IHI Announces National Coalition Aiming For Systemic Change in Health Equity

The Institute for Healthcare Improvement (IHI) and American Medical Association (AMA) will spearhead a new National Coalition for Equity in Health Care, which aims to catalyze individuals and organizations committed to health equity and justice to build, change, and transform health care with shared solutions and collective actions.

Announced yesterday at the IHI Forum 2022 by IHI president and chief executive officer, Kedar Mate, MD, the coalition, called Rise to Health: A National Coalition for Equity in Health Care, is in collaboration with Race Forward, among other organizations.

“The time has come for a system-wide approach—where health care organizations, individual practitioners, payers, professional societies, and pharmaceutical, research, and biotech organizations come together and align activities to make the whole ecosystem of health care more equitable,” said Mate. “By doing this together we will change the story on equity from one of confusion and competition to one of hope, possibility, collaboration, and alignment.”

During Mate’s keynote address, he urged audience members to change the narrative around inequities from “inevitabilities” to issues that can be improved. IHI’s work with national health systems has shown that quality improvement methods can address inequities, he said, since inequities are fundamentally examples of unwanted variation.

“Here’s the good news: quality science—methods now widely understood in health care and that all of you are here to study and learn—are designed to identify and eliminate undesired variation in our systems.”

One such initiative that aims to promote systemic action regarding improvements in health equity and racial justice is the Pursuing Equity Initiative, which was announced at the Forum to have selected teams for its third iteration. A total of 10 teams were chosen for an Action Community and 60 teams were selected for a Learning Network, both of which will begin in January 2023 and run through June 2024.

Several other initiatives were announced at the IHI Forum that address health equity (inequities in postpartum care), workforce and patient safety (diagnostic excellence and workforce well-being), and system resilience (whole system quality and climate and health care).

Another keynote address today at the forum by Donald Berwick, MD, MPP, president emeritus and senior fellow of IHI, provided an overview of the current state of health care quality going into 2023.

Describing the funding put into the US health enterprise as “misallocated,” and put into what he calls the repair shop—a hospital, fix it up structure—Berwick said that it is not tending to upsteam causes of illness that have a disproportionate effect on marginalized populations.

“As long as health care has 20% of GDP [gross domestic product], we need to step up and take resources that are currently allocated in hospitals and acute care systems and they need to own this, they need to devote resources, time, and energy to influence this,” he noted.

Citing greed as one of the major issues limiting progress on health equity, Berwick said efforts are warranted to address the degree to which the pursuit of profit, the acquisition of money, high valuations, and investor-oriented business models have taken over health care.

Systemically, these manifestations can be observed regarding confiscatory drug pricing, single-cost market consolidation and pricing, concentration of pricing power, and large delivery systems. And this consequently leads to more high risk insurance benefits structures for patients at the individual level who face higher out-of-pocket costs, which would then significantly impact care outcomes for disadvantaged individuals of lower income.

“Post COVID-19 and even prior, hospitals are in a very stressed position. Labor costs, shortages—they're losing money. I understand that, but I don't want to back down. We've got to stop this profit-driven excess in health care,” said Berwick.

“I think that we have enormous pricing games going on in the system—many of them are not illegal, but they're not right. And I think this is a time when we need a lot more transparency. We need more discipline—we have to end rules like the current [Hierarchical Condition Categories] coding system at CMS that opens the door for behaviors that are just moving money from the poor to the rich. And I think that's a matter of regulating them properly.”