Health equity and why it matters
Should a person’s circumstances in life determine how deserving they are of medical care?
The answer in my heart—and, I imagine, most hearts—is no. From the physician’s office to the pharmaceutical manufacturer and everywhere in between, when we see a person facing a life-changing diagnosis, we want them to get the care they need regardless of who they are, where they live, or how much money they have. In fact, a 2022 report from Accenture and HIMSS Market Insights reveals that 93% of US healthcare executives believe in the importance of initiatives that promote health equity,1 or making sure everyone gets the high-quality care they deserve according to their specific needs.
But despite widespread support for the idea of health equity, it is far from our current reality. In the complex web of private and public entities that comprise the United States healthcare system—such as healthcare provider organizations, life science companies, pharmacies, insurance companies, and government agencies—access to quality health care is often dependent on a person’s ability to afford it. Many Americans lack adequate insurance coverage or are unable to pay out of pocket for necessary medical treatment, and this inequitable access to care contributes to an alarming disparity in health status and life expectancy: research shows that Americans in the bottom third of household wealth can expect to live 7 to 9 years fewer without disability (in terms of difficulty performing activities of daily living) than those in the top third.2
Because of statistics like this and the people behind them, advancing health equity has long been a passion of mine. It’s what led me to join the team at Annexus Health, a company on a mission to improve patient access to care by reducing the financial and administrative burdens that often stand in the way. But before we explore how Annexus Health’s solutions promote health equity, let’s take a closer look at the current state of affairs.
Where we are now: health disparities in the United States
While health equity is the goal, health disparities are the unfortunate status quo. Findings from the American Association for Cancer Research Cancer Disparities Progress Report 2022 help illustrate what health disparity looks like today, including:
- A 12% higher cancer death rate in people living in poverty compared with those who are not,3
- A 17% higher cancer death rate in people living in rural areas compared with those in urban areas,3
- And a 12% higher cancer death rate in Black women compared with White women (despite an 8% lower cancer incidence in the former group compared with the latter, likely due in part to fewer cancers being diagnosed at an early stage in Black women)3,4
The CDC defines health disparities as preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.5 The encouraging key word there is “preventable”—we can level the playing field to ensure optimal health care for everyone, but doing so is a big job, as health disparities are multifaceted, interrelated, and often deeply rooted in our socioeconomic system.
Indeed, socioeconomic status (including income, education, employment, and overall economic stability) is one of the primary drivers of health inequity in the United States.5,6 People with higher incomes and more resources are far more likely to have access to quality health care than those in poverty.7 Today, one in every 10 Americans is living in poverty, leaving even those with insurance unable to afford healthcare services—and avoiding care as a result.6,8 Moreover, many people affected by poverty struggle to afford other necessities of a healthy lifestyle, such as nutritious food and housing.6
Other significant areas of health inequity include race, ethnicity, gender, sexual orientation, geographic location, age, and disability status, with many of these factors often interlinked with socioeconomic status.9-13
Social determinants of health and how to effect positive change
As we look for ways to address disparities and move toward equity in health care, focusing on social determinants of health (SDOH) can provide a framework. SDOH refer to the environmental conditions that affect health, functioning, and quality of life outcomes and risks, and they are grouped into 5 domains14:
Interventions aimed at improving economic stability include employment programs, career counseling, and childcare opportunities. The goal is to help people find and keep jobs and earn steady incomes so they can afford basic health care. Programs and policies that help people pay for food, housing, health care, and education fall into this domain as well.6
Education access and quality
Because people with higher levels of education are more likely to live longer, healthier lives, increasing educational opportunities and investing in student success is critical to achieving health equity.15
Neighborhood and built environment
Improving the health and safety of communities can include policy changes at the local, state, and federal levels, such as those that improve air or water quality, address violence, or even add sidewalks and bike lanes.16
Social and community context
A person’s health and well-being can be significantly influenced by the quality of their relationships and interactions with family, friends, coworkers, and others in their community. Examples of interventions in this domain include efforts to provide social support to victims of bullying and children whose parents are incarcerated.17
Healthcare access and quality
Helping people get timely, comprehensive, and high-quality healthcare services is essential to health equity. This means overcoming barriers to care such as high healthcare costs, administrative hurdles, lack of adequate insurance, and transportation issues.18
The role of financial assistance and patient access services
Financial assistance and other patient access services offered by life science companies and charitable foundations play an important role in counteracting inequity in health care. They can dramatically reduce out-of-pocket treatment costs and other expenses (travel, lodging, physical therapy, psychosocial help, wigs, etc) for eligible patients, providing them with the opportunity to receive care that would otherwise be inaccessible to all but the wealthiest Americans.
In most cases, healthcare provider organizations (typically financial counselors or other administrative staff) are the gatekeepers for these critical resources. They are responsible for seeking out financial assistance and other access services for their patients, enrolling them into available programs, and tracking the status of the awards. For patients with serious health conditions requiring complex treatments, specialty pharmacies are often involved in the process as well.
But while these resources can make all the difference in a patient’s ability to get the care they need, they are often underutilized. And when available funds are left on the table, patients are left struggling unnecessarily to afford treatment. Many delay or simply go without needed care, their conditions worsening as a result; others take on medical debt that impedes their ability to pay for basic necessities like food, rent, and heat.19-21 In this way, the cycle of health disparity is perpetuated.
So, if financial assistance and other patient access services are out there, what keeps eligible patients from getting them? The answer is administrative toxicity across the patient access journey, including limited human resources within the provider organization, a reactive approach to managing patient access (that is, only seeking out financial assistance for those patients who state they cannot pay a medical bill), and cumbersome manual enrollment processes.
This is where Annexus Health comes in.
Annexus Health: we are health equity
When I started in my current role as Vice President of Strategic Initiatives at Annexus Health, I was eager to establish a health equity initiative at the company, as I had done at other workplaces in the past. But I quickly realized that health equity is already baked into every aspect of what Annexus Health is and does: our innovative solutions are designed to provide an equal opportunity for care by alleviating the administrative toxicity that keeps patients from receiving the resources they qualify for.
On the provider and specialty pharmacy end, our software platform, AssistPoint®, simplifies, streamlines, and speeds up the process for managing financial assistance and other access services. This makes it possible for these organizations to take a proactive approach and work up all patients for assistance so no one misses out on available resources—or needed care. AssistPoint users can search a comprehensive library of assistance options at the click of a button, quickly apply and enroll eligible patients into individual assistance opportunities, and actively monitor award fulfillment to ensure utilization and adherence. Moreover, a comprehensive suite of AP Analytics® reports available within AssistPoint helps organizations stay on top of all activities related to patient assistance.
For provider organizations that lack the human resources or infrastructure to proactively manage patient access, or those simply looking to improve efficiency and free up their administrative staff for other important work, our Adparo® services division empowers them to do so. Adparo minimizes the administrative burden on provider organizations by providing trained, experienced staff to utilize AssistPoint to perform an array of tasks related to patient access.
As part of our Adparo team’s commitment to health equity, we proactively work up every patient for financial assistance and other access services, dramatically increasing the number of patients who actually receive assistance. In a recent analysis of customer data, Adparo amplified financial assistance searches by a median of 323%, leading to a median boost in financial assistance awards secured of 158%.
On the life science and foundation end, Annexus Health is helping to improve the delivery of the actual patient support programs through which financial assistance and other access services are offered. Our technology-driven solution, AP Connect®, digitally integrates these programs with AssistPoint, bringing them directly into the provider workflow in connection with the practice management system to streamline and speed up the application, enrollment, and fulfillment processes so more eligible patients can benefit from these valuable resources.
Moving forward with optimism—and the right tools
As a society, we have a long way to go before we achieve true health equity, but I do believe we’ll get there. I believe it because health equity is finally a part of the cultural conversation, and a growing number of stakeholders across the spectrum of health care are actively seeking ways to advance it. Healthcare provider organizations, life science companies, foundations, and specialty pharmacies looking to address health disparities can leverage Annexus Health’s solutions to improve access to care for all patients.
About the contributor
Nicole Chambers is Vice President of Strategic Initiatives at Annexus Health, overseeing third-party relationships and partnerships. Prior to joining Annexus Health, she was a Corporate Account Director with AmerisourceBergen Specialty GPOs. Her background also includes work on AmerisourceBergen’s Innovation Team and the sales team at IntrinsiQ, as well as five years as an adjunct business and marketing professor at Monmouth University.
Nicole has been a champion of health equity and patient access throughout her career. She helped create and orchestrate the Disparities in Cancer Care Summit, a first-in-industry meeting that assembled thought leaders in health equity and led to the development of a consortium and a resource center for oncology practices. She also developed the first Solution Partner Summit, bringing together various technology and platform partners to collaborate on further improving care for patients using digital health care.
References: 1. Nine out of ten healthcare executives say that health equity initiatives are a top business priority, according to Accenture and HIMSS Insights: yet only 36% have a dedicated health equity agenda budget. Accenture. March 15, 2022. Accessed April 12, 2023. https://newsroom.accenture.com/news/nine-out-of-ten-healthcare-executives-say-that-health-equity-initiatives-are-a-top-business-priority-according-to-accenture-and-himss-insights.htm 2. Zaninotto P, Batty GD, Stenholm S, et al. Socioeconomic inequalities in disability-free life expectancy in older people from England and the United States: a cross-national population-based study. J Gerontol A Biol Sci Med Sci. 2020;75(5):906-913. doi:10.1093/gerona/glz266 3. AACR Cancer Disparities Progress Report 2022: Achieving the Bold Vision of Health Equity for Racial and Ethnic Minorities and Other Underserved Populations. Philadelphia: American Association for Cancer Research; 2022. https://cancerprogressreport.aacr.org/wp-content/uploads/sites/2/2022/06/AACR_CDPR_2022.pdf 4. More Black women die from breast cancer than any other cancer. American Cancer Society. February 14, 2022. Accessed April 12, 2023. https://www.cancer.org/latest-news/facts-and-figures-african-american-black-people-2022-2024.html 5. Health disparities. Centers for Disease Control and Prevention. Updated November 24, 2020. Accessed April 12, 2023. https://www.cdc.gov/healthyyouth/disparities/index.htm 6. Economic stability. Healthy People 2030. Accessed April 12, 2023. https://health.gov/healthypeople/objectives-and-data/browse-objectives/economic-stability 7. Khullar D, Chokshi DA. Health, income, and poverty: where we are and what could help. Health Affairs. October 4, 2018. Accessed April 12, 2023. https://www.healthaffairs.org/do/10.1377/hpb20180817.901935/ 8. Weinick RM, Byron SC, Bierman AS. Who can’t pay for health care? 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Last Census Bureau data shows Americans 65+ only group to experience increase in poverty. National Council on Aging. September 13, 2022. Accessed April 12, 2023. https://ncoa.org/article/latest-census-bureau-data-shows-americans-65-only-group-to-experience-increase-in-poverty 14. Social determinants of health. Healthy People 2030. Accessed April 12, 2023. https://health.gov/healthypeople/priority-areas/social-determinants-health 15. Education access and quality. Healthy People 2030. Accessed April 12, 2023. https://health.gov/healthypeople/objectives-and-data/browse-objectives/education-access-and-quality 16. Neighborhood and built environment. Healthy People 2030. Accessed April 12, 2023. https://health.gov/healthypeople/objectives-and-data/browse-objectives/neighborhood-and-built-environment 17. Social and community context. Healthy People 2030. Accessed April 12, 2023. https://health.gov/healthypeople/objectives-and-data/browse-objectives/social-and-community-context 18. Health care access and quality. Healthy People 2030. Accessed April 12, 2023. https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality 19. Poll: nearly 1 in 4 Americans taking prescription drugs say it’s difficult to afford their medicines, including larger shares among those with health issues, with low incomes and nearing Medicare age. Kaiser Family Foundation. March 1, 2019. Accessed April 12, 2023. https://www.kff.org/health-costs/press-release/poll-nearly-1-in-4-americans-taking-prescription-drugs-say-its-difficult-to-afford-medicines-including-larger-shares-with-low-incomes/ 20. Perez SL, Weissman A, Read S, et al. U.S. internists’ perspectives on discussing cost of care with patients: structured interviews and a survey. Ann Intern Med. 2019;170(9)(suppl):S39-S45. doi:10.7326/M18-2136 21. Collins SR, Gunja MZ, Aboulafia GN. U.S. health insurance coverage in 2020: a looming crisis in affordability: findings from the Commonwealth Fund Biennial Health Insurance Survey, 2020. The Commonwealth Fund. August 19, 2020. Accessed April 12, 2023. https://www.commonwealthfund.org/publications/issue-briefs/2020/aug/looming-crisis-health-coverage-2020-biennial