As serious systemic inequities have come into focus in recent years, health equity is top of mind for many of today’s healthcare leaders. This includes providing high reliability care (i.e., patient care that is consistently excellent and safe over long periods across all services and settings), addressing social determinants of health, increasing the diversity of healthcare leadership, and more.
One very important aspect of health equity that should not be overlooked is access to care.
While a key part of access is being able to get an appointment as quickly as possible when you’re sick, it’s broader than that. Access is about receiving acute, chronic, and preventive care and being able to tap into accurate health information to make informed decisions about your health in a timely manner. Without equitable access, patients will not experience equitable outcomes.
Defining—and Redefining—Access
Provider organizations have traditionally viewed access as a patient’s ability to receive timely care. However, a more comprehensive definition covers a wider spectrum, says LaTonya O’Neal, Principal at The Chartis Group.
“Health equity in access is achieved when every person has the opportunity to attain their full health potential regardless of race, gender, social position, or other socially determined circumstances,” she says.
Several factors in the current healthcare model contribute to inequitable access to healthcare. These can include a person’s zip code, their ability to pay, language barriers, and biased algorithms built into automated clinical decision-making tools, among others. Researchers have found that these factors can be so influential that in 56 of the largest U.S. cities, life expectancy disparities are as high as 20 to 30 years between people in different neighborhoods.
Many organizations do not trend patient outcomes data to assess whether access to care or delivery of care is equitable across all of the communities they serve. The result is that even though many organizations are well-intended and have missions to support equitable access, the reality is that they may not even know where inequities in access exist.
Analyzing internal data and integrating external patient data, as the American Hospital Association recommends, can help hospitals work to identify and address inequities within their communities.
Additionally, health systems and communities need to expand their concept of access beyond traditional brick-and-mortar hospitals.
“Do people have access to care only when they get sick and need to go to the emergency department, or are there resources within the community to promote general health and wellbeing?” asks James Karpook, Principal at The Chartis Group. “Access begins long before the patient sets foot in their provider’s office or other setting. This is where the conversation needs to go if we’re going to move the needle on patient outcomes. If we only improve on timeliness, we may not see equity in outcomes.”
Kathy Poston, Principal and Vice President of Client Delivery at Chartis Just Health Collective, agrees. “Hospitals tend to focus on social needs once the patient walks in the door,” she says. “Why can’t we flip this? Social needs are addressed before this point.”
Addressing New and Emerging Access Challenges
One of the biggest access-related challenges is having enough providers to meet the needs of the community, says Michael Topchik, National Leader for the Chartis Center for Rural Health.
“Nursing shortages are profound. However, persistent health professional shortages are very challenging. It’s not about timing to get in to see a specialist. In some areas, these specialists simply don’t exist,” he adds.
In addition, significant wait times increasingly exist in areas where access has traditionally not been a problem, says Raúl Zambrano, MD, Senior Consultant with Chartis Clinical Quality Solutions. Clinician burnout and turnover are growing causes. Political influences that make practicing in certain states challenging are another cause.
One emerging way to increase access to care is providing care beyond the traditional hospital or office setting. Delivering care at home via telehealth options, for instance, can dramatically improve access for those who may face challenges just to travel to a facility for in-person care. At the same time, organizations need to plan how they will address digital equity to help ensure these additional options increase access for everyone.
Taking Steps to Enhance Access to Care
How can provider organizations move the needle toward equitable access? Consider the following five strategies:
1. Form partnerships. Experts agree that provider organizations can’t solve the access to care issue completely on their own. They need to partner with payers, community organizations, local nursing homes, federally qualified health centers, and others.
Patient partnerships are equally as important. “One of the most important steps is to invite patients in the community to the table so stakeholders can hear what they need,” says Poston.
2. Address physician burnout. Provider shortages and physician burnout go hand in hand, and addressing burnout can potentially alleviate access challenges, says Zambrano. “Primary care physicians don’t want to spend hours at night documenting in the medical record after they’ve seen 20 to 30 patients. Doctors are leaving the profession because the burnout is so intense,” he adds.
3. Increase capacity. Some strategies can help improve the practice environment for physicians and increase the organization’s capacity to see patients. “Better leveraging other practitioners is one such strategy,” says Karpook. “Patient navigators can also help alleviate burnout while simultaneously improving efficiency and enhancing patient satisfaction.”
4. Think outside the box. Along with a push toward moving preventive care upstream, some communities have also embraced paramedicine, a new and evolving healthcare model in which paramedics and emergency medical technicians assist with public health efforts by providing primary healthcare and preventive services to underserved populations, says Topchik. This can greatly enhance health equity, he adds.
5. Leverage outcomes data. Provider organizations must be able to collect and trend patient outcomes data to understand whether access to care is truly equitable across all patient populations, says O’Neal. “Simply committing to equitable care isn’t enough—organizations need data to ensure that what they’re doing actually works,” she adds.
Paving the Foundation for Equitable Outcomes
Creating equal access paves a foundation for health equity, and it’s something that all provider organizations must improve, says Zambrano. Acknowledging this challenge and taking measurable action to address it is an important step toward achieving health equity.