How Health Care Systems Are Working to Improve DEI Efforts

How do we solve health equity problems in the world, and how do we do a better job on diversity, equity, and inclusion (DEI) initiatives internally?

Those were the first 2 questions Bansi Nagji, president of health care at GoodRx, asked the room during his session on DEI in health care at Asembia 2023.

It is not news that there is inequitable access to health care in United States and that health care deserts are sprinkled throughout the country, especially in the Midwest. According to research from GoodRx, about 30% of Black patients in the United States have to cross county lines to access cardiology care, and that around half of Black and Latino patients do not have access to primary care.

“So we're here spending hundreds of billions of dollars on a health system that’s not serving the people that are most in need,” Nagji said.

He also shouted out some organizations that are putting in the work to improve DEI in various aspects of this health system. One of these is Merck, which declared its commitment to improving diversity in clinical trials by making sure at least 50% of enrolled patients come from diverse backgrounds, on top of improving community recruitment and removing barriers to enrollment.

UC Davis School of Medicine is also on this list. Research shows that patient experiences and sometimes outcomes are improved when they are treated by health care professions from similar communities. With this in mind, UC Davis began focusing on diversifying their admissions committee and staff—which also removes bias in the admissions process going forward—and cultivating potential “hometown” physicians from medically underserved areas who also wish to practice in these same areas.

With 20% of patients with multiple myeloma being Black, and while they may get diagnosed earlier but tend to be severely undertreated, Johnson & Johnson’s Janssen reassessed its patient engagement with this group. As a result, the “That’s My Word” campaign was launched to tackle disparities in this area through improving awareness and spreading information.

Nagji also emphasized that true health care DEI starts internally within the organization, preaching, “You can’t properly serve your customers unless you resemble your customers.”

As for what GoodRx is doing in this area, there are a number of efforts. For patients, the organization is focused on improving awareness, access, and adherence to health care. For employees, more than 40% of the organization’s workforce is female, and nearly 50% are non-White.

Nagji also emphasized that we need to shift the mindset from “What can organizations do to improve DEI?” to “What must organizations do to improve DEI?” With this new perspective in mind, Nagji led a panel joined by Preeti Parikh, MD, practicing physician and executive medical director at GoodRx, and Pierre Theodore, MD, executive director of health equity at Genentech.

Theodore began by emphasizing that, when focusing on patient centricity, practices need to keep in mind that there is no one patient at the center, as there are different populations that experience different barriers to care.

“It takes a very focused and concentrated effort to understand why one population may encounter a very strong structural barrier—history of racism, sexism, misogyny, those sorts of things that can drive significant outcomes differences,” Theodore said “it's taking that concept of patient centricity and then building it out to be much more robust by understanding that populations do vary quite significantly with respect to the barriers they face.”

When asked whether improving DEI in health care organizations requires a grassroots or top-down approach, both Parikh and Theodore said the answer is not so black and white.

Theodore said there is “no silver bullet” approach, saying it takes the combination of increasing workplace diversity, understanding cultural barriers and other access barriers like transportation issues in the health care system, and looking at environmental exposures and significant risk factors that different or all populations encounter.

For example, at Genentech, they have taken a more broad approach to several areas, including how they engage customers, how they invest in diversity and education for health care providers, how they deliver medications, and more. They have also focused more on ensuring diverse participant groups in clinical trials and doing additional observation trials to see how various populations can interact with different drugs and solutions.

Internally, Genentech has also made board commitments to increase the representation of Black and Latino executives and ensure that Asian employees are also represented in both individual contributor and leadership ranks.

Parikh praised the trends she has been seeing in terms of more personalized patient care in clinical trials and more research going towards really understanding patient health care disparities. According to the World Health Organization, South Asians make up 25% of the global population and 50% of cardiovascular deaths.

Stanford University created a South Asian Research Organization, which is led by South Asian physicians and nutritionists to study the risk factors that disproportionately affect South Asians. They are focusing on prevention and treatment plans, including lifestyle changes based on culturally specific heart-healthy diets, as they have a South Asian nutritionist that has put together a diet based on South Asian diets. The organization is also incorporating gender and ethnicity into clinical trials, and using digital health content and health campaigns to bring awareness to the research and empower communities to take action.

So what’s next going forward?

Genentech created a consortium of clinical trial centers to advance inclusive research and reach patients who have traditionally been overlooked in clinical trials. While lack of representation is a reflection of disparity rather than the cause, inclusive clinical research is crucial in providing patients access to innovative health care. The company is purposefully working to put patients into clinical research protocols and ensure their remarkable portfolio is accessible to a broad range of patients, which Theodore said brings joy and pride to himself.

At GoodRx, Parikh is excited about the focus on personalization in medicine and how it's becoming more of a dialogue. The organization is also taking their awareness campaign to another level by creating different hubs, such as a Black Health Hub, Latino Health Hub, and Women's Health Hub, to bring awareness to specific communities.

Additionally, they are providing doctor discussion guides and affordable solutions to make health care accessible, and is collaborating with the community itself by bringing in patient advocates, patients, and people who represent the community to be part of their content. The focus is on personalization, access, and affordability to ensure the best health outcomes for everyone, Parikh said.

This article originally appeared on AJMC.