How Deloitte Health Equity Institute Tackles Inequalities, per Director Kulleni Gebreyes, M.D.


In this final part of a three-part video series, Managed Healthcare Executive® Managing Editor Peter Wehrwein recently interviewed Kulleni Gebreyes, M.D., director of Deloitte's new Health Equity Institute about her career, healthcare disparities and equity issues and the work of the institute.

The transcript below has been edited for length and clarity.

Maybe this is a good time to shift to more of the nitty gritty of what this Deloitte Health Equity Institute is about. Could you just fill us in exactly when it was created, about how many people work for it and, you know, maybe a project or two that that the institute is taking on?

I'll start with saying that, you know, Deloitte as an organization has been doing many things advance health equity for decades. So this is not a brand-new idea.

But the recent events have really made us look at ourselves to say how can we truly be impactful in society. So we established the Health Equity Institute in March of this year. And the way we define it is that it's a new social innovation and knowledge development organization that moves the field for public good and advances equity as an outcome.

Every single word is selected very intentionally, which is to say that we, as business leaders and professional services firm, believe that if you can define an outcome, and organize around it and create frames around it, that you can advance it.

So our main objective is exponential change. How do we drive exponential change through pro bono programs, philanthropy and cross-industry collaboration?

Related: Kulleni Gebreyes, M.D., Shares Experiences with Racial Bias and How to Curve This Problem

(There are) intelligent, idealistic people, not just in medicine, but actually among business leaders, community leaders, government leaders — we believe that we have the platform to pull them together.

So a couple of examples of that.

We're working with United Way to increase COVID vaccination rates among communities of color, and we're increasing access to it and awareness and education at local community and faith-based centers. In the Washington, D.C., area, we're working with Mary Center, where the COVID cases per capita have been disproportionately high. And once again, we're increasing access to vaccination.

(We are also) working with the Lourie Center (for Children’s Social and Emotional Wellness in Rockville, Maryland) to look at what's the burden on students and teachers as a result of COVID-19.

That's just three small projects.

We actually have over 15 collaborations, both with academic medical centers and HBCUs. We believe that our power is that we can provide data-backed ways of approaching this issue, and we have partners and business leaders who are willing to hold hands and link arms with us to make change.

Could you unpack what you mean by “work with”? My vision of Deloitte is that if, for example, a hospital is having financial problems, and Deloitte comes in and analyzes and figures out this surgical service is inefficient, and you should expand this service, and so on and so forth. It's sort of the outside eyes with a lot of data and spreadsheets.

There's definitely some of that, but within the institute, we're approaching things in three critical ways.

One, we are actually partnering to implement programs that we believe will advance health equity, and we're doing that with partners, so that could be health plans, healthcare providers, not-for-profit community organizations. We're both providing financial dollars to invest in order for the work to be done, as well as giving the time and resources of our talented, high-competency folks to actually help go and implement the program.

Another thing that we're doing is spending quite a bit of time collecting data in order to provide insights that make a difference … trying to understand which communities are most impacted, and being able to understand, who's most affected, where are the largest vulnerable communities. We're providing data and insights.

And then, finally, the third way we're advancing health equity is by creating a knowledge hub that actually democratizes it. So we worked with a large academic medical center, for example, to set up a testing site at a house public housing area. Not only did we do that project as a community partnership, but we created a playbook of how do you identify where to set up vaccine or testing and what are the steps that you need to take logistically — how many people do you need, what's the staffing model. Those playbooks are available for no cost on our website. We're trying to empower and enable others.

As you know, healthcare is driven by metrics. So are you developing metrics that would begin to measure health equity outcomes, and in some sense, make organizations accountable for either for meeting those metrics, and the same way in value-based care, they're held to account for, for example, the number of patients who get a beta blocker after being in the emergency room for a cardiac event?

We are developing a health equity index. And we've helped a number of organizations create a dashboard for their own organizations, both in terms of looking internally (at their workforces) in terms of diversity, equity, and inclusion, (but also) where are the clinics located, what are the operating hours and does that reflect the needs of the community? And where are the data gaps? If we're really to understand, how race, gender, geographic area impacts disparities and outcomes (we need to have the data).

There's the conventional wisdom or a myth that we're really trying to debunk, which is that if you want to advance health equity, you have to do it as a public good only as a program and initiative, and it erodes your bottom line. We're focused on saying here is how health equity can actually be the basis for competition, especially within the healthcare industry.

CMS actually just announced that health equity is going to be centered to their value-based care. So when you're looking at quality, we're actually helping tease out that, yes, it's important to have overall adherence to whatever treatment protocol you are dealing with, but then can you break that up to say, are there disparities. You can have 80% adherence in one group and lower mortality, but another group that could be 50% or 30%. So we're helping define that.

(There is an) the assumption that it's going to cost you more to solve it. When we've done the math. Other organizations have done the math. Disparities actually cost all of us more money. It's more expensive. And so you can actually use it as a business strategy, how to win and how to become more profitable if you figure out ways to advance health equity.

I guess you're saying that the ROI on addressing health disparities might be pretty good.

It's fantastic.

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