IHI Chief Reflects on Launch of New Coalition to Promote Health Equity
By Christopher Cheney
The recently launched Rise to Health Coalition is designed to move work on health equity from primarily documenting healthcare disparities to addressing healthcare disparities, the president and CEO of the Institute for Healthcare Improvement (IHI) says.
Health equity emerged as a pressing issue in U.S. healthcare during the coronavirus pandemic. In particular, there have been COVID-19 health disparities for many racial and ethnic groups that have been at higher risk of getting sick and experiencing relatively high mortality rates.
The Rise to Health Coalition is a nationwide initiative co-led by IHI and the American Medical Association. The Rise to Health Coalition has three primary goals, IHI President and CEO Kedar Mate, MD, told HealthLeaders.
“We are trying to build the capability for change. We are trying to create real results. And we are trying to change the story of health inequity in the country. Those are the three interlocking goals for the initiative—building the ability for our systems to change across many sub-sectors in healthcare, creating real results for real people, and by virtue of creating the capability for change and real results we are hoping to change the narrative around inequities in healthcare from a story of inaction and inevitability to a story of active change and preventing health inequity in the future,” he says.
The Rise to Health Coalition includes a measurement committee, Mate says. “The measures essentially fall into several broad buckets. There are measures of access to care. There are measures of quality and safety. There are measures on the clinical side, which tend to bucket largely in cancer services, cardiovascular disease, and diabetes—for each of them there are efforts to create specific measurements and stratification guidance to help understand where disparities exist. There are also workforce measures around workforce diversity, workforce inclusion and belonging, and workforce turnover and burnout concerns that are prevalent at the moment.”
Addressing systemic racism in healthcare is among the top objectives of the Rise to Health Coalition, he says. “Addressing systemic racism is an important question that we have built into the fabric of what we are trying to do. There is a lot of effort in Rise to Health to try to coproduce the goals of the initiative with agencies and community-based organizations that are responsible for trying to end systemic racism. Fundamentally, this focus is on trying to bring a racial justice lens to not just what we do but also how we understand the impact of the coalition.”
The Rise to Health Coalition will also address inequities in patient care, Mate says. “Rise to Health builds on several initiatives that IHI and partner organizations have run for many years. We have been focusing on questions of where inequities arise in patient care and how we might go about resolving them. Fundamentally, Rise to Health like its antecedent initiatives builds on quality- and quality improvement-related methods. These efforts were originally designed to reduce variations in healthcare. Now, we are using quality and quality improvement methods to try to reduce inequities in specific care practices where we have found inequities.”
Changing the health equity narrative
For many years, the narrative about health equity has reflected the belief that disparities and inequities are not changeable—that they are baked into the healthcare system, Mate says. “The belief is that if we are going to practice medicine, we are going to have some aspect of disparities. But as we start to improve cancer screening rates, or change stroke care outcomes, or improve maternal survival, we must be able to tell that story to demonstrate that these are not just things we document. In fact, we can tell stories about how we can change practices and change the story about inequity in healthcare.”
Changing the health equity narrative could be the most significant impact of the Rise to Health Coalition, he says. “Yes, we will improve many different aspects of clinical care. Yes, we will change pharma discovery processes. Yes, we will modify many payment programs. All of these things are already in the works and are being done right now. But the bigger thing that we will hopefully accomplish is we will look back on this time and say, ‘Until 2023, we had spent most of our time documenting the disparities in our healthcare system. But in 2023 and 2024, this was the time when the narrative shifted from documenting disparities to doing something about disparities.'”
Changing policy, payment, education, and standards
The Rise to Health Coalition will build on fundamental changes already occurring related to health equity, Mate says.
“I see government moving increasingly toward reducing race-based disparities—I see more effort to understanding where inequities are present in the healthcare system and more action to try to resolve those disparities. I see both public and private payers starting to configure incentive schemes as part of quality contracting to understand where disparities may be present in racial disparities, gender disparities, LGBTQ disparities, location-specific disparities, and income disparities. Payers are starting to pay differently for improvement in specific areas, which is going to be an important aspect of how addressing inequity attains long-term sustainability,” he says.
Health equity is becoming a significant element in healthcare education, Mate says. “We have added to medical curricula and nursing curricula to understand implicit bias. We have started to understand where health equity education as well as anti-racism education has a role for us moving forward.”
Health equity is also being incorporated in healthcare standards, he says. “The Joint Commission has started to accredit institutions based on equity standards. So, we are starting to see some standard-based change.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.