Medicaid Services (CMS): Realizing Equity, Access, and Community Health (REACH) was one of the first new payment models to be introduced by the Biden administration, which has made health equity a specific goal. According to CMS, Medicare FFS beneficiaries who receive care through a REACH ACO (Accountable Care Organization) will have access to enhanced care-coordination services, telehealth visits, post-discharge home health care services, and may receive assistance with copayments. This new ACO model went into effect on January 1.4 (See our blog, New Medicare ACO payment model targets health equity.) Last August, the agency finalized a rule to establish “Birthing-Friendly” hospital designations to denote a hospital's a commitment to maternity care quality, safety, and equity. The new designations, along with three health equity-focused measures for hospital quality programs, are slated to go into effect this fall.5
The White House: Shortly after his administration began two years ago, President Biden launched a whole-of-government initiative to advance racial equity across federal policy making, programs, and institutions. The Executive Order (EO) on Advancing Racial Equity and Support for Underserved Communities, helped to establish health equity as a priority for the administration.6 On February 16, the president signed a new EO to build on earlier efforts to strengthen racial equity and support for underserved communities.7 The White House has also issued a Blueprint for an AI Bill of Rights, which contains several elements relevant to health care, including a call for continuous disparity testing to prevent algorithmic discrimination (see Can digital tech and regulators help improve health equity?)
Trade associations: Some trade groups have established internal groups focused on health equity. The American Medical Association (AMA), for example, launched its Center for Health Equity in 2019 and hired its first Chief Health Equity Officer. The AMA has also developed a three-year roadmap to improve action and accountability to advance health equity.8 The American Hospital Association has an Institute for Diversity and Health Equity.9 Last fall, America’s Health Insurance Plans (AHIP) finalized new demographic data-collection standards for its member health plans. The trade group intends to use better data to reduce health disparities.10
Consider the Four Domains of Health Equity
We encourage health care leadership to identify the root causes of health disparities among their patients and within the communities they serve, quantify them, look for ways to address them, and measure their progress. These leaders should also consider ways to incorporate a regulatory/compliance strategy into all health equity initiatives.
We have identified Four Domains of health equity that could be a part of that strategy:
Over the past couple of years, we have seen health equity be prioritized by the number of new rules, regulations, standards, and measures that could have a real impact. At the same time, some organizations are pushing back on efforts that they consider too onerous. Many of the rules and regulations cited above were developed to help ensure health equity becomes integrated into the core business. Health equity appears to be becoming an important component for all organizations. We expect health equity may eventually be elevated to the same level as finance, quality, and safety within organizational priorities.
This publication contains general information 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 advisor.
Deloitte shall not be responsible for any loss sustained by any person who relies on this publication.
Latest news from @DeloitteHealth
1 Clinical Trial Diversity, US Food & Drug Administration, November 4, 2022
2 Advancing health equity, together, The Joint Commission
3 Nondiscrimination in health programs and activities, the Federal Register, August 4, 2022
4 CMS announces increase in 2023 in organizations and beneficiaries, January 17, 2023
5 CMS proposes policies to advance health equity and maternal health, CMS press release, April 18, 2022
6 Executive Order On Advancing Racial Equity and Support for Underserved Communities, January 20, 2021
7 Executive Order on Further Advancing Racial Equity, The White House, February 16, 2023
8 AMA Center for Health Equity
9 AHA Institute for Diversity and Health Equity
10 Here’s how we reduce health disparities with better data, AHIP, October 19, 2022
11 Emergency savings program fuels employees’ financial security and well-being, Delta News Hub, Delta Airlines, January 23, 2023
12 Economic well-being of US households, The Federal Reserve System, August 22, 2022
13 Emergency savings program fuels employees’ financial security and well-being, Delta News Hub, Delta Airlines, January 23, 2023
14 Health Equity Accelerator, Boston Medical Center, November 16, 2021
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