Defining, assessing, and achieving health equity in behavioral health

The Centers for Disease Control and Prevention defines health equity as the state in which everyone has a fair and just opportunity to attain their highest level of health.¹ However, according to a recent study, hospital and healthcare staff show little consensus regarding the meaning of health equity, and very few staff can define it.²

“Unfortunately, health equity is often discussed as a vague concept or ideal, with insufficient focus on how to operationalize it,” said Hossam Mahmoud, MD, MPH, East Region Chief Medical Officer, Carelon Behavioral Health. Dr. Mahmoud appeared on the panel discussion, Health Equity Focus: Big Ideas and Most Impactful Initiatives, at the Becker’s Payers Issue Roundtable in November 2023.
 

Defining health equity

“There are so many different ways in which we can think about health equity,” said Dr. Mahmoud. “We need to think about individual patient needs, provider services, and the systemic factors shaping care access and delivery.”

He highlights various approaches. “In addition to providing better access, we need to deliver care that mitigates barriers. Care delivery needs to incorporate cultural and linguistic requirements. We have to integrate health-related service needs into the delivery approach.”

Dr. Mahmoud emphasizes the necessity for reliable data. “A key element in our supporting health equity is generating reliable data through data analytics. This helps us to develop actionable algorithms to mitigate health disparities.”
 

Improving underserved populations’ access to high-quality care

“When looking at underserved populations and their need for better health care access, we examine our data for disparities. It’s essential that we identify disparities associated with race, ethnicity, language, disability status, geography including zip codes, sexual orientation, gender identity, and a range of social determinants of health,” says Dr. Mahmoud.

As a next step, he stresses the importance of including community stakeholders in a continual quality improvement process. “We reach out to stakeholders within the community and get their feedback to better understand the dynamics and the factors contributing to these disparities. That process would allow us to develop programs and interventions to decrease these disparities. Once these interventions are implemented, we evaluate whether these interventions have mitigated the disparities. Then we gather additional input from stakeholders, refine the interventions, and evaluate further. It’s a continuous quality improvement process that aims to impact health equity using operationalized dimensions.”
 

Carelon Behavioral Health programs increasing access to care

Dr. Mahmoud highlights Carelon Behavioral Health solutions that are helping to increase access. “Thrive is a whole-health program supporting people of childbearing age, who identify as having substance use disorder (SUD) or at an increased risk of SUD or opioid use disorder (OUD). The program’s goals are to improve maternal and neonatal health outcomes. It uses data analytics and predictive modeling to identify members, and peer support to engage members on recovery and overall wellness, with the help of an app. Case managers work with members to provide intensive, wraparound case management during the member’s pregnancy to support prenatal care engagement and SUD treatment, up to twelve months post-delivery”

Dr. Mahmoud shares additional examples. “Access Mental Health in Connecticut  and Massachusetts Child Psychiatry Access  are consultative programs helping primary care providers identify members’ mental health needs, which is particularly important given the extreme shortage of maternal and child psychiatrists across the country. These programs support behavioral health care within a primary care setting. This support increases whole health access for many underserved populations.”
 

Innovative strategies to address health equity

Dr. Mahmoud points to technology and digital tools as novel ways to bridge the health equity gap. Telehealth, remote and in-person care navigation, and peer support can help increase access.

However, technology comes with advantages and disadvantages. “Telebehavioral health has been very effective in providing more individuals access to mental health treatment. However, we need to be very cognizant about not using technology in a manner that perpetuates the digital divide. Not everyone has a smartphone, internet, or high-speed access, especially individuals in underserved populations,” says Dr. Mahmoud. “We also need to think of technology as a vehicle to diversify care delivery, rather than just a replication of in-person care with two-way screens.”

Dr. Mahmoud stresses additional factors that make technology effective in improving health equity. “Using technology on the backend for data analytics and predictive modeling, as well as delivering innovative care models utilizing peers, coaches, and other non-clinicians, is highly effective in increasing health equity.”
 

Innovative funding models

“Resilience Through Information, Support and Education (RISE)  is a Carelon Behavioral Health program that employs predictive modelling to proactively identify individuals who are at risk of opioid and alcohol-related negative health outcomes over the subsequent twelve months,” says Dr. Mahmoud. “The RISE model uses case managers and peer support specialists to deliver care coordination and coaching to impact physical and behavioral health. Through RISE, we have seen reduction in overdoses, inpatient admissions, and emergency room visits.”
 

Making progress in health equity

“We talk about health equity as an abstract concept. We all know it’s important and essential, but we need to be able to translate the concept into more operational and actionable components to attain health equity,” says Dr. Mahmoud. “We need to start incorporating health equity into every aspect of health care. We need to make health equity part of the quality of our programs to move the needle.”