Individuals with multiple chronic health conditions (MCCs) face challenges obtaining the healthcare services and resources they need for improving and maintaining their health. Integrated care improves the way information about a person’s health is shared with their care team and makes healthcare services and benefits more accessible. Beginning in 2018, the UPMC Center for High-Value Health Care collaborated with patients, caregivers, healthcare providers, researchers, and community members and organizations to study different ways of providing integrated care to people with MCCs. The study team wanted to know how these different ways of providing care impact the health of people living with MCCs.
The verdict is in: not everyone in the United States receives the same care1 from our healthcare system. Sadly, there is a long-standing reality of structural inequality, racism, and bias in healthcare. Because of this, your race, ethnicity, language, age, and where you live can impact your overall health2, much like smoking and exercise do.
When societal inequities are present in our healthcare system, they result in some people having poor health that could be improved while other people remain in better health. This difference in health outcomes is called a health disparity. Health disparities can occur on several different levels. They can impact individual people, families, and entire communities.
Health disparities are also caused by nonmedical factors. In fact, much of what impacts our health takes place outside of the doctor’s office. Social determinants of health – the “conditions in which people are born, grow, work, live, and age”3 – have been found to have a greater impact on an individual’s health than medical care. For example, not everyone has access to the same information about healthy lifestyle choices or to grocery stores with healthy food options. For some, finding and keeping stable housing is a challenge and can take priority over other important things like scheduling checkups with a doctor. Others may have difficulty finding transportation to medical appointments. These are only a few examples, but there are many nonmedical needs that contribute to health disparities.
Health equity is when everyone receives the support they need to live their healthiest life possible. In healthcare, equality is a word that is often confused with equity. Equal healthcare means that everyone receives the same services or treatment. Equitable healthcare means that everyone receives the services, treatment, and resources that are best for them. For example, providing all patients with prescriptions for the medications that they need is equal healthcare. But, providing a prescription delivery service for patients who do not have accessible or reliable transportation to get to and from the pharmacy is equitable healthcare.
How do health disparities and health equity affect integrated care for individuals with multiple chronic health conditions(MCCs)?
We recognize the challenges that nonmedical social needs create for individuals and their families and work in our community to help people who need extra support with these social determinants of health. Addressing health disparities and promoting health equity are as complicated to address as they are important. Our care team, the UPMC Health Plan Community Team, aims to reduce health disparities and improve health equity for all by connecting individuals to social resources like affordable housing waivers or utility bill programs, in addition to traditional medical resources like medications or appointments with specialists.
How can we be sure that we are addressing health disparities and ensuring more equitable healthcare for individuals with MCCs?
At UPMC, we develop and test innovative ways to support value-driven healthcare, address health disparities, and advance health equity. The Integrated Care Study is one example. This study examined what types of integrated care for MCCs work best for which patient and under what circumstances. In The Role of Stakeholders in Informing Research, we had to first understand the health disparities and inequities experienced by our patients with MCCs and how these factors influence their health.
In addition to evaluating how working with a care manager could improve the health of people with MCCs, the Integrated Care Study was also designed to evaluate if factors like race, age, sex, and where people live also affect their health outcomes. In providing this connection and care, the UPMC Health Plan Community Team addresses health disparities and promotes health equity.
What insights and learnings about health disparities and health equity can we share?
One of the goals of the Integrated Care Study is to share the lessons and information that we learn with the communities who participated in the research and the healthcare providers who work with them. Our hope is that by looking at ways to deliver better quality healthcare and improving the way in which we share our findings with different communities, we can begin to reduce some of the health disparities and inequities that exist in the healthcare system today.
Interested in learning more about UPMC’s programming to address health disparities and advance health equity? Check out the UPMC Center for Social Impact web page.
Follow this blog series to learn more about the Integrated Care Study, how social determinants of health impact people living the multiple chronic conditions, and what the UPMC Health Plan Community Team has been doing to support them. Our final study results will be published in late 2024.
Acknowledgement: Research reported in this blog series was partially funded through a Patient-Centered Outcomes Research Institute® (PCORI®) Award (IHS-1609-36670). The views presented in this series are solely the responsibility of the author(s) and do not necessarily represent the views of the PCORI. PCORI is an independent, nonprofit organization authorized by federal law. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. PCORI is committed to continually seeking input from a broad range of stakeholders to guide its work.
1Pennsylvania Department of Human Services. (2021). Racial Equity Report 2021. Retrieved August 29, 2024 from https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/about/documents/2021-DHS-Racial-Equity-Report-final.pdf.
2U.S. Department of Health and Human Services (n.d.). Social Determinants of Health. Retrieved August 29, 2024 from https://health.gov/healthypeople/priority-areas/social-determinants-health.
3World Health Organization. (n.d.). Social Determinants of Health. Retrieved August 29, 2024 from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1