June 14, 2016
Gaps in Care: What You Need to Know

Despite the push for more joined-up healthcare, there continues to be significant gaps (or disparities) in healthcare that affect the quality of care for certain groups of people compared to others. These inequalities in appropriate, streamlined medical services mean that the healthcare system inadequately provides for a portion of the nation’s population — making gaps a crucial topic to address. Here are a few things you need to know to increase your awareness of and improve your plan for tackling care disparities.

Defining disparity

Gaps in medical care refer to disparities in healthcare access, healthcare needs and medical services when comparing different populations that fall along racial, ethnic, or socioeconomic lines. The key takeaway: despite expanded health insurance coverage, certain populations are not benefitting from the high quality of healthcare that is available and, therefore, we need to take action to minimize inequality and transform it into quality for all.

Who falls between the cracks

Affected individuals include minority and ethnic groups, and the socioeconomically disadvantaged (which are not necessarily mutually exclusive), who are either unable to afford health insurance and thus do not have access to proper medical care, unable to access adequate medical care due to geographical location (e.g. in rural areas), or unable to receive the proper treatment for their medical needs due to high costs, lack of adequate information regarding medical options, or potentially subtle biases. The movement to bring awareness to the public of the disparities that need addressing was pioneered by the first comprehensive study (the Heckler report) on minority health differences in the 1980’s which cited wide disparities in death and illness between minority and non-minority Americans.

Money down the drain

Since then, further research has focused on understanding how these gaps in care develop and, in turn, what can be done to close them. Aside from the obvious moral and ethical reasons to improve the status of those in need, the disparities that are found are important to address, since these disadvantages are actually costly to the system as a whole — approximately $1.5 trillion every three years in direct and indirect costs. Furthermore, eliminating health disparities for minorities alone (not counting other categories where gaps exist) would have reduced direct medical care expenditures by $229.4 billion from 2003–2006. If hospitals and other healthcare facilities are to strive for cost-effective care, minimizing disparities is a critical place to start.

What is currently being done about it?

Multi-level measures are needed to alleviate the issues posed by gaps in care.

  • System-level measures include expanded access to insurance coverage. The Affordable Care Act (ACA) promotes the closing of socioeconomic gaps by offering eligibility to Medicaid, greater access to preventive care, and easier access to pharmaceutical meds (via discounts) to those people that fall way below the poverty line. In addition, the Center for Medicare and Medicaid Services (CMS) has established the Office of Minority Health to find innovative ways to look at the problem and come up with solutions.
  • Local-level measures include making the most of data analytics to institute fixes that fit the region, a hospital or healthcare facility serves. The first published CMS Equity Plan for Improving Quality In Medicare and the Mapping Medicare Disparities (MMD) Tool let you analyze health outcomes based upon various factors such as race, age, and gender, and correlate them with geographic location, so that you can target the areas of need and the intervention types that are needed in your area. Furthermore, the Patient-Centered Outcomes Research Institute (PCORI) is another organization that provides funding for research that compares different approaches to care in order to find the ones that fit best in various types of scenarios and different population groups.
  • Micro-level measures are the fixes that are enacted on a day-to-day, interaction-to-interaction basis. This includes, for example, instituting technology solutions such as telemedicine and electronic communication (e.g. apps, a secure online portal) to provide ongoing care for patients who may live far away, or who might not have easy access to transportation. You can also make the most of medical scribesto ensure thorough documentation that’s easily communicated between multiple providers who may be part of the multi-disciplinary team. Or you can make the health record more portable for patients so that they can better engage in their care — a key factor in joining up health services.

Mind the gaps

Data analytics and technological advancements are increasingly opening opportunities for better treatment of chronic diseases — and the quality of healthcare service delivery should be, too. Across the healthcare system, fixing gaps in care is vital for ensuring that patients get the treatment they need, while saving all of us money.