We Won't Achieve Health Equity Without TechQuity

Under the leadership of our Chief Health Equity Officer, Dr. Joneigh Khaldun , CVS Health is committed to helping build a health system that equally values all individuals and populations so personal attributes, like race and zip code, no longer drive health outcomes among our colleagues, members, clients and communities. Internally, we are working to foster a culture of diversity and inclusion that engages our teams in executing our health equity strategy.

Leveraging technology to achieve health equity, or what I like to call "TechQuity ,” is foundational to this strategy and to overcoming the disparities that exist in health and health care. At its heart, TechQuity is focused on the broad application of effective, ethical, and equitable technology to deliver positive impacts. In the health industry, collaboration across the transdisciplinary teams responsible for care (see the 7Ps here ) will be critical to drive meaningful change. At CVS Health, we leverage expertise across our clinical, social and data science teams to support universal, efficient and equitable use of technology as part of our TechQuity strategy. CVS Health recently affirmed this commitment by appointing Tilak Mandadi as Chief Data, Digital and Technology Officer, a newly created role.

While technology has the power to transform health, the industry has shown an inconsistent approach to the adoption, implementation, utilization and oversight of digital health technologies. For example, virtual care significantly grew during the pandemic, but as a clinician I have encountered providers who continue to use documentation systems other than electronic medical records. Despite the many benefits of digital tools, the health industry must be careful to safeguard against the worsening of existing inequalities and further expansion of the “digital divide.” We must recognize that health information technology could extrapolate and exacerbate current health disparities and structural racism that persists in the U.S. and in medicine.

It is estimated that 15 to 24 percent of Americans lack internet access, a critical tool for nearly all aspects of life; from education and housing, to applying for a job and accessing assistance programs. In fact, digital literacies and access to the internet have been deemed “super” social determinants of health (SDoH), non-medical factors that influence health outcomes, because of their wide-reaching impacts. However, robust digital health policies can also increase inclusivity. To achieve TechQuity, organizations must focus on four core priorities: 1) workforce diversity, 2) data completeness and trustworthiness, 3) equity dashboards, and 4) transparent, equitable, and ethical AI.?

Workforce Diversity: “It’s Hard to Be What You Can’t See”

Because healthcare is deeply personal and often involves treating patients at their most challenging and vulnerable moments, the people providing that care must understand and represent the distinct communities they serve to build rapport and trust. This was especially true with the COVID-19 vaccine, which faced initial hesitancy from communities of color due to historic mistrust of vaccines. At CVS Health, more than 40 percent of our pharmacists and over 50 percent of our pharmacy technicians identify as people of color, and they have served as important trust brokers, helping communities of color understand the safety and effectiveness of the COVID-19 vaccine.

Although visible representation makes an undeniable impact, it must be coupled with meaningful actions. Last year, CVS Health shared its first-ever Strategic Diversity Management Report , in which we committed $600 million to advance employee, community and public policy initiatives that address a 360-degree view of the inequities faced by historically disenfranchised communities. While there is a long road ahead, we are committed to this work, and we hope our peers across the healthcare industry will join us. ?

Data Completeness and Trustworthiness: Why Representation and Quality Are Important

When Aetna became the first national health plan to collect race and ethnicity data in 2003, it was a progressive and unmatched step towards improving population health. Standardized demographic data is key to identifying disparities in quality of care and targeting quality interventions to achieve equity. However, to address health equity challenges comprehensively, the entire industry must standardize the collection and stratification of these data. We must also expand collection efforts beyond just demographics to capture behavioral, psychological, and social health measures as recommended by the National Academy of Medicine (NAM) .

After working across public health and primary care settings, I believe it is important to assure trust and build datasets that reflect determinants of health and are able to measure additional characteristics, such as race, education, food and housing insecurity, disability status, and sexual orientation and gender identity (SOGI). Behavioral, psychological and social measures should also be considered.

TechQuity is also dependent on the quality of data: if you put bad data in, bad data will come out. In this context, quality means ensuring a dataset fits its intended use and that the inputs are accurate, complete, consistent, and timely. So, if the data are inaccurate, or unrepresentative, they will not be trustworthy or generate broadly useful insights.

The data scientists who manage our datasets serve as crucial trust brokers and are part of a healthcare team for every patient. I’m proud that our team of 900 data scientists at CVS Health view representative, inclusive, equitable and trustworthy data curation as a central responsibility of their job.

Equity Dashboards: “We Measure What We Treasure”

To put data to use once it has been collected, visualization tools like dashboards are key to quickly identifying patterns or trends, providing actionable insights, and supporting communications using real-time data. If data are considered a currency because of their value, then dashboards are the bank storing the money and providing you dynamic insight into your bank account.

For example, health dashboards are used to analyze and demonstrate quality of care for hospital ratings and other important industry metrics. Historically, these dashboards have supported standardized metrics for safety, timeliness, effectiveness, efficiency, and patient-centeredness (STEEP ) to measure healthcare quality. Although "Crossing the Quality Chasm" reports, which sparked the healthcare quality movement at the turn of the century, included equity, equity-based metrics have typically been left out and not valued due to myriad of reasons, including a lack of consensus around data collection processes . It is only recently that equity-specific dashboards, featuring data for measures where the largest inequities exist, have been created. However, equity needs to be a foundational, standardized, and required metric for dashboards that are used to generate healthcare organization ratings and their accreditations like the NCQA health equity program.

At CVS Health, we think health equity should be treasured, and unequivocally, it needs to be measured to be improved. We are building expanded equity-specific dashboards to measure racial and ethnic disparities and, eventually, will include language and linguistic preferences, SOGI, socioeconomic status, geography, veteran and disability status and more.

Artificial Intelligence: Must be Transparent, Ethical, & Equitable?

To achieve TechQuity, the health industry must expand its knowledge of artificial intelligence (AI). While the COVID-19 pandemic accelerated the use of AI-related health technologies, such as wearables and sensors for remote patient care, using AI has often been problematic because of data misinterpretation and data bias (e.g., algorithms trained using poor-quality data).

At CVS Health, with the collection of sociodemographic data, we are committed to improving representation in our datasets that are used to train our AI-based tools and prevent bias. While it is impossible to eliminate bias completely, we have a responsibility to think about how to create transparent, ethical, and equitable AI to ensure technology advances health equity goals and does not hinder them. Just like a nutrition label on food, it is important to understand the “ingredients ” in AI: who trained the AI, which datasets were incorporated and what models and respective algorithms were used?

When due diligence is taken to safeguard the implementation of AI, it has the power to transform individual and population health and significantly improve care. At CVS Health, we have leveraged AI to improve behavior change using Next Best Action recommendations. This novel program uses AI-based data analytics of previous behaviors to nudge consumers and providers to make personalized health decisions that can improve outcomes and well-being.

For decades, the health industry has focused on improving quality of care for patients while simultaneously failing to give proper credence to equity in datasets, metrics, health studies, ratings, and certifications. But, we cannot have one without the other.

Quality is equity, and equity is quality.

Leveraging our technology via the principles of TechQuity is one way we will achieve health equity. ?????