Health Equity and Risk Management

🔥 Equity across the regulation, implementation and evaluation of digital health ⚖️ The digital transformation of healthcare should benefit the many, and in particular take into consideration the access and availability of health technology for vulnerable or disadvantaged population groups. 📢 The WHO Regional Office for Europe just published a much-needed report, reflecting how and to what extent equity is being covered in current (digital) health frameworks. 🕸️ Equity is being considered across six key components of a digital health system: digital infrastructure and systems, data, digital health tools, access to digital technology, digital skills for health, and use and engagement. 📌 The report identifies the need to 🔹 move towards an equitable digital health system 🔹 use tools and frameworks to operationalise equity 🔹 strengthen regulation, governance and financing for digital health equity 🔹 build capacity and cross-sectoral collaboration for digital health equity ⚡More detailed recommendations can be found in the report, such as - an interoperability maturity model that considers digital inclusion - addressing commercialisation risks, data exploitation and unethical use of AI - the inclusion of underrepresented groups in health data collection - evaluation frameworks to extend beyond technical performance - the impact of user-centred design on health outcomes and inequities - education and awareness to critically evaluate online content, navigate security risks and make informed choices 👍 Highly recommended reading! #digitalhealth #healthdata #equity #interoperability

Same disease, different journey... I operated on two patients in the same week. Both needed quadruple bypass surgery. Both had similar pathology. On paper, their risk profiles should have been comparable. They were not. The first arrived early. They were diagnosed, referred, optimised. Surgery was planned, controlled. Risk was acceptable. The second arrived late. Rural. Limited access to consistent primary care. Longstanding hypertension. Delayed presentation. Emergency attendance. By the time he reached us, his disease was advanced, his heart failing, his physiology compromised, and the margin for error significantly narrower. Same disease. Different journey. Different risk. Different outcome trajectory. That gap is where inequity resides. As clinicians, we often meet patients at the endpoint. But leadership requires us to look upstream, to the system that shaped that moment. Who gets access early? Who is delayed? And more fundamentally, are we providing care that is safe for everyone? Where is trust built? Where is it undermined? In Aotearoa, these patterns are consistent and they disproportionately affect Māori and rural communities. This is not about individual decision-making. It is about system design. We must do all we can in the moment of care. In hospital, we work hard to mitigate risk, restore health, and give every patient the best possible chance. But the greater the inequity in the community, the harder it becomes to overcome it within a single hospital episode. That does not lessen our responsibility. It sharpens it. It means striving for excellence in the care we provide, while also thinking more deeply about what we can do beyond the hospital walls through leadership, partnership, service design, and a sustained commitment to equity across the whole system. Leadership, then, is not simply delivering excellent care in the operating theatre. It is asking why patients arrive in fundamentally different states—and having the resolve to change that. Kia whakatōmuri te haere whakamua #Leadership #HealthEquity #Aotearoa #RuralHealth

💡 Been thinking a lot lately about how value-based care (VBC) and health equity tie together… and it’s clear there’s a long road ahead to make them work seamlessly. VBC has its heart in the right place—it’s supposed to bridge gaps in healthcare access and quality. But let's be for real: if we don’t address some stubborn barriers, we risk widening those gaps instead. Here’s what keeps coming up in conversations: 1️⃣ Disparities Aren’t New: Patients with public insurance (Medicaid/Medicare) or no insurance often see lower-quality care and worse outcomes. VBC is designed to change this, but without real structural shifts, we’re going to keep bumping into the same issues. 2️⃣ Unintended Setbacks for Safety-Net Providers: Some VBC programs inadvertently penalize the very hospitals and clinics committed to serving high-need communities. These places need more support, not added pressure, to serve patients effectively. 3️⃣ Risk Adjustment Matters: Not all patients start at the same place. VBC needs robust adjustments for social determinants of health. Otherwise, providers might find themselves navigating impossible choices with patients who need extra care. 4️⃣ A Health Equity Lens is Essential: We can’t just assume VBC will “naturally” reduce disparities—it has to be built to. We need metrics that specifically measure health equity progress and reward real reductions in care disparities. (I know I said physicians don't need more metrics in a previous post, but this is to measure work already being done, not add on more work!) 5️⃣ Insurance Barriers Are Still Real: Coverage type too often dictates care quality and access, even under VBC. Publicly insured and uninsured patients shouldn’t face added administrative and financial hoops. What am I missing? How are you making VBC work toward actual equity? Let’s keep this conversation real and solutions-focused! 👇 #ValueBasedCare #HealthEquity

Most health inequities don’t begin in hospitals. This new paper makes one thing painfully clear: Health disparities are not driven by isolated behaviors or single exposures. They are the biological consequence of cumulative structural stress, experienced across a lifetime. ✓ Chronic economic insecurity. ✓ Persistent discrimination. ✓ Environmental risk. ✓ Unequal access to safety, stability, and opportunity. These stressors don’t just shape lives. They shape biology. ⸻ What the data show is striking: → Long-term exposure to social and racial stressors accumulates physiologically → This accumulation manifests as chronic inflammation → And that inflammation helps explain persistent racial gaps in mortality They accounted for 49.3% of the racial disparity in mortality. In other words: Inequity gets under the skin long before it shows up in the clinic. ⸻ This has profound implications for global health and policy. For decades, our systems have focused on: → access to care → individual behavior change → downstream interventions But the evidence keeps telling us the same thing: You cannot treat your way out of structural harm. The real question is: “What conditions repeatedly place certain populations at risk long before care is needed?” ⸻ If we are serious about health equity, then equity must be: → upstream → cumulative → structural Not episodic. Not reactive. Not limited to the healthcare sector alone. ⸻ Health inequities are designed into systems, reinforced over time, and written into biology. And until policy reflects that reality, disparities will persist, no matter how advanced our medicine becomes. Equity is not achieved by equal access at the end of life’s pathway. It’s achieved by unequal investment at the beginning. — When people say, “health is political,” this is what they mean: Policy becomes biology. Biology becomes survival.

Honored to contribute to the Forbes conversation on making the business case for health equity. As EY's Chief Medical Officer and Center for Health Equity Leader, I believe that developing a business case that supports health disparity elimination, driven by astute financial modeling is an imperative to achieving health equity. First, we must define prioritized clinical conditions to address for gap closure. Second, we must understand the projected investments in health equity strategy and execution (people, programs, processes etc.). Thirdly, use financial modeling to codify the cost avoidance achieved through prevention, early disease detection, and efficient clinical care coordination in populations at risk for health disparities. Finally, aligning this insight with the required investment provides line of sight towards a realistic ROI related to this work. Let's make health equity an integral pillar of our business strategy. Read the article: https://lnkd.in/dJbFYTcA #HealthEquity #EY #Forbes #BDHEA Sophie O. Susan Garfield Caretha Coleman Deborah D. Phillips John Daniels Jr Regina Benjamin, MD, MBA Joe Wilkins, MBA, FACHE Alfonse Upshaw, NACD.DC

NCQA’s Latest Equity & Digital Quality Updates: What Every Value-Based Leader Should Know The next evolution of NCQA’s Health Equity & Digital Quality strategy is here — & it’s reshaping how we measure care, risk & performance across the VBC ecosystem. Here’s the short version 👇 1️⃣ Equity: Accessibility, Disability & Data Inclusion The 2026 Health Equity Accreditation (HEA & HEA Plus) standards expand what “equity” means in practice. 🔹 Disability & accommodation data collection is now a core requirement. 🔹 Geographic classification joins race/ethnicity as a disparity stratifier. 🔹 Community Health Worker (CHW) standards are formalized for training & supervision. 🔹 Focus expands from “cultural & linguistic” to appropriateness & accessibility for all populations. These shifts elevate equity from a program to a measurable system function — embedded in workflows, digital access & data infrastructure. 2️⃣ Digital Quality: From HEDIS to Real-Time Intelligence NCQA’s digital transition continues: 🔹 Digital HEDIS® moves quality reporting from annual to continuous. 🔹 Validation, test & parallel reporting pathways define readiness milestones. 🔹 New “dQM Implementation Validation” supports interoperability & trust in digital measures. Bottom line: manual abstraction & spreadsheet reporting won’t cut it in a digital quality era. 3️⃣ Why It Matters for Risk & Quality Leaders ✅ Equity is now quantified — you’ll need complete, stratified data to stay compliant. ✅ Digital readiness becomes a competitive advantage in payer & provider contracts. ✅ Success means blending analytics, accessibility & automation across the risk & quality continuum. What to Do Now ✔️ Audit how your org captures disability, accommodations & geographic data. ✔️ Check your portals & apps for accessibility — this is now an NCQA standard. ✔️ Engage with NCQA Digital Content Services & test your digital HEDIS readiness. ✔️ Educate stakeholders that “digital quality” = real-time & reliable performance. In short: These updates redefine equity & quality — moving us from reactive compliance to proactive, data-driven accountability. The leaders who prepare now will own the next generation of value-based care. At VBC One, we’re helping plans & provider partners navigate this exact transformation — aligning risk & quality in real-time. https://lnkd.in/gZRf9gU7 #NCQA #HealthEquity #DigitalQuality #HEDIS #ValueBasedCare #MSO #QualityImprovement #RiskAdjustment #PopulationHealth

There is increasing emphasis on using quality improvement to address health inequalities—but what does the evidence say about impact? A 2025 synthesis from The Health Equity Evidence Centre reviewed multiple QI programmes designed to reduce disparities in access, experience, and outcomes. 🔗 Read the report: https://lnkd.in/eMrJNKGd Across studies, the most effective interventions shared three core design features: - Data stratification (e.g. by deprivation, ethnicity) - Co-design with affected populations - Iterative testing using PDSA cycles Where quantitative results were reported: - Screening uptake increased by ~5–15 percentage points in underserved groups - Improvements in chronic disease outcomes (e.g. HbA1c reduction in targeted diabetes cohorts) - Reduced non-attendance when culturally tailored engagement strategies were used However, the review also highlights methodological gaps: - Limited use of controlled or quasi-experimental designs - Small-scale studies with variable generalisability - Sparse long-term sustainability data The implication is nuanced: 👉 QI can reduce inequalities—but only when equity is explicitly integrated into the design and delivery of the quality improvement work. Are we truly co-designing our quality improvement work with those who are most affected and most vulnerable to inequitable outcomes? Are we integrating equity into the way we design aim statements and measurement plans? Are we designing targeted interventions—not just universal ones? Are we testing and adapting with the same rigour we apply elsewhere in QI?