For the last several years, I have wrapped up my reporting with a look back at some of my favorite quotes from healthcare stakeholders as a way to help emphasize how our publication’s coverage is reflecting shifts in industry dynamics. In 2021, there was no question that how to build health equity into payment models, data standards, and clinical care was discussed far more than ever before. It was refreshing to be able to cover so many discussions of where healthcare has fallen short in terms of addressing inequities and how it can begin to do better, so I decided to devote this year’s version of favorite quotes entirely to health equity. So in no particular order, here are 10 provocative quotes that can be food for thought as we head into 2022.
• “COVID exposed vast racial and ethnic disparities in the health system and the care it provides, and it also demonstrated the shortcomings of fee for service when volume drops precipitously.” — Elizabeth Fowler, J.D., Ph.D., director of the federal Center for Medicare and Medicaid Innovation
• “Sometimes people use a form of ‘magical thinking’ to believe that value-based payment and alternative payment programs are going to fix everything. Well, not if they are not intentionally designed. There are a lot of ways to get around addressing equity issues — hence the virtue of designing the incentives to do the right thing. The vast majority of providers in healthcare would love to do the right thing, but they’re working under rules of the game which don’t enable them to do the right thing in the long term.” — Marshall H. Chin, M.D., associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago
• “We have to move to a place where collection of self-reported demographic and drivers of health data is routine for all programs. We need to be clear about why we're collecting it and how we're using it. In some instances, like language, transgender standards, disability and drivers of health, we need it for the point of care. But equally importantly, we need to stratify our data to understand how we're doing and how to prioritize and target investments, and adjust our payment models.” — Alice Chen, M.D., the chief medical officer at Covered California and formerly the deputy secretary for policy and planning and chief of clinical affairs at the California Health and Human Services Agency
• “Health policies matter to people's day-to-day lives. For generations, federal, state and local leaders have made policy choices that have produced worse health outcomes for people of color, including economics, oppression, residential segregation, and failing to invest in the places where people of color live and work. Policy decisions have also affected access to and quality of health services available to racial and ethnic groups. There is no question that healthcare services are an important source of observed inequities.” — David Blumenthal, M.D., president of the Commonwealth Fund
• “Equity work is fundamentally quality work. A question that I recommend organizations ask themselves is how are you ensuring that your organization understands the population being served — and are you reflecting the population being served? Value-based care is not just about the metrics. It's not just about the structure. It's also about intention — what are you trying to achieve and how are you trying to achieve it? — Tosan Boyo, M.P.H., senior vice president of hospital operations at California-based John Muir Health
• “I think we have to push back on an instinct that the fixes are quick. There is not a checkbox, where we can say ‘do these three things.’ But it is a process, and if we can do more in partnership, genuinely, with the communities that have been most affected, that's how we begin to establish trustworthiness.” — Marcella Nunez-Smith, M.D., senior adviser to the White House COVID-19 Response Team and associate dean for health equity research and professor of internal medicine, epidemiology and public health at the Yale School of Medicine
• “We have to think not only about how we stop overt discrimination and racism, but also how we weed it out within policies and change the power dynamics, such that those people who have not traditionally had a voice in this country are able to have that voice.” — Alyce Adams, Ph.D., professor of epidemiology and public health at Stanford University
• “We can do a lot of measurement, but eventually you have to do something about it, right? And doing something about it requires money and resources. The last year has provided that catalyst for boards to realize that they have to put some money into this — like serious money.” — Aswita Tan-McGrory, M.B.A., M.S.P.H., director of the Disparities Solutions Center at Massachusetts General Hospital in Boston
• “We need to make sure that we understand that the structural racism and other elements of the healthcare system that have disadvantaged patients and the facilities where they receive their care for decades don't get further disadvantaged by innovation programs that are put in place.” — Thomas Sequist, M.D., M.P.H., chief patient experience and equity officer at Mass General Brigham
• “The COVID pandemic has really galvanized the need to stratify data in order to tailor your efforts. So hopefully we can use some of that momentum more broadly as part of these Medicaid innovations, and also use either existing or planned value-based contractual requirements as a starting point.” — Shilpa Patel, Ph.D., the associate director for health equity at the Center for Health Care Strategies
