Massachusetts took a step toward greater health equity last week, with all hospitals in the state achieving a national standard of access to care, addressing social needs that impact health and tracking disparity data for people of color. It is the first state in the country to reach the benchmark.
That achievement, based on standards from The Joint Commission, a national health care accreditation and certification nonprofit, shifts the focus to equity efforts in hospitals while setting a baseline for higher standards of certification that Massachusetts hospitals are aiming for by 2025.
“This is really the groundwork,” said Elena Mendez-Escobar, co-executive director of the Health Equity Accelerator at Boston Medical Center. “Having mandated standards from a regulatory body … is really helpful to advance the work, to have a shared understanding of what the issues are.”
The accreditation standards include criteria like appointing someone to lead equity efforts, greater assessment and consideration of patient social needs and demographic data, and developing an action plan to address disparities.
Mendez-Escobar said the new achievement doesn’t come as a surprise, given the state’s regulatory environment and longer-standing commitments to equity work from health care organizations.
It builds on previous equity steps that the state has been a leader on, like the near-universal health insurance coverage passed by the state legislature in 2006, said Juan Fernando-Lopera, the inaugural chief diversity, equity and inclusion officer at Beth Israel Lahey Health and co-founder of the Health Equity Compact.
The accreditation is part of a broader effort to increase equity efforts and standards for patients in the state.
In 2023, as part of a regular five-year process called the 1115 Medicaid Waiver that allows states to test new ways to operate Medicaid, MassHealth set a series of goals that included collecting more patient demographic data to identify disparities; improving multilingual care; and screening for “social determinants of health,” those elements like housing or food access that impact human health but are not traditionally treated at hospitals.
The Medicaid Waiver included an accompanying $2 billion in support to address health equity initiatives.
“For a system like Beth Israel Lahey Health, there’s significant resources there that could be used to invest in all the things that we just haven’t been able to invest in, because they historically had not been reimbursed,” Fernando-Lopera said.
He pointed to technology infrastructure investments, increased resources for the system’s practices that see the greatest disparities, and new ways of connecting with patients who don’t primarily speak English.
Current health equity work comes amid an ongoing fight between financially struggling Steward Health Care and the state government, as state officials seek greater clarity around the company’s financial situation and push for increased monitoring and better staffing and supplying of Steward’s nine Massachusetts hospitals, many of which serve low-income patients in heavily minority communities.
Last month, Gov. Maura Healey called on Steward Health Care to sell its locations in the state and end its business in Massachusetts after the company failed to meet a deadline regarding the submission of audited financial statements. According to reporting from the Boston Globe, the health care system’s hospitals employ about 16,000 people in Massachusetts and serve more than 200,000 patients, including thousands of patients at the Carney Hospital in Dorchester.
Health equity efforts in the state aren’t new, but the COVID-19 pandemic and simultaneous movement around racial equity following the 2020 murder of George Floyd prompted health equity work in the state to kick into gear, moving from what was largely just research on what disparities exist to actually working to change them, Fernando-Lopera said.
Often, work around health equity requires approaches that go beyond traditional medical treatments, with a focus on social factors that impact access to care.
For example, at Boston Medical Center, addressing disparities around diabetes involves a multi-faceted approach that includes financial planning to reduce barriers patients encounter to paying for medication; culturally competent care that helps people from different ethnic backgrounds assess healthy food choices; and more proactive care to reduce delays in diagnosis.
“There’s no single silver bullet,” Mendez-Escobar said, “so what we have put together are new initiatives in each clinical area that are very multidisciplinary … addressing the problem from many different angles to be able to have an impact.”
The Health Equity Compact hopes to take its work beyond MassHealth’s five-year goals around Medicaid recipients.
“The reality is that these deeply rooted, long-standing, multi-generational disparities are not going to go away in three or five years,” Fernando-Lopera said. “They’re going to require relentless, sustainable efforts.”
At the Health Equity Compact, part of that work is finding ways to measure health disparities in the state. A 2023 report from the Compact in partnership with the Blue Cross Blue Shield of Massachusetts Foundation found a $5.9 billion cost from health care inequities experienced by Black, Hispanic/Latino, and Asian populations in Massachusetts and the lost labor productivity and premature death caused by those inequities.
Mendez-Escobar said long-term efforts to address health disparities will require continued regulatory focus and funding, especially as current work, much of it experimental, starts to point to concrete solutions to gaps in access.
“As we learn more [about] what health care services are critical to health equity, they have to become part of the standard funding system for them to be able to stay and be sustainable over time,” she said.
