University of California Health joins approximately 40 cross-sector health care organizations committing to collecting, stratifying, and reviewing data about race, ethnicity, language and sex across top metrics and sharing anonymized, aggregate-level information to inform best practices.
COVID-19 and the social injustice crises of 2020-2021 shined a new light on the systemic disparities in the U.S. health care system. Some disparities – such as with maternal and infant health – have long been understood within the industry. Many disparate impacts, however, remain unstudied and underappreciated. New research published last month, for instance, found that Black children experience higher complication rates that White children after having their appendix removed, an indication that such inequities are more widespread than previously believed.
A dearth of data continues to hinder a more comprehensive understanding of these disparities. Recognizing that fact, a Health Evolution Forum work group has been convening across the past year to agree on a consistent set of measures and approach to collecting, stratifying, and analyzing disparities data.
“The lack of data on health care outcomes by race, ethnicity, language and sex has kept the deep level of health disparities in our state and nation hidden. We need this information to be able to identify specific areas for actionable change that will make a difference in improving health equity,” said Carrie L. Byington, M.D., executive vice president of University of California Health and a co-chair of the Health Evolution Forum work group. “Once we can see patterns better through this additional data, we can tailor and test approaches to improve outcomes for people from groups that have not experienced the benefits of our health care systems on an equal basis.”
University of California Health has joined approximately 40 leading organizations in signing the Health Equity Pledge, committing to collect data about race, ethnicity, language and sex (REaLS) and then share what they learn to develop best practices that are ultimately disseminated broadly across the industry.
Organizations will share aggregate-level data (not patient/member-level data) directly with Health Evolution related to data capture and outcomes by race, ethnicity, language, and sex (REaLS) for 5-7 quality/access measures identified as being particularly disparity-sensitive and subject to opportunities for positive intervention (e.g., maternal mortality rate, substance use disorder rate, readmission rate, etc.). Submitting organizations would then be able to review how they compare to an aggregated and anonymized set of responses, with the idea of creating a safe place for organizations to benchmark against other organizations and to review results on disparity areas.
Going forward, the Health Evolution Forum will convene executive leadership and subject matter experts to develop real-world solutions around:
- Increasing collection of voluntarily self-reported (gold standard) race, ethnicity, language, and sex data
- Strengthening industry partnerships to dismantle collection and stratification barriers, including with large employers
- Driving more consistent adoption of data standards and definitions for improved stratification and review
“A concerted commitment to such collection and stratification for all key quality and performance metrics is critical to understanding and, most important, redressing disparities,” said Richard Schwartz, President, Health Evolution. “We are pleased to serve as a learning lab for this important endeavor and welcome other industry leaders to join in.”
Per results from a preliminary 2021 survey conducted by the Health Evolution Forum, the vast majority of responding organizations are collecting some patient/member data on race and ethnicity, but sizeable shortfalls remain in these collection efforts. Fewer organizations are tracking data at all on language and sex, and only 30 percent regularly review the disparities data they do collect. And none of the respondents stratified these data for all or nearly all (greater than 90 percent) of their business lines.
“Too few organizations are actually analyzing disparities data internally, developing dashboards, embedding it into clinical workflows, and making it public,” says Laurie Zephyrin, M.D., who is a Forum Fellow, and vice president, Advancing Health Equity, at The Commonwealth Fund.
These substantial gaps limit awareness and ability to implement equity-focused interventions and establish accountability mechanisms that strategically address health disparities.
To reduce variation in the ways data is applied to advance equity, Forum Fellows and other organizations pledge to, in the next three years:
- Collect REaLS data for at least 50 percent of the organization’s patient, member, or customer population
- Stratify and regularly review these collected data by the top-priority quality or access metric for 90 percent of major business lines and/or departments/divisions of adequate size
- Participate in the Health Evolution Health Equity Learning Lab by sharing stratified data for select measures to facilitate anonymized benchmarking and to identify best practices for reducing disparities
“It was important for us to figure out how to address this issue in ways that could resonate with everybody in our health care system, because our health care system doesn’t exist outside the void of the social polarization in our country,” said Mark Smith, M.D., a Forum Fellow and founding president & former CEO, California Health Care Foundation. “Equity is not separate from quality…it is part of quality. One doesn’t have to necessarily agree with my definition of social justice or yours to have equity as a professional aspiration and goal to which we hold ourselves and our institutions accountable.”
Organizations that have signed on to the Pledge to date:
Health plans: Blue Cross and Blue Shield of North Carolina, Blue Cross Blue Shield Association, GuideWell & Florida Blue, North Carolina Department of Health and Human Services, SCAN Health Plan
Health care providers: AIRnyc, Cancer Treatment Centers of America, Cityblock Health, Eleanor Health, Everside Health, Galileo, Gillette Children’s Specialty Healthcare, Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Hazel Health, John Muir Health, Link Primary Care, Marshfield Clinic Health System, Monogram Health, Nemours Children’s Health System, Northwell Health, Oak Street Health, Rebalanced-Life Wellness Association, Spectrum Health, SUN Behavioral Health, Thomas Jefferson University and Jefferson Health, University of Arkansas for Medical Sciences, University of California Health, VillageMD
Other organizations and individuals: ARCHANGELS, Accountable Care Learning Collaborative, Bloom Standard | Newborn Foundation, Capital Rx, Change Healthcare, eMed, Health Level Seven, Inc., Mark Smith – Founding President & Former CEO of California Health Care Foundation, Newtopia, Primary.Health, Socially Determined
The Health Evolution Forum is underwritten by Change Healthcare. No payment is required for an organization to endorse the Health Equity Pledge.