When I graduated from medical school and took the Hippocratic Oath, I vowed to not just treat the illness on a patient’s medical history form but to treat the person behind the diagnosis. To do this well, clinicians need to understand the whole person and the context in which they live — their race, gender identity, native language, socioeconomic status, or zip code, among other things — to ensure equitable care. According to the CDC, health equity is reached when every person has the opportunity to attain his or her full health potential regardless of social position or other socially determined circumstances.
Yet, health inequities abound in our healthcare systems. Research says that those Americans who live in rural communities have less access to care and subsequently worse health outcomes than those who live in non-rural communities. African American adults are more likely to report they cannot afford to see a doctor, leading to worse health outcomes. African Americans ages 18-49 are twice as likely to die from heart disease than whites. Beyond race and community, even employment status has a great effect on one’s health. Members of the LGBTQ community are twice as likely to be unemployed and uninsured than their straight counterparts, reporting lower health and quality of life.
Healthcare inequities are also a drag on our economic systems. Medicare and Medicaid have an obligation to taxpayers who are paying into the system to help as many people as possible. When there are inequities in the healthcare system, it means that taxpayer dollars aren’t being well spent to impact the people they need to. If a health insurance company’s risk pool is warped toward people who are very sick and don’t have decent access to healthcare, it’s going to make that health plan a lot less profitable, increasing premiums for everyone.
Artificial intelligence (AI) technology and algorithms can help us bridge this health equity gap. But it’s important to remember that AI is not a one-size-fits-all solution. Data is great, but without an application, it’s not useful. AI allows us to use the data to interpret what’s going on with a patient population and prescribe what to do with the data. Here are three ways we can apply this technology to help solve the health inequity problem in America and around the world.
1. Using AI to identify the problem
Health systems are dealing with a seemingly infinite amount of data on massive patient populations. It’s hard to spend time sifting through the data by hand to understand what’s happening within their population. AI technology can help these systems sort through that data to understand exactly where providers should focus to get the best ROI for positive patient outcomes. In a real-world example, a case manager logs onto work on a Monday morning and receives an email with details about their patient, John Doe. An AI-powered algorithm flagged that John Doe has two issues that may impact this ability to manage his diabetes: his current provider isn’t a native Spanish speaker and he currently doesn’t have a vehicle. This means that John Doe, who doesn’t speak English, is facing two serious health inequities that could affect his ability to get the right information and physical access to the clinic for his appointments.
2. Using AI to identify next-best actions
Now that we know the problem, it’s important to take action and solve it. No one wants to spend time analyzing a million charts or rows of data in a spreadsheet. Decision-makers need to know what the issue is, what they need to do and how they need to do it to affect change. By using AI to provide predictive and prescriptive recommendations in a culturally sensitive way, we can bridge the equity gap.
In the John Doe example, the prescriptive recommendations that will improve John’s outcomes include finding John a doctor that speaks Spanish and setting up John with the telehealth services to ensure he has continued care regardless of his transportation challenges. AI allows us to replicate this over millions of patients quickly when compared to doing so by hand. If Amazon can predict which book on the history of World War II I should read next based on my buying history, certainly we can use similar technology to predict what issues will arise for our patients and what we need to do to intervene.
3. Using AI to better allocate limited resources
Resources are often limited in healthcare. AI technology can help providers make better decisions on where to invest, build and allocate resources more effectively to close the disparities. This type of technology provides a more strategic view that helps managers and executives answer the question, “do I have the right skill sets and resources to meet my health equity challenges?” If not, do I need to shift certain resources (e.g. Spanish speaking doctors) to other clinics and patients, or do I need to invest in new approaches (e.g. telehealth) or partnerships (e.g. taxi company, local churches) that help me to better treat each patient?
Healthcare is a human issue
AI can make the entire healthcare system more efficient and effective at identifying and solving these inequity issues. But at the end of the day, healthcare is still a people issue. As a doctor, I was trained to believe that I am in charge of a person’s health. They come to me for a diagnosis and I write the prescription for a medication they need to address it. In reality, 99% of the patient’s life occurs outside the doctor’s office and in their community. In order to improve health equity, we must find ways to partner with the leaders of the communities in which they live.
Medical male circumcision has long been known to be a key tool in reducing the risk of HIV transmission. Now imagine yourself, an outsider, entering a Zulu community in Southern Africa. No one speaks English and they have a very specific understanding of healthcare. Try to convince a 21-year-old Zulu man to get circumcised for his health — it’s an uphill battle. Who does this 21-year-old man listen to? Most likely his community tribal leaders. A lot of the work the BroadReach Group does today is identifying the local on-the-ground structures, whether they be the tribal or cultural structures, that would influence the community’s decision-making. Essentially choosing the next-best actions informed by behavior science. We then partner with these community groups to craft messaging and create programs to convince the population to take these health steps.
While it may look a little different, we face the same distrust patterns in the U.S., now more so than ever before. How do we convince people that are wary of health systems to see a doctor every year or get vaccinated against COVID-19? Close partnerships with trusted local community leaders.
The healthcare industry can’t solve the equity problem alone — we need partnerships. When healthcare companies partner with the private technology sector, it helps us think outside of the industry about what’s cutting edge — like new AI-driven technology — and how we can apply it to healthcare. When healthcare companies partner with local community leaders, we can effect real change within a hard-to-reach population. Health inequity is a comprehensive problem that covers all of society. We can’t do it alone.
About Dr. John Sargent
Dr. John Sargent is a globally recognized innovator focused on developing 4th Industrial Revolution technologies to radically improve healthcare delivery and catalyze broader development sector outcomes. John co-founded BroadReach Group in 2003 and currently serves on the Board of Managers. He is a popular speaker and thought leader on technology, innovation and health equity. He has been recognized by the World Economic Forum as one of the Social Entrepreneurs of the Year in 2015, by Frost & Sullivan with the Visionary Leadership Award in Healthcare, and by Devex as one of the Top 40 Under 40 Leaders in Development.
Prior to co-founding BroadReach Group, John was a management consultant specializing in strategic and clinical operations projects for top academic and private US hospitals. His last position before founding BroadReach was Senior Director and National Practice Leader in Clinical Operations for the Advisory Board Company (ABCO), a leading US healthcare think-tank. Additionally, he has served as a member of the Board of Directors of the Fulbright Association. John earned an undergraduate degree from Dartmouth College, a master’s degree from Oxford University as a Fulbright Scholar and an MD from Harvard Medical School.