by Michael B. Garrett, MS, CCM, CVE, BCPA

In light of the racial and justice issues impacting the United States that have reverberated around the world, there is a growing awareness of the impact of racism and other forms of discriminatory actions impacting the health and safety of marginalized populations. The clients that case managers serve who are members of these populations have been dealing with these challenges in society for centuries. These inequities have been felt in healthcare, education, criminal justice, and other systems in society. Case managers are becoming increasingly aware of terms such as health disparities, health equity, and diversity, equity, and inclusion (DEI). The health and human services organizations that case managers work for are also gaining a growing awareness of the need to address the impact of health disparities on the ability to achieve health equity. Employers are recognizing that in order to have flourishing businesses that are responsive to the needs of customers and employees, they need to embrace DEI initiatives. Insurance carriers are also realizing the need to identify and address health disparities in order to improve health outcomes while also realizing cost savings.

Health disparities result in adverse impacts on groups of people who experience barriers and gaps in care based on one more demographics, such as race, ethnicity, gender, sexual orientation, socioeconomic status, disability status, language, gender identity, nationality, or other factors. These disparities are closely linked with social, economic, and/or environmental disadvantage. They also result in increases in the incidence, severity, and mortality rates of the affected people. Health disparities are inherently unjust and are compounded by systemic barriers to timely and effective culturally competent healthcare services due to explicit and implicit discrimination as well as stigma.

In light of the challenges of health disparities, health equity has evolved by focusing on those barriers and gaps in care, such as coordinating timely access to culturally competent providers, increasing preventive screening rates, and improving adherence to chronic care guidelines. From a societal perspective, that requires addressing poverty, joblessness, homelessness, and safety. At an individual case manager level, it requires case managers to identify potential and actual health disparities, so that interventions can be taken to eliminate the gaps and barriers in health and its determinants.

The social determinants of health (SDoH) are also closely connected to the challenges and opportunities.  Inherent in SDoH are the economic and social conditions that impact the health of both people and communities. In order to effectively deliver case management services, case managers need to identify and address the social needs of their clients. This requires awareness, data, screening tools, and effective interventions.

The case manager may address the SDoH needs of client by coordinating referrals for services in the home and community, such as:

  • Preventing falls
  • Facilitating access to healthy foods
  • Coordinating access to transportation
  • Reducing social isolation
  • Addressing homelessness
  • Identifying culturally competent providers

These kinds of interventions and services are particularly important for clients with complex health conditions and social risk factors who likely have significant functional limitations. These services can improve the health outcomes of these high-risk clients while reducing healthcare costs.

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