Best Practices for Addressing Health Disparities

As of 2018, life expectancy among Black Americans was 4 years lower than White people. In comparison to their White counterparts, Black, Hispanic, American Indian or Alaska Native, and Native Hawaiian or other Pacific Islander people are approximately twice as likely to die from COVID-19. Several challenges complicate the initiative to combat health disparities and achieve health equity, including data collection and analysis, clinical trial diversity, and formulary management. This session at the Academy of Managed Care Pharmacy (AMCP) Nexus meeting explored potential solutions to address each of these challenges.

Demographic data play a crucial role in addressing health equities, but challenges exist within standardization and measuring impacts. The National Committee for Quality Assurance (NCQA) works to test and implement initiatives with the goal of achieving equitable outcomes for all. Knowing the importance of data on race/ethnicity, language, gender identity, and sexual orientation, NCQA gathers these patient data using a standardized method. To reduce health disparities, NCQA utilizes these data to assess the existence of disparities and to focus quality improvement efforts toward improving the supply of culturally and linguistically appropriate services. Piloting with an assessment of 9 organizations (7 health plans and 2 health systems), NCQA found that organizational infrastructure must support data collection, use, sharing, and analysis. NCQA subsequently identified a need for educational resources informing healthcare stakeholders on the importance of demographic data, in addition to how to collect, use, and share it. NCQA concluded that having accurate demographic data to guide care, quality improvement, and national benchmarking is needed to make progress toward equity. NCQA provided the following recommendations in working toward health equity:

• Assess barriers to collecting data and using it effectively
• Map out the service area to determine areas of high disparities and overlapping needs
• Leverage community partners and healthcare providers to expand sources of data

According to the FDA, in 2020, 75% of clinical trial participants were White, 11% were Hispanic, 8% were Black, and 6% were Asian. Considering the lack of trial diversity, Takeda Pharmaceuticals found that equitable scientific discovery must be advanced through partnerships and community-centered strategies focused on education, access, and awareness. Thus, Takeda devised a strategic global health equity clinical trial framework known as PAVE:

• Partnering with community stakeholders
• Addressing operational barriers impeding patient access
• Verifying that internal diversity and inclusion goals represent real-world data
• Enhancing the diversity of trial sites

By partnering with community stakeholders, addressing operational barriers impeding patient access, verifying that internal diversity and inclusion goals represent real-world data, and enhancing the diversity of trial sites, Takeda aims to PAVE the way to diversity, equity, and inclusion. To achieve health equity, the focus must first center on the needs of historically marginalized patients and communities to provide actionable solutions; community-based organizations and stakeholders across the health ecosystem must be engaged to identify solutions and advocates for policy, to improve care delivery, to enhance digital equity, and to support patients and caregivers.

Acknowledging that many challenges in addressing health inequities in formulary management exist, Humana made addressing these challenges a priority by creating the capacity and resources to identify and implement strategies to address these inequities and to measure their subsequent impacts. Through this process, Humana found education to be key in shifting the culture of equity. Once equity gaps are identified, care should be taken to fill these gaps both in the short- and long-term. Lastly, Humana found that cross-collaboration among community members, providers, healthcare systems, payers, pharmacies, manufacturers, and state and national organizations is crucial, and that investing in resources, education, training, and cross-collaboration can help advance health equity.

Source:

Bedri A, Ndehi-Rice L, Powell L, Thuomi A. AMCP talks: best practices in addressing health disparities. Presented at: 2022 Academy of Managed Care Pharmacy Nexus Annual Meeting; October 11-14, 2022; National Harbor, MD. Educational session M7.