Inequities within the health care system are not only proving to be persistent, but they are getting worse.
Panelists at the Providence Business News Spring 2023 Health Care Summit and Health Care Heroes Awards on April 6 at the Providence Marriott Downtown discussed some of the causes of these inequities and the effects they have on patients from underserved communities in the state.
“Things are continuing to be pretty devastating on the health equity front,” said Martha Wofford, CEO and president of Blue Cross & Blue Shield of Rhode Island. “This is such a big set of issues; we need everybody in the state to work together to address this.”
Wofford was joined during one of the panel discussions by Eric Swain, vice president of sales and account management at United HealthCare of New England Inc.; Kirsten Hokeness, director of the Bryant University School of Health and Behavioral Sciences; Dr. Claire Levesque, chief medical officer of commercial products at Point32Health Services Inc.; Peter Marino, CEO and president of Neighborhood Health Plan of Rhode Island; and Dr. Methodius Tuuli, chief of obstetrics and gynecology at Women & Infants Hospital.
Panelists touched on several topics concerning health care in the state, from health equity and affordability to workforce shortages and access to care. On health equity, they agreed that the state is facing a critical crisis that requires collaboration not just from health care leaders but from everyone in the sector.
“Maternal health is a collective societal problem for which each of us has a part to play,” Tuuli said.
One of the most staggering examples of health inequities in the state is evident when looking at maternal mortality rates. Tuuli had a bleak outlook to share with the panelists: Black and brown patients suffer two- to threefold higher rates of mortality than non-Black or non-brown patients, he said.
Earlier this year, a report by Rhode Island KIDS COUNT highlighted the disparities in maternal, infant and child health that disproportionately affect women and children of color, finding that women of color are more likely to be uninsured and more likely to receive delayed prenatal care.
It’s not just Rhode Island: overall, the United States ranks last among developed countries in terms of maternal health, Tuuli said.
“Maternity care in general shouldn’t be last in developed countries,” Levesque said. “It’s really an embarrassment for our country.”
This only got worse during the pandemic, as maternal mortality rates increased 40% across the United States, Tuuli said. And this is only looking at mortality, which is the “tip of the iceberg.” Countless patients suffer from life-altering complications. But the only way to make progress overall, Tuuli said, is to “make an impact on those who suffer the complications the most.”
Two things are key to tackling the issue of inequities, Wofford said: creating ways to measure and understand the existing gaps and addressing those gaps in a collaborative way.
Blue Cross has been conducting the RI Life Index since 2019, in collaboration with the Brown University School of Public Health, to assess Rhode Islanders’ perceptions of their quality of life. Among the various issues, participants are asked about affordable housing, access to food and food security, discrimination and access to medical care.
Over the years, results from this survey have painted a grim picture of health equity in the state, especially around affordable housing. These are all important factors to look at, as panelists agreed health is affected by factors that are outside of the medical sphere, such as housing and cost of living. The context in which people live is just as important to their health outcomes as the medical treatment they receive.
But identifying these factors is not enough: leaders must take action.
“One of the biggest frustrations as we evaluate social determinants on health is you assess and see needs in that patient and you do nothing,” Tuuli said.
Another key element is listening to the patients who are affected by these inequities.
“We need to get people to the table and ask them what they need as opposed to what we think they need,” Levesque said.
This means listening to patients before, during and after their pregnancies. The postpartum period, Levesque said, is often neglected by providers, but it is equally critical for mothers. Behavioral health such as depression, anxiety and psychosis that can affect both parents during the pregnancy should be monitored in the months following the child’s birth, too.
Marino said Rhode Island has a real shot at closing some of these gaps because of the size of the state.
“It’s one of those few places where we actually know it’s a ground game and we can actually do it because we know how many people [give] birth every year, we know who they are, we know where they go,” he said.
Over the next few months, as the state starts renewing eligibility for Medicaid, ensuring coverage for all populations – especially the most vulnerable ones – is crucial.
“If we don’t, there’s going to be folks, primarily those who don’t have a voice, that are going to fall through the cracks,” Marino said. “That’s probably our No. 1 task over the next couple of months, to make sure people maintain their coverage.”