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1/8/21

Can value-based care solve healthcare inequity? It gets us one-step closer.

Coronavirus disease 2019 (COVID-19) has rapidly swept across the globe during this past year, causing significant challenges to our society as a whole.  The advanced science guiding our communities has proven to be volatile, thus creating further challenges for society to make sense of it all.  Humana’s chief medical and corporate affairs officer, Dr. William Shrank, had the unique opportunity to speak with four former U.S. surgeons general asking for their insights and understanding of the learnings so far, and how to move forward as this pandemic continues to surge across our country.

Dr. Shrank opened the session at the Value-based Care (VBC) Summit, hosted by Xtelligent Media, on November 19th in the company of Dr. Antonia Novello (14th Surgeon General), Dr. M. Jocelyn Elders (15th Surgeon General), Dr. David Satcher (16th Surgeon General), and Dr. Richard Carmona (17th Surgeon General). He highlighted the significant and unpredictable changes our communities are experiencing due to the recent pandemic, and noted that this is the most damaging public health emergency we have faced as a nation in over a century. 

Click here to see a clip of their conversation. 

Experts agree that disparities in healthcare have been illuminated by this pandemic and value-based care principles have proven worthy of inclusion in a future healthcare system. It was an honor to hear from these four surgeon generals, who have tackled a multitude of global health crises while serving the U.S., including climate change, addiction and mental health, as well as viral outbreaks – just to name a few. Listening to their wisdom and heeding their advice, and of those like-minded, is imperative during these trying times.

Dr. Carmona did not waste time in pointing out, “…there’s a sensitivity to understanding the differences in populations that we have the privilege to care for, and if you don’t understand the culture, then you’re going to miss the boat.” Along with several colleagues, Dr. Carmona published an article in JAMA in the early summer reporting disturbing national trends that highlight the disproportionate effect COVID-19 has had on ethnic minority populations. Our current healthcare system tends to overlook the various factors that determine a population’s health state. Just as genetic factors can cause disease, certain societal, cultural, and environmental factors equally do so as well; unfortunately, addressing the latter has eluded our health system until recently.

The Hispanic and African-American populations are under a particular amount of stress from the pandemic. “We [Hispanics] are a quarter of the labor force, but we are three-quarters of those that get infected. We are the forefront of the workforce. Therefore, we are the most infected,” Dr. Novello emphasized, as she noted the deficiencies of our current system to serve a multicultural society. A significant recurrent theme delivered by the surgeons general was that COVID-19 is a wakeup call to pay attention to social determinants of health, making sure we achieve health equity for each and every American. 

This concept lies at the heart of a value-based care system, as policies, technologies, and community partnerships integrate into basic patient care in order address these problems. Dr. Elders voiced similar concerns regarding the distribution of the newly developed vaccine. She highlighted that rural communities, in particular, are at a higher risk of not receiving adequate vaccinations. An alarming degree of social disparities exist in these regions, such as high rates of unemployment and barriers to education. Dr. Elders emphasized, “A lot of people will be missed, and those will be the people who need it the most.”  She reiterated the necessity for communities to work as one unit, as payers and providers ensure the efficient allocation of vaccines.

This idea was echoed by Dr. Satcher who said, “We have the opportunity, as a nation, to really lead the world in terms of public health. It’s when they [payers, providers, and public health officials] work together that we see the best results.”  Dr. Satcher recently published a book that details his experiences and approach to leadership, and how he has worked to eliminate health disparities.

During this conversation, one thing was clear: no one entity has the ability to remove these barriers alone. Value-based care principles reinforce community-based organizations and healthcare interconnectivity, because these partnerships are poised uniquely to address social determinants of health. Each surgeon general recognized that the increased adoption of value-based care will be important as we move forward, and it is going to take all industry stakeholders, aligned around this model, to create lasting change.

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