Seven Steps for Improving Equity in Health Care Delivery: A Roundtable Discussion

Ed Quick, MA, MBA, CDMS, Rebecca Fisco, CDMS, R. Keith Franklin, PhD, LPC, CEAP, LCDC, CCM, ACS, and Kendra Greene, MSN, MBA/HCM, RN, CCM

Note: The following article is based on a presentation by the authors at the Commission for Case Manager Certification (CCMC) Symposium held in October 2022.

When we think of equity in health care, one of the first things that often comes to mind is the concept of equal access. But equality is not synonymous with equity; in fact, they are distinct. One way to understand the difference is to view equality as beginning at the hospital entrance; every patient who arrives for care will receive treatment. Equity, however, looks at how—and if—a person can get to the door of the hospital. Financial, environmental, mobility, and other barriers can stand in the way, preventing access.

With this understanding, we see the close connection between equity and the social determinants of health (SDOH): the economic, environmental, and social factors that impact health and well-being. With the goal of improving equity, certified case managers (CCMs) and certified disability management specialists (CDMSs) can devise and implement care plans that bridge the gaps within the systems that influence the health of individuals and the population.

Pursuit of equity elevates advocacy within case management and disability management, ensuring that all clients (known as patients in some care settings) receive the right care and treatment at the right time, in the right setting, and of the same quality. Here are seven steps case managers and disability managers can take to ensure greater equity in health care access and delivery:

1. Understand the difference between equity and equality: Although these two terms are sometimes used interchangeably, they are not synonymous. As stated above, in health care, equality can be thought of ensuring everyone who comes to a hospital or other facility receives treatment. Equity, however, accounts for if and how people can access that treatment by considering financial, environmental, mobility, and other barriers.

2. Screen for SDOH: We cannot assume that poverty and financial insecurity affect only those who are unemployed, have no health insurance, or are undomiciled. Inflation and a higher cost of living are putting pressures on more individuals, including those who are employed. As part of intake and assessment, case managers and disability managers need to ask open-ended questions that can uncover the potential impact of SDOH. For example: Are you able to fill your prescriptions on time? How do you get to your doctor appointments? Do you have access to quality providers or ancillary services? What issues cause you stress continues on page 36

Ed Quick, MA, MBA, CDMS, is a Commissioner and Chair-elect of the Commission for Case Manager Certification (CCMC), the first and largest nationally accredited organization that certifies more than 50,000 professional case managers and disability management specialists. He has more than 30 years of experience in disability and workforce management with Fortune 100 companies and currently works as a global senior benefits manager.

Rebecca Fisco, CDMS, is a Commissioner of the CCMC and the Associate Director of Integrated Absence Management and Vocational Services for The Ohio State University.

R. Keith Franklin, PhD, LPC, CEAP, LCDC, CCM, ACS, is a Commissioner of the CCMC and an EAP psychologist with the U.S. Department of Defense’s Employee Assistance Program (EAP), with more than 20 years of clinical experience.

Kendra Greene, MSN, MBA/HCM, RN, CCM, is a Commissioner of CCMC and a Sr. Consultant— Medical Management for Optum/UnitedHealth Care.