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Brief

How to Advance Health Equity While Improving Your Bottom Line
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Executive Summary
  • Health equity ranks among US healthcare executives’ top five priorities, yet only 18% say they have a well-defined strategy supported by goals, metrics, and milestones.
  • Many treat health equity solely as a philanthropic effort, without the rigor and accountability they apply to other strategic efforts, hindering its success.
  • Companies that tie health equity to their core strategy and operations can encourage more equitable patient outcomes while also improving financial outcomes and deepening customer engagement.
  • Addressing health equity requires the same steps as any complex business issue: Set measurable goals, quantify the value potential, target specific inequities, and hold people accountable for execution.

The nationwide data on health inequity is established and well-known among US healthcare leaders. What is less understood is why they continue to struggle to see meaningful results.

Healthcare executives know that they are uniquely positioned to advance health equity. They see the imperative: Across providers, payers, pharma, and medtech companies, executives rank it among their top five priorities, according to a recent Bain survey (see Figure 1).

Yet this hasn’t been enough to move the needle on such a pressing societal need. While 78% of healthcare executives say that they have a health equity strategy, just 18% say that their strategy is well-defined and supported by tracked goals, metrics, and milestones. Only 43% of those who have a strategy believe that it has been effective.

Figure 1

Health equity is a top priority, but few executives say that their strategy is effective

The disconnect between intent and outcome stems from perceptions around why health equity is a top priority. About 30% of executives believe the case for improving health equity is entirely social, without business motivations. As a result, they often treat health equity initiatives as philanthropic endeavors that lack the same rigor and dedicated resources as critical bottom-line strategies. This allows other initiatives to take precedence and pull focus from health equity—our survey shows that competing priorities are the No. 1 barrier to progress, according to executives (see Figure 2).

Figure 2

Competing priorities represent the biggest barrier to advancing health equity

Competing priorities represent the biggest barrier to advancing health equity

Addressing health equity can mutually improve patient and financial outcomes. In addition to the widely recognized effect of bolstering brand reputation and customer loyalty, visible and effective health equity strategies have the power to grow market share and supercharge productivity and efficiency. With so much room for improvement, early movers stand to gain an outsized competitive advantage. The healthcare organizations that identify and implement tactical strategies can make real and sustained progress in reducing health inequity while capturing new value.

The case for change

Health equity means everyone has a fair and just opportunity to be as healthy as possible. That’s not currently the case in the US.

Closing the gap will require countering racial, socioeconomic, and other forms of discrimination by reducing and eventually eliminating the complex and interrelated structural obstacles to health. While there are many forms of health inequity, our research primarily focuses on racial inequities—and we believe that improving health outcomes for underserved populations will have a knock-on effect for everyone in bringing more innovative strategies, products, and services to market.

Inequity by the numbers: Black Americans
  • 2 times higher age-adjusted mortality rate of diabetes for Black Americans vs. white Americans
  • 3 times the rate of pregnancy-related deaths for Black women vs. white women
  • 1.5 times the likelihood of nonelderly Black Americans to be uninsured vs. nonelderly white Americans
  • 2 times more Black adults report not seeing a doctor in the past year because of cost vs. white adults

Despite good intentions, progress has been slow. Improving health equity is undoubtedly the right thing to do, but compassion and morality alone haven’t proved enough to sustain the clear strategy, leadership commitment, and funding needed to make real progress.

Today, the most successful healthcare leaders are marrying a critical moral imperative with a strategic one and establishing the specific business case for health equity at their company. As with any other critical strategy, making the business case ensures that health equity is supported by concrete actions and the dedicated time, talent, and funding it needs.

The business case hasn’t always been clear, but more executives are starting to see the full picture. Around 75% indicate that health equity bolsters customer loyalty and brand value. What’s more, 53% see it as a strategy to increase revenue, and 34% see it as an opportunity to cut costs, according to our survey.

With a thoughtful, comprehensive strategy, health equity can achieve all these ends and spur a virtuous cycle of value creation. Consider, for instance, a pharmaceutical company with a successful cancer drug. Recognizing that structural inequities create obstacles to early screening and effective treatment in marginalized communities, the company developed programs to increase access. These efforts led to earlier and better treatment, in turn, increasing sales of its cancer drug. Armed with a clear business return for its efforts, the company invested in better understanding the obstacles to care and deepening its partnerships with community and nongovernmental organizations that could expand the company’s reach. Beyond increasing sales, the company’s efforts have been a differentiating factor among clinical partners and customers, further improving its competitive positioning.

Today, few companies have taken the necessary steps to propel this virtuous cycle. While 59% of companies report publicly announcing their strategy, fewer than 30% tie health equity outcomes to their commercialization and other corporate strategic initiatives, and only 15% tie it to executive compensation (see Figure 3). That’s a miss: We’ve found that companies that say they have made progress in health equity initiatives are nearly twice as likely to tie them to executive compensation and commercialization.

Figure 3

Many companies publicly announce a health equity strategy, but few have implemented best practices

Many companies publicly announce a health equity strategy, but few have implemented best practices

Four pragmatic steps to close the health equity gap

We are in the early days of CEOs tackling health equity as a strategic priority. Opportunities abound for companies to improve their leadership position, capture new sources of value, differentiate from competitors, and inspire employees. CEOs can take four important steps to establish the economics of health equity and start to close the gap.

Step No. 1: Set a health equity ambition. A deep understanding of the racial health inequities that affect customers is critical to setting the right ambition. Health equity leaders start by building a fact base of internal and external health data to identify disparities and develop a specific mission for improvement in areas in which they are best positioned to propel change.

Pursuing this ambition is a top-down effort—otherwise, competing priorities will continue to consume funding, time, and resources. Some companies create a sponsorship spine, or a coalition of individuals from core business units who possess the influence to generate enduring change at every level. When business units own the health equity strategy, it strengthens the case that health equity goals are tied to business goals.

Early in its health equity journey, payer Blue Cross Blue Shield of Massachusetts (BCBSMA) realized it had not systematically measured racial and ethnic inequities in the care its members received. To build trust and public accountability, leadership started systematically measuring and publishing data on a set of comprehensive equity metrics.

That was only the start. The CEO and board aligned on a clear ambition to address these racial and ethnic inequities in care, allocated the necessary resources, and cascaded a centralized strategy down to the front line. Their goal was to turn their health equity program into a market differentiator that attracts both individuals and employers with a higher level of care quality, consumer experience, and affordability for all members.

To improve performance on their equity metrics and realize their vision, leadership understood the need to incentivize change. BCBSMA partnered with Massachusetts’s largest providers to measure and reward measurable reductions in health inequities, introducing financial incentives tied to improvements in healthcare equity. To jump-start change and support providers’ efforts, BCBSMA also provided $25 million in grants to physician practices and hospitals for initiatives intended to improve equity of care, such as extended cancer screening hours and mobile mammography units.

Working to eliminate health inequities is the right thing to do. It’s also probably the most powerful lens through which we can improve the healthcare system for everyone. I am thrilled that our plan is helping lead the way on a new generation of health equity work that is grounded in deep partnership, support, and accountability.

Sarah Iselin, president and CEO, Blue Cross Blue Shield of Massachusetts

Step No. 2: Establish that what’s good for society also is good for business by quantifying how health equity improvements also deliver economic value. It can be difficult for companies grappling with margin pressures and other urgent investment needs to reconcile the immediate cost of advancing health equity with the long-term gains. Health executives tend to quantify the investment needed today but often fail to calculate the estimated potential value or the timeline for the return on that investment. Groundbreaking companies, however, do both. They quantify the economics of health equity by identifying areas where their strategy will not only address inequities but also create value through growth, profit expansion, or both. They have proven that their efforts can result in financial outcomes and should be a core part of their business model.

One leading medtech company, which had started out with a range of fragmented grassroots health equity efforts, knew that the scale, reach, and potential value of its efforts were falling short. Its business unit leaders realized they would need to demonstrate tangible, sustainable value early on to justify the sizable investment of an organization-wide strategy. Leaders pinpointed three specific goals—increase the volume and usage of a lab for identifying a particular condition; gain market share with higher equipment sales; create more revenue from service contracts—in three different geographies, showcasing how increasing health access in these specific areas could be a win-win for customers, patients, and the company. For each initiative, they quantified the overall potential value, the capabilities and partnerships required to scale, and specific metrics to track success. In clearly articulating the value at stake, business unit leaders mobilized everyone from the board to the front line.

Through this work, the company also realized that it didn’t need to shoulder this strategy nor its required investments alone. Recognizing it could only improve certain parts of the value chain, the company strategically partnered with policymakers, nongovernmental organizations, and companies in care delivery and pharma to help fund and execute its new initiatives.

Step No. 3: Create a strategy that targets inequities. The most successful companies are focusing on highly specific, achievable, and measurable goals, which they prioritize by the greatest potential for health and business outcomes and plot on feasible timelines. For each goal, leaders track progress with the right metrics—and they don’t shy away from data complexity, ensuring that they can affect real change. To establish organization-wide accountability, executives tie targets back to employee incentives, such as bonuses, and publicly and consistently report on progress.

For example, provider Mass General Brigham (MGB) started its system-wide health equity journey by collecting data to quantify health disparities, then establishing internal and external goals to close the gaps. Establishing specific timelines and metrics to measure its pace and effectiveness, MGB has already seen tangible progress since launching its United Against Racism strategy in 2020. The provider has met its ambitions to hire 11 bilingual digital access coordinators, invested $50 million in community mental health and social risk mitigation strategies, and established a more accurate calculation for chronic kidney disease that has reclassified one in three Black patients to their correct stage.

In a well-articulated, focused strategy, all short-term goals contribute to the organization’s longer-term ambitions. They are also rooted in patients’ health outcomes rather than focusing on donations or ancillary activities.

Biopharmaceutical company Global Blood Therapeutics (GBT) set the bold ambition to revolutionize sickle-cell disease treatment with the first oral drug to treat the root cause of the disease. To lay the groundwork for this clear, differentiating mission, GBT made several short- and long-term moves. For instance, understanding the importance of racial representation at the R&D stage, GBT conducted clinical studies at nontraditional sites in Kenya, Oman, and Nigeria while working with community advocacy groups to fund, train, and build new research sites for the future.

Everything we did was focused on improving the lives of underserved communities.

Jung Choi, chief strategy and business officer, Global Blood Therapeutics

Step No. 4: Establish strong buy-in and execution. To sustain momentum, leading companies create a detailed execution plan. Similar to other revenue and cost initiatives, the best plans include an implementation roadmap that defines milestones, owners, and capital allocation. Practical industry leaders don’t try to fix all aspects of health equity at once. They start with specific programs and pilots, use robust analytics and monitoring tools to identify areas for improvement, and iterate as they scale initiatives across the organization.

Companies can pair this roadmap with a change management plan. Change management must start at the top, requiring executive leadership to visibly support health equity initiatives. This includes concise, tailored internal and external communication, ensuring employees and stakeholders have the right information at the right time. Clear action and accountability can bring the organization’s ambition to life, inspiring employees, strengthening engagement and morale, and enhancing productivity.

Health equity leaders are also adapting their business processes and incentives to support their strategies. Best practices include incorporating health equity goals into quarterly and annual budget meetings, protecting employee time for necessary trainings, developing a multiyear graduated scale of incentives for senior leadership, and hosting panel discussions of patient communities to bring the faces and voices of health inequity to employees.

A commitment to health equity has to be in the water. We equated health equity with our efforts to improve safety and quality, which resonated with clinicians.

Elsie Taveras, MD, MPH, chief community health and health equity officer, Mass General Brigham

The health equity toolkit

Meaningfully advancing health equity will require many new capabilities. These four can be a good place to start:

  • Collecting and analyzing racially disaggregated data. According to our survey, only 57% of healthcare companies say that they are currently collecting and analyzing standardized race, ethnicity, and language data. Those that do have a distinct advantage: With data-based insights, they can design and execute customized interventions that target the specific needs of different racial groups.
  • Advancing equity within their own companies. Health equity leaders embed equity within the organization by tracking hiring and promotion statistics by race and gender, establishing leadership diversity goals, setting up health benefit packages for equitable access, and investing in unconscious bias training and formal sponsorship programs.
  • Developing and learning from community and patient advisory boards. Given the historical and systemic racism in healthcare, it’s critical for companies to give communities of color a voice in solving the inequities they face, yet only 11% of healthcare companies surveyed are partnering with community organizations. Some leading companies are bringing together advisory boards of beneficiaries, caregivers, community health advisers, care coordinators, and patients to share their perspectives and provide feedback around key decisions.
  • Starting or supporting coalitions of complementary organizations. No healthcare company can close the equity gap on its own, and in some instances, blended capital may be a critical part of delivering equitable outcomes to the most vulnerable in society. Leading companies are leveraging the collective strengths of key opinion leaders, policymakers, complementary healthcare organizations, community advisory boards, and community-based organizations to address shared goals and overcome complex challenges.

Making tangible progress in health equity requires more than public commitments and good intentions. The most effective leaders will treat health equity as both a moral imperative and a way to improve financial outcomes and deepen customer engagement. This perspective has the power to sustain efforts in the long-term and close health equity gaps at scale, ensuring that the companies on the front lines are a critical part of the solution, with the added benefit of improving their bottom line.

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