The Role of Finance, Revenue Cycle in Advancing Health Equity

The business care for health equity

There is a critical business case for addressing health equity, according to Kim Griffin-Hunter, CPA, MBA, managing partner for Deloitte & Touche LLP’s South Florida practice. Disparities cost the US $93 billion in excess medical costs and $42 billion in lost productivity each year, Griffin-Hunter reported at the Annual Conference, citing data from Kaiser Family Foundation.

By addressing race-based disparities within and beyond healthcare though, US economic outpatient would increase by $2.7 trillion annually, Altarum found. That same study also showed that eliminating health disparities by 2050 would reduce the need for more than $150 billion in medical care.

Going further, Griffin-Hunter explained that increasing health equity could also save human lives. For example, over 17,000 Black lives could potentially be saved annually if disparities in hypertension diagnosis and care are addressed. Another 8,400 Black lives could potentially be saved each year by tackling race-based diabetes care disparities, Deloitte data showed.

“Some people make difference and changes based on moral, ethics, and what they want to do. Some people make changes based on dollars and cents, and some people like to make changes based on lives. We've got all three,” Griffin-Hunter told attendees.

“These are data points that are critical to understand why there is a critical business case for solving health equity.”

Healthcare chief financial officers (CFOs) are recognizing the business case for addressing health equity. Results from a Deloitte Center for Health Solutions survey shared at the Annual Conference found that health equity is among top organizational goals, according to healthcare CFOs. That same survey found that 85 percent of CFOs said they were prepared to align investments with their organizations’ health equity objectives. The same percentage of surveyed CFOs also said they were prepared to improve diversity and inclusion in the finance function’s workforce.

But healthcare organizations—and their finance leaders—are just starting on the path to doing something about health equity. An informal poll of session attendees showed that most healthcare finance stakeholders are “actively working to advance health equity” (e.g., identifying key performance indicators to track progress and communicating health equity strategies to all core functions) and their initiatives have yet to make an impact—a result that did not shock Deloitte experts.

What healthcare finance leaders can do to impact health equity

Most healthcare finance and revenue cycle management leaders are still preparing to address health equity. But “finance leaders are going to be elevated amongst the C-suite as strategic enablers to continue the conversation,” says Tina Wheeler, CPA, US Health Care Sector lead at Deloitte LLP.

“I always say cash is king. We're always wondering about the numbers and really thinking about how we can be someone who collaborates to put numbers around things and shows what the business imperative looks like,” Wheeler explained. “What is the return on investment? Where should the organization invest? What technology? What are going to be those key performance indicators that we're going to measure to try and figure out how we make a difference? I think that those are some key things to be asking yourselves as a finance leader.”

The data finance leaders deal with on a day-to-day basis will inform health equity strategies at healthcare organizations, making the CFO and other finance heads key players in developing and executing initiatives.

The CFO’s role, in particular, will be to launch an enterprise discussion around ecosystem collaboration, sources of funding, and revenue streams, as well as to measure financial return of initiatives, and provide investors and business leaders with health equity updates, Griffin-Hunter shared.

Including but not limited to CFOs, healthcare finance leaders should be looking inward at their own teams to start with their health equity strategy, Wheeler also advised.

“See where you're at, see what your team looks like, see how you can show your commitment to diversity, equity, inclusion, and belonging by building that team,” Wheeler elaborated.

Additionally, Wheeler recommended healthcare finance leaders to “align your investments and determine what's important to impact the geographies and communities that you serve.”

“Think about risk-based payment models, think about population health, and how you can make an impact across the continuum of health. How does health equity play into that? Then, coordinate with state regulators along with your board.”

How Northwell Health’s CFO addresses health equity

New York-based Northwell Health has made a commitment to improving health equity. The 23-hospital system operates a dedicated Center for Equity of Care. It has also been recognized by several organizations for its health equity efforts, including the Healthcare Association of New York State, which awarded the system this year’s Community Health Improvement Award, and DiversityInc, which named Northwell Health the best health system for diversity in the US.

A key person involved in Northwell Health’s health equity strategy is Michele Cusack, CFO. At the Annual Conference, Cusack shared her role in the health system’s initiatives to reduce care disparities and the keys to Northwell Health’s success.

“What we have set up at Northwell is a small team dedicated to those relationships. But we also have a big volunteer organization, which we call our employee research group,” Cusack shared with attendees. “We have hundreds of employees volunteering to work in various aspects across the organization to ensure that we continue making strides in that space.”

It was these team members and volunteers who were on the frontlines of the COVID-19 pandemic providing testing in churches located in low-income neighborhoods and bringing vaccines to people’s homes.

The employees were “physically going out into the community, having that dialogue, having that conversation, bringing Northwell to them,” Cusack said.

“It’s not just what's within the four walls of the hospital. COVID showed us that everything needs to move out. Everything needs to move to a home, whether you do home dialysis, bring vaccinations to where they need to be, bring testing into the communities in places that they trust, convert [communications] into languages that they understand and communicate it in a plain language way that makes sense to them. And while we're out there, we're also understanding what the other clinical needs are not just from the COVID perspective. It's understanding what kind of interventions, whether it's the diabetic population or preventative in terms of early pregnancy.”

But the COVID-19 pandemic also underscored an important lesson when it comes to advancing health equity: you can’t do it alone.

“As we were going through the pandemic, we realized that we couldn't do it by ourselves,” Cusack stated. “We needed to build our ecosystem outside, along with our peer organizations and state and local governments.”

Just as Northwell Health partnered with churches for COVID-19 testing, the health system also collaborated with other local community benefit organizations to meet the specific needs of populations. This included a variety of organizations since “every population was slightly different in terms of where we had to reach.”

For example, the health system has partnered with United Way and local businesses to prevent care disparities in the first place.

“We'll be launching within the next six months a Community Scholars Program. So really going upstream by going to the high schools and working with the students in areas of need to be able to show them a pathway forward, help them get into community colleges, help them get set up on programs, understand what their social needs are,” Cusack explained.

The program aims to connect students with social determinants of health linked to poor outcomes with resources to help them gain employment or appropriate internships in the future.

“We’re going to five or six different communities and about 10 to 15 different scholarships will be offered with the expectation of that growing over time. But we can't do that alone. We can't do it all on our dime,” Cusack said. “We are working with corporate sponsors and others locally, as well as coordinating with other organizations such as the United Way to be able to ensure that this will be successful.”

Healthcare finance and revenue cycle management leaders play a critical role in showing others where investments need to be made to advance health equity within their organizations and communities. These investments may be technology—Northwell Health, for example, recently partnered with a technology provider to leverage predictive analytics to do earlier interventions—or programs and initiatives that support community health.

The data flowing through their finance offices can help to inform investment strategy and the larger health equity strategy. Revenue cycle generates useful data points on healthcare affordability and socioeconomic status, which can be used in conjunction with clinical documentation to identify patient needs and create interventions before care disparities emerge.

With the help of healthcare finance leaders, health equity strategies can evolve to the next level to make a real impact on organizations and patients.