© 2022 Health Catalyst
Melissa Welch, MD, MPH, Chief Medical Officer
Trudy Sullivan, MBA, Chief Diversity, Equity and Inclusion Officer
Health Equity Investments: Opportunities
and Challenges in 2023
1

Poll Question: Who’s on the Call Today?
• Direct Service Clinical Provider
• VP / Director
• C-suite level (CEO, CMO, COO, etc.)
• Payers / Agencies (CMS, NCQA, CDC, etc.)
• DEI Governance
• Other

Agenda
Call to Action
Imperatives for addressing health inequities.
Health Equity Is a Quality Imperative
Core to the business strategy, health equity can be achieved as a quality imperative.
Agencies Catalyzing Actions
Joint Commission, CMS and other federal agencies holding health care systems accountable for action.
Health Catalyst Case Studies
Applying economic indicators, coupled with other objective indicators, with AI/ML and quality improvement
methods, inequities can be reduced.

Poll Question: What is the Priority of Health Equity in Your
Organization Today vs Pre-Pandemic?
• More.
• Less.
• Same.
• Unsure.
• Not Applicable.

Healthcare Inequity
Sources: Washington Post, JAMA Pediatrics Study 2018, MHA Keystone Center, NIH, AHA, VA +
JAMA Pediatrics Study found an
increase in teenagers’ stress and
worry about discrimination.
More stress translates into
drinking, smoking, and
experimenting with drugs.
Lower birthweight
babies are born to
African American
mothers suffering
from discrimination.
15%
OF NURSES &
NURSE PRACTICIONERS
10%
OF PHYSICIANS
PEOPLE OF COLOR ACCOUNT FOR
African Americans are more
likely than whites to die of
diabetes and have a higher
prevalence of hypertension
and heart disease.
2022
2040
$320B $1T
Economic
burdens of
health
disparities in
the U.S. if
unchanged.
*than predominantly white counties
19.4% of Asian adults compared to 12.9% of whites
report being without a usual source of health care.
40% of Mexicans and Mexican Americans, 26% of Cubans, and 21% of
Puerto Ricans were uninsured in 2006 as compared with 16% of white
non-Latinos.
LGBT youth receive poor quality
care due to stigma, lack of
healthcare providers’ awareness,
and insensitivity to their unique
needs.
of returning veterans needing
mental health services receive
treatment. Of those receiving PTSD
and major depression treatment.
are receiving evidence-based care.
~23.5 million Americans are living in food deserts,
associated with adverse cardiovascular outcomes in
patients with coronary artery disease, independent of
their traditional cardiovascular risk factor burden.
Black children are
as likely to be admitted to
the hospital for asthma.
4x
U.S. Korean children are
more likely to have no health
insurance as compared to others.
4x
<50%
<1/3

CDC COVID-19 Response Health Equity Strategy: Accelerating Progress Towards
Reducing COVID-19 Disparities and Achieving Health Equity
Updated MAY 18, 2022
HEALTHCARE STAKEHOLDERS REACT TO VERDICT IN GEORGE FLOYD CASE
ANALYSIS | BY JACK O'BRIEN | APRIL 20, 2021
“America's Essential Hospitals issued a statement about how the case [George Floyd]
could provide an opportunity to address "health disparities and barriers to care that
afflict people of color and other underrepresented groups.“
Recent Headlines
Social Imperatives Demand Equitable Care

Identifying and Eliminating Healthcare Disparities
• Offering health equity insight to hospitals and
other parts of the healthcare ecosystem.
• Starts with existing process and performance
measures and patient personal characteristics.
• Applying AI designed to quantify disparities
across measures and contributing characteristics.
• Identify focus areas for achieving massive,
measurable, data-informed health equity
improvements.
Equity Is a Core Dimension of Healthcare Quality

What Is Quality?
• Safe, Effective, Person-Centered,
Timely, Efficient, and
• Equitable: Care that does not vary in
quality because of personal
characteristics, such as gender,
ethnicity, geography, and
socioeconomic status.
From IOM but nicely captured by AHRQ
https://www.ahrq.gov/talkingquality/measures/six-domains.html

How to Measure the Effectiveness of Quality Interventions
Methodology for Measurable Outcomes
Analyze
Opportunity,
Define Problem
1 2 3 4 5 6 7
Scope
Opportunity,
Set SMART Goals
Explore Root
Cause,
Set SMART
Process Aims Design
Interventions,
Plan
Implementation
Implement
Interventions,
Measure Results
Monitor, Adjust,
Continuously Learn
Diffuse,
Sustain

CMS 2022-2032
Framework for
Health Equity
Expand Priority 1: Expand the Collection, Reporting, and
Analysis of Standardized Data
Assess Priority 2: Assess Causes of Disparities Within
CMS Programs, and Address Inequities in Policies
and Operations to Close Gaps
Build Priority 3: Build Capacity of Health Care
Organizations and the Workforce to Reduce
Health and Health Care Disparities
Advance Priority 4: Advance Language Access, Health
Literacy, and the Provision of Culturally Tailored
Services
Increase Priority 5: Increase All Forms of Accessibility to
Health Care Services and Coverage

Joint Commission
“Every patient deserves the right to safe,
equitable health care. All health care
organizations have a responsibility to
identify and address the disparities that
their unique patient populations face.”
Dr. Jonathan B. Perlin, M.D. - President
and CEO - The Joint Commission
Joint Commission Accreditation Standards
Make Health Care Equity a Leader-Driven Priority
Assess Health-Related Social Needs
Use Data to Identify Disparities Across Patient
Groups
Prioritize, Plan and Take Action
Monitor Progress in Achieving Health Care Equity
Inform Key Stakeholders About Progress to Reduce
Disparities
Evidence-Based Interventions

Poll Question: Is Your Organization Already Aligned with CMS or Joint
Commission Health Equity Priorities?
•Yes.
•No.
•Still investing in capacity.
•Not yet investing in capacity .
•Have used data and analytics to provide a clear understanding of disparities at the point of
care.
•Still creating links to individuals, families and communities to address disparities.

During the last 18 Months, we have invested $1.5M+ in Health Equity Tech Access learnings.*
>1M lives could benefit from changes in care.*
In less than two weeks, our AI Solution identifies quantifiable disparities, contributing characteristics,
affected sub-groups and areas of needed focus.
Health Equity governance teams are using these insights to drive clinical, financial, and operational improvements.
• Increasing proactivity.
• Removing bias.
• Allowing focus on inequities, related investments and
monitoring improvements.
• Changing internal perspectives.
• Enabling aggregation and consolidation of equity data.
• Creating consistent definitions.
$320B Economic burden of U.S. health disparities. $1T Forecasted by
2040.*
Success Methodology
Integrate data from diverse source systems—EHR,
scheduling, public health and more. Patient
Characteristics + Process/Performance Measures.
1
Apply domain expertise to help establish meaningful
measures of excellence and equity, prioritize improvement
opportunities, and design interventions.
3
Apply AI to identify and quantify disparities across
measures and pinpoint contributing characteristics,
affected sub-groups.
2
Monitor performance to assess impact and continually
identify, quickly prioritize, and effectively address
opportunities; regularly communicate results.
4
*https://www2.deloitte.com/us/en/insights/industry/health-care/economic-cost-of-health-disparities.html
Pilot Partners Themes from Pilot Partners’ Feedback
*Health Catalyst invested $175K to produce insights for each of the 7 Pilot Engagements *Cumulative total of lives potentially favorably improved (Pilots)

Assumption and anecdote. Disparities quantified using holistic measures.
Interest, passion, brilliance but minimal forward
momentum.
Return on Invested time and resources, measurable
clinical, financial and operational improvements.
Lack of understanding disparities’ impact on clinical
outcomes in communities served.
Impactful community partnerships and improved access.
Ashamed to share current state.
Shared learnings in healthcare ecosystem for greater,
sustainable improvements nationally .
Transforming Care for All
From To
Assessment
Outcomes
Guidance
Aspirations

Poll question: How Far Along Are You in Your Equity Journey?
• We aren’t yet formally addressing equity.
• We’ve used data and analytics to identify disparities.
• We have a strategy to drive disparities out of care and related goals.
• We have a Health Equity Governance Committee driving our efforts.
• We are using dashboards and reporting out our challenges and progress at the board level.
• We transparently share our journey with a broad list of stakeholders.

Health Equity Initiatives: Making Plans a Reality
Prioritizing Health Equity Programs
89%
agree health equity
programs are a part
of their core
business strategy.
Implementing a Health Equity Program
50%
say they have a health
equity plan in place.
34% 16%
plan to implement
within 12 months.
plan to implement
in 1+ year or more.
Source: HIMMS Market Insights, https://newsroom.accenture.com/news/nine-out-of-ten-healthcare-executives-say-that-health-equity-initiatives-are-a-top-business-priority-according-to-accenture-and-himss-insights.htm
Addressing Funding and
Reimbursement Challenges
36%
have a specific budget
dedicated to advancing
their health equity agendas.
55%
say securing funding is a
barrier to addressing health
equity.
52%
cite reimbursement issues
with health insurance,
Medicare and Medicaid.
MARCH 15, 2022
• HIMSS Market Insights, on behalf of Accenture, surveyed 110 U.S. healthcare executives and senior leaders
in December 2021 and January 2022 who have a decision-making or influencer role in health equity
initiatives at their organizations.
• The research was conducted to understand the importance of health equity initiatives in hospital and health
system settings. Forty-one percent of the respondents worked at multi-hospital systems, 30% at academic
medical centers, and 29% at integrated delivery networks; 81% of all respondents worked at not-for-profit
organizations.

Identifying and Eliminating Healthcare Disparities
• Offering health equity insight to hospitals and
other parts of the healthcare ecosystem.
• Starts with existing process and performance
measures and patient personal characteristics.
• Applying AI designed to quantify disparities
across measures and contributing characteristics.
• Identify focus areas for achieving massive,
measurable, data-informed health equity
improvements.
Equity Is a Core Dimension of Healthcare Quality

Borrowing from Strength in Economics and Education
Gini Index Measuring Income Inequality Can Be Applied to Healthcare
https://en.wikipedia.org/wiki/List_of_countries_by_income_equality
http://uis.unesco.org/sites/default/files/documents/handbook-measuring-equity-education-2018-en.pdf

Misconceptions Miss the Biggest Opportunities
0.27
Diabetes Care HbA1c <8%
Depression Care
Post-Heart Attack Medication 0.34
0.27
Pediatric ADHD Medication 0.13
GREATER
EQUITY
GREATER
INEQUITY
AI Identifies Quantifies across Measures…
Gini Index
Applied to Healthcare

0.03
Diabetes Care
HbA1c <8%
0.18
Depression Care
0.20
0.06
Race Age
…and the Contributors within Measures
Misconceptions Miss the Biggest Opportunities

Challenges & Impact Solution Results
A Health Catalyst Success Story
AI Can Advance Health Equity
Healthcare leaders are increasingly aware of the power of technology and
augmented intelligence (AI) to impact health equity. To ensure practices help
reduce—not exacerbate—health disparity, ChristianaCare established health equity
as a strategic priority, pursuing it with the same commitment and focus it would
give to other domains of quality.* Using its data platform and Healthcare.AI™,
ChristianaCare now has a single “source of truth” for personal characteristic data
and performance measures. Using AI, it can conduct systematic equity analysis to
guide interventions, helping the organization address disparities and meaningfully
advance its mission.
 Inconsistent collection of personal characteristic
data—such as race, ethnicity, and language.
 Multiple source systems that categorized and
stored characteristics differently.
 Changing classification schemes.
 No specific analytics for health equity.
 Impact: With challenges in data collection,
storage, organization, and analytics
ChristianaCare struggled to use its data to
understand and improve health equity.
 ChristianaCare now has a systematic
approach to evaluate health equity as a core
part of its commitment to quality.
 The organization has driven key
improvements using this approach, including
overcoming disparities in COVID-19 testing
and increasing access to care through
innovative clinics that combine virtual
primary care and COVID-19 testing in some
of Wilmington's underserved communities.
 Leveraged the Health Catalyst® Data
Operating System (DOS™) platform as the
organization’s single “source of truth” for
personal characteristic data and key
performance measures.
 Applied AI to perform an equity analysis that
evaluates a range of measures over multiple
dimensions to identify success and
opportunities for improvement.
* https://www.ahrq.gov/talkingquality/measures/six-domains.html

Challenges & Impact Solution Results
A Health Catalyst Success Story
Innovative Care Management Program Avoids
Nearly $16M in Costs and Transforms Lives of
Super-Utilizers
The Queen’s Medical Center in Hawaii was the site of nearly 60 percent of all emergency
department (ED) visits by people who were experiencing homelessness, with some of them
visiting the ED every day. Knowing that in most cases patients would receive better care
outside the ED—and seeing that inordinate resources were needed to treat them—The
Queen’s Health Systems sought a better approach. The organization leveraged its analytics
platform, payer data, and patient flow data to refine care management for this vulnerable
population, an effort that led to dramatic improvement in patient outcomes and costs.
 Developed the Queen’s Care Coalition, an
innovative care management program, to address
the needs of super-utilizers.
 Leveraged the Health Catalyst® Data Operating
System (DOS™) platform for data and analytics and
the Instant Data Entry Application (IDEA).
 Established mechanisms for using payer data,
patient data, and patient flow data for ongoing
program evaluation and data-informed decisions.
 Patients experiencing homelessness were
consuming a disproportionate share of ED
resources.
 Existing program for high-utilizers had not
managed to shift ED utilization patterns for
this population.
 Impact: The organization wasn’t able to meet
the needs of this unique patient population,
deploy care management effectively, or
expend its resources most effectively.
 Nearly $16M in cost avoidance.
 68.5% reduction in the number of days
patients spent hospitalized.
 22.8% reduction in length of stay.
 43.8% reduction in readmission rate.

Sample visualization from Health Equity Assessment
Key Metrics
 Adherence to best practices
 ED visits
 Inpatient admissions
 Readmission rate
 Mortality rate
 Patient access
 Care management enrollment rates
 Patient and provider engagement
Success Methodology
Keys for Realizing Value
Health Catalyst Solution
Statistics from the COVID-19 pandemic shine a bright light on a disturbing truth: disparities in
patient outcomes are tied to socioeconomic indicators. As healthcare systems increasingly
recognize that equity is a core dimension of quality, leaders seek expert guidance and support to
identify disparities, design effective interventions, and manage organizational change. Leveraging
data and AI, successful organizations can not only achieve measurable health equity improvement—
but may also experience a cascade of clinical, financial, and experience improvements.
 Products
‐ Healthcare.AI Product Suite
‐ Care Management Suite
‐ Twistle Patient Engagement
‐ Safety and quality applications and
tools, e.g., Patient Safety Monitor™,
clinical analytics accelerators
 Services
‐ Health Equity Assessment &
Guidance Services
‐ Healthcare.AI Expert Service
Integrate data from diverse source systems—EHR,
scheduling, patient engagement, public health and more.
1
Apply domain expertise to help establish meaningful
measures of excellence and equity, prioritize
improvement opportunities, and design interventions.
3
Apply AI to identify and quantify disparities across
measures and pinpoint contributing characteristics.
2
Monitor performance to assess impact and continually
identify, quickly prioritize, and effectively address
opportunities; regularly communicate results.
4
Improving Health Equity

Health Equity Opportunities in 2023
Key Messages
Imperatives for addressing health inequities have accelerated with societal influences.
When addressed as a core element of an organization's business strategy, health inequities can be
addressed.
Addressing health equity as a quality imperative leads to sustainable methods to drive measurable
improvements in clinical outcomes.
Joint Commission, CMS and other federal agencies are holding health care systems accountable for
actions to achieve health equity.
Case studies demonstrate the impact of of applying economic indicators, coupled with other
objective indicators, with AI/ML and quality improvement methods, inequities can be reduced.

Questions?