Advancing Health Equity for Black America

The challenge of delivering equitable health care through a system that is broken and holds little incentive to do so, during a pandemic, is a monstrous feat. But that’s no excuse to back down from that challenge. Right now, more than ever, it is a moral imperative to create solutions that reduce disparities in care for Black people. This is a driving force for us at RubiconMD, and top of mind today, at the close of Black History Month. 

In 2015, NAM conducted a widely publicized study showing that “racial and ethnic minorities receive lower-quality health care, compared to white people – even when insurance status, income, age, and severity of conditions are comparable.”  This is heartbreaking and angering.  So, we choose every day as an organization to channel that anger and frustration into our mission to build solutions that reduce disparities in healthcare and to whittle away at one of the many injustices that have unfairly affected Black Americans for far too long.

The RubiconMD vision statement shines a light on our whole-hearted belief that healthcare is a right. It reads, “We envision a world where everyone, regardless of who they are, or where they are from, can access high-quality specialty care.” This is the cornerstone of health equity: that everyone has the opportunity to achieve their highest level of health and well-being, regardless of their social position or circumstances. 

By integrating primary and specialty care together, we are enabling patients to receive appropriate, equitable care. As an organization, we are charging forward with building and evolving our tech solutions to make the best specialist insights accessible to patients, through the convenience of a primary care clinic. This means that Black patients can get care informed by a top specialist from their primary care doctor.

We feel well-positioned, obligated, and honored to be charged with the difficult task of reshaping specialty healthcare to be more equitable. Our efforts account for only part of what needs to be done to make quality healthcare accessible to all, but they are incredibly impactful. 

Three areas where we are specifically focused on making an impact for Black patients are trust, access, and cost, all of which raise the bar for quality of care. By demonstrating our commitment to each of these, we are not only helping to create health equity – we are improving healthcare quality and patient outcomes, and we can begin to influence systemic change that benefits everyone.

Trust

Given that structural racism and discrimination remain pervasive in healthcare, it is understandable why some members of the Black community would mistrust a system that has historically failed them.

To begin to repair trust amongst clinicians and patients, we must build a patient experience that is centered around them and their needs, and one that validates their concerns. This starts with intentional listening and empathy, showing patients we care, and the development of high-quality, customized care plans that take the whole person into account.

We know that Black patients disproportionately suffer from a number of chronic health conditions, exacerbated by institutional racism, and are dying younger than white patients. If their clinician is unclear what the latest evidence-based guidance is, or needs resources for a condition that is specific to the Black population, eConsults can be extremely helpful to deliver care that is more personalized and centered on the individual, and help providers understand their blind spots and learn how to best care for their Black patients.  

RubiconMD eConsults allow primary care teams to get insights and guidance for their patient’s care plans from over 140 specialties. Our platform allows local PCPs to remain at the center of patient care in their communities, building on a foundation of trust with their patients, delivering culturally competent care, and ultimately ensuring better outcomes for patients. 

Access

Access to quality care is an issue as complex as the healthcare system itself.  Data shows that Black Americans have less access to preventive doctor’s appointments and specialist care, and more preventable hospitalizations.  Just getting to a doctor’s appointment can come with major challenges like securing reliable transportation or childcare or taking time off work. If patients do make it to see a doctor, it can take weeks – sometimes longer – to make critical follow-up appointments. And at the end of it all, the issue of institutional and interpersonal levels of racism and discrimination still exists within medical care, regardless of a Black patient’s socioeconomic position.

It’s no surprise that up to 50% of patients don’t follow through with specialty care appointments if referred for one. With every eConsult submitted, RubiconMD is helping close the healthcare access gap. eConsults allow PCPs to bring seemingly out-of-reach specialty care into the primary care setting. For a Black patient who lives in an underserved or under-resourced community, this approach shifts specialty healthcare from being daunting and difficult to more accommodating and convenient. RubiconMD creates access to quality specialty care for Black patients of all ages, socio-economic status, education, and location.  

The connection between expanding access and bettering health outcomes should not be overlooked. Not only does virtual specialty care expand access for Black patients, but it also helps reduce the length of time from diagnosis to treatment, which can dramatically improve health outcomes. 

To put this into perspective, we can look at the example of chronic kidney disease and end-stage renal disease (CKD and ESRD) among Black patients. Although chronic kidney disease affects people of all races at similar rates, Black Americans are three to four times more likely than white Americans to reach kidney failure. There are a number of factors contributing to higher Black mortality, such as delays in nephrology referrals, access to and delivery of dialysis, and other relevant interventions. Embedding specialty care via eConsults into primary care shrinks the gap between diagnosis and treatment by putting resources in the hands of a trustworthy PCP, which can ultimately mean the difference between an appropriately managed condition and a life-threatening later-stage diagnosis.

Cost

High costs top the list of challenges plaguing the American healthcare system.  About 25% of patients say they have avoided treating serious medical conditions because of cost and the Black community is disproportionately affected by this. Difficulty affording care can lead patients to delay or forgo care altogether.  Black patients are more likely to be enrolled in Medicaid or live without medical insurance due to broad structural failures in advancing economic inequality.

eConsults ease financial concerns for patients by taking costs out of the equation about 50% of the time when unnecessary referrals, diagnostics, and procedures are avoided.  By submitting an eConsult instead of immediately referring patients out to a specialist, expensive co-pays, deductibles, transportation costs, or other burdensome costs associated with making time to see a specialist may also be eliminated.

At RubiconMD, we partner with value-based care organizations that have a shared commitment to improving outcomes and increasing health equity for disadvantaged populations. Through investment in innovative technology and processes, our partners are improving access to care for all, slowly but steadily helping to dismantle systemic racism within our healthcare system. 

The road ahead is long and ripe with challenges, but we envision a world where everyone can access high-quality specialty care. During Black History Month and always, we press on in our mission, and we invite you to join us.