Written by LeRoi S. Hicks, MD, MPH, FACP

As a Black physician who has dedicated his 25-year career to understanding and addressing health equity, I am deeply concerned about Delaware’s proposed House Bill 350. The bill aims to address rising health care costs by creating a politically appointed body to oversee the budget. Number of nonprofit hospitals in Delaware.

While the goal of bending the health care cost curve may be well-intentioned, this bill has dire consequences for Blacks, Hispanics, and other traditionally underserved Delawareans who are among the most vulnerable. right. We can and must work together to solve this problem and provide the right care in the right place at the right time.

A tale of two cities

In the words of Charles Dickens, Delaware, like much of America, is a tale of two cities. Living experiences, such as a healthy and safe environment and access to quality healthcare, vary widely depending on where you live and your demographic background. For example, in the city of Wilmington, just a few miles apart in zip codes can make a difference in life expectancy of more than 20 years. This is fine. This indicates that there are serious structural problems in the community that are harming people and shortening their lifespans.

Importantly, cutting $360 million from Delaware’s hospital budget, as House Bill 350 does in its first year, will not solve this problem, it will make it worse. . Doing so would ultimately make health care in Delaware more expensive, not cheaper.

The key to reducing health care costs is improving quality, access, and equity

Data shows that in the United States, approximately 5% of patients account for more than 50% of all healthcare costs. These are primarily patients with complex and poorly managed chronic conditions that result in admission to the most expensive healthcare facilities, including hospitals, operating rooms, and emergency departments.

The key to reducing health care costs is to ensure that everyone is supported to achieve their best health, and those who frequently use the most expensive types of health care can be better supported in managing health conditions such as diabetes and heart failure. As such, it is about improving quality and equity. In the right way. This avoids the need for costly emergency or “rescue” treatment.

Do more of what you already know works, not less.

Healthcare is not a one-size-fits-all industry. Providing care to patients across diverse populations requires multiple interventions simultaneously. These interventions aim not only to improve quality of care but also to close gaps in terms of health disparities. This is important. Because improving care and outcomes for the most vulnerable tends to make things better for everyone.

One type of intervention is to do exactly the right thing for patients, based on evidence of what works, and to avoid doing extra things that cause harm or incur additional costs without providing additional benefit. The thing is to do nothing. An example of this would be to ensure that all patients who have a heart attack are given certain drugs called beta blockers immediately after the heart attack, and to be clear about the actions that should be taken to reduce the risk of a second heart attack. The idea is to make sure that they receive proper guidance and support. Attacks like regular exercise and proper nutrition.

The second type of intervention targets the most at-risk populations. These patients live in poor neighborhoods without gyms or grocery stores, and generally have problems with transportation and lack of access to resources, making it difficult, and in some cases difficult, to follow plans for follow-up care. It has become impossible. They are unable to consume nutritious foods that reduce the risk of a second heart attack. They also live in areas with fewer health care providers than wealthier areas.

These interventions tend to be highly intensive and do not generate income for the health system. In fact, they require significant unreimbursed investments, but are necessary to keep the most vulnerable patients healthy.

The medical community has developed interventions for these people that are proven to be effective. A local example is the Delaware Food Pharmacy program, which connects at-risk patients with healthy food and supports their ability to prepare it. This program helps patients improve their overall health, effectively manage chronic conditions, and prevent adverse events that result in a return to the hospital or emergency department.

we succeed when we work together

We have seen great examples of how this effort can be successful right here in Delaware. Delaware was the first state in the nation to close racial disparities in colorectal cancer, and we did this by expanding cancer services, including making cancer prevention treatments and screening more accessible to vulnerable populations. did. This was an incredible success story that continues to this day, and was the result of a thoughtful and detailed partnership between the state and the medical community. This effort continues in a collaborative effort to reduce the impact and mortality of breast cancer in the state.

Unfortunately, these types of interventions are among the first to be taken when health budgets are cut. This is because these interventions do not generate income and are not self-sustaining. These types of activities must be funded by grants, external funders, or by hospitals and health systems.

Focusing only on cost risks losing progress made

Delaware House Bill 350, as proposed, could cause harm in two ways:

• First, it would undermine our ability to invest in these types of interventions that work.
• Second, it increases the risk that Delaware will lose access to costly health care services and programs that are disproportionately needed by people in vulnerable communities.

In states like Vermont and Massachusetts, where government has intervened in the name of cost-cutting, the result has been lower quality and less equitable access to much-needed services. House Bill 350 would widen the gap between people of means and those who are more vulnerable.

These changes will lead to an increased burden of disease in these populations. They end up going to the emergency room more often and ending up in the hospital, which is the most expensive treatment. That’s not what anyone wants, and it’s the opposite of what this bill was trying to accomplish.

At this time, Delaware has an opportunity to put the state on a sustainable trajectory to improve the health outcomes of all Delawareans. House Bill 350 is not that path. But the discussion House Bill 350 started is one we can build on by bringing together the stakeholders we need to work together to solve these complex problems. This includes Delaware’s government and legislators, hospitals and health centers, insurance, pharmacies, the medical device industry, and most importantly, patients and the physicians who care for them.

Dr. Leroy Hicks is campus executive director of ChristianaCare at the Wilmington campus.