Health Equity blog

Kaiser Family Foundation’s (KFF’s) most recent Survey on Racism, Discrimination, and Health, shows that, although mental illness reported by Hispanic, Black, and Asian adults is comparatively less than among White adults, the figures may be misleading due to such factors as lack of culturally sensitive screening tools used in diagnosing mental illness. The survey’s data includes responses indicating that people of color encounter difficulties locating health care providers with shared backgrounds and experiences, lack access to mental health information, and experience stigma and embarrassment obstacles to seeking mental health care in the first place. According to KFF, this data suggests that enhancing knowledge of culturally competent care among mental health care providers and diversifying the mental health care workforce are desperately needed. In addition, targeted outreach and education efforts among specific communities could increase awareness of mental health resources and help eradicate the stigma associated with seeking mental health care.

During the past ten years, many California hospitals – 17 in L.A. County alone – have been shuttering their labor and delivery programs because of devastating financial losses compared to other service lines. In L.A., however, nonprofit Martin Luther King Jr. Community Hospital is defying the odds by continuing to offer these desperately needed services to the largely non-White community it serves in furtherance of its charitable mission. Although some of these closures are attributed to large national for-profit hospital systems concerned about their bottom line being negatively impacted, low Medi-Cal reimbursement rates have definitely been a culprit as well. The consensus among California hospital administrators appears to be that the labor and delivery crisis will continue, jeopardizing access to maternal care in many already underserved communities, until Medi-Cal reimbursement for these services at least enables hospitals to break even.

For the first time, U.S. News & World Report has identified 53 hospitals that have produced enviable health care outcomes, while at the same time serving significant numbers of disadvantaged people of color, in an overt commitment to ensuring equitable access to care. Each of these hospitals was previously recognized by U.S. News in its Best Regional Hospitals rankings for its laudable health care outcomes without taking into consideration the impact such additional Social Determinants of Health (SDOH) factors might have had on patient outcomes. To make this new list, each hospital had to meet at least two of three additional criteria: at least 40% of Medicare inpatient visits involved patients living in socioeconomically deprived communities, the hospital serves a sizable Medicaid population, and its patient population reflects the racial and ethnic diversity of the surrounding community. 

In 2022, the Center for Medicare and Medicaid Innovation (CMMI), as part of its Advance Health Equity objective, rolled out a new health equity initiative. Its stated goals are to increase safety-net provider participation, develop new models and revise existing models to promote and incentivize equitable care, monitor and evaluate models for health equity impact, and increase collection and analysis of equity data. Notable achievements have been made with respect to each goal. New work this year includes payment innovations to narrow disparities in care, a focus on safety-net provider participation in models to improve care for more beneficiaries, and data collection that advances a comprehensive approach to care.

The Department of Health and Human Services (HHS) Office of Minority Health has been tracking efforts within the industry to reduce biases in healthcare algorithms and AI. Most recently, it described how the Agency for Healthcare Research and Quality and the National Institute for Minority Health and Health Disparities assembled a diverse panel of experts to review evidence, hear from stakeholders, and receive community feedback. This information will help inform development of a conceptual framework that includes five guiding principles for mitigating and preventing bias in health care algorithms, thereby promoting health care equity.

Still in the wake of the highly controversial Supreme Court of the United States (SCOTUS) 2022 Dobbs v. Jackson Women’s Health Organization decision, the Department of Health and Human Services (HHS) has amended the Privacy Rule to prohibit covered entities and their business associates from disclosing protected health information (PHI) for the purpose of investigating or imposing liability on individuals simply because they seek, obtain, provide, or facilitate reproductive health care that is lawful under applicable state law. (To read more about this regulation, please see HLB’s previous alert available here.)

On other reproductive law fronts, two forthcoming SCOTUS opinions could stand to have wide-reaching repercussions. One is FDA v. Alliance for Hippocratic Medicine, which will decide whether mifepristone – one of two FDA-approved medication abortion drugs – remains readily available in the U.S. The other, Moyle v. United States,  will determine whether EMTALA’s requirement to provide “necessarily stabilizing treatment” preempts an Idaho law, in the emergency context, that bans most abortions.

On May 6, CMS and Office of Civil Rights (OCR) issued a final rule promulgated pursuant to Section 1557 of the ACA as a regulatory attempt to instill further protections against discrimination in health care. Among the new rule’s objectives are a broadening of physical/digital accessibility, decreased presence of language access barriers, and reduction of bias in health technology. In a nod to the growing prominence of AI usage in health care, the rule clarifies that nondiscrimination in health programs and activities applies to the use of AI, predictive analytics, clinical algorithms, and other technology tools.

The Nursing is STEM Coalition is leading efforts by the nursing profession to end the current divide among federal agencies as to whether nursing should be considered a STEM occupation. The Department of Homeland Security (DHS) is its first targeted agency because adding nursing to DHS’s STEM Designated Program List would allow foreign nursing students to stay in the U.S. longer following graduation, thereby helping to alleviate the dire nursing shortage that continues to plague the health care industry. The Coalition notes that other federal agencies tend to follow DHS’s lead when deciding whether to recognize a discipline as a STEM field. Moreover, such broadened recognition could make additional federal monies available to expand nursing education, which would also help further reduce the U.S. nursing shortage.

The Increasing Organ Transplant Access (IOTA), through the Centers for Medicare and Medicaid Innovation (CMMI) seeks to increase access to transplant through incentive opportunities for transplant hospitals and measurement based on number of transplants, organ acceptance rates and outcomes. Notably, aspects of the IOTA Model would promote health equity in the process since access to organ transplantation is often impacted by race and other socio-demographic characteristics. Toward this goal, two of the features the model would include a health equity adjustment for transplants performed on certain low-income populations and allow flexibilities to address social drivers of health.

The latest measure by the Food and Drug Administration (FDA) to help reduce health care disparities and improve health outcomes for minorities and underserved populations aims to make health care services available to patients in their homes. Spurred by the proliferation of telehealth that occurred during the COVID-19 pandemic, the FDA’s Center for Devices and Radiological Health (CDRH) has retained an architectural firm to design a prototype home that is equipped with Augmented Reality/Virtual Reality (AR/VR) and other state-of-the-art technology that will help promote health equity. The FDA’s aspiration is that the Home as a Health Care Hub will also bring together policy makers, medical device developers, and providers to begin developing home-based solutions that further advance health equity.