A focus on equity has risen to the fore in many U.S. health care systems in reaction to the killings of George Floyd, Breonna Taylor, and their repercussions, as well as the many racial and ethnic disparities highlighted anew by the COVID-19 pandemic.  Both senior management and boards of directors of health care systems across the country have undertaken new efforts, or redoubled existing ones,  to address equity: first in the context of provision of care and the fundamental operations of health systems, and second, in addressing the broad upstream drivers of social and economic inequity that are largely extrinsic to health care. Actions are being taken by health systems in five main categories: speaking out publicly against inequity;

taking larger steps internally to address diversity, equity, and inclusion (DEI), combat racism, and advance empowerment; widening their traditional equity lens to encompass widespread discrimination against multiple population groups; ramping up efforts to address the safety and quality of care and reducing undesirable variation as a means to reducing inequity and disparities; and using their resources to address upstream health drivers,  including in priority areas of the social and economic determinants of health.  Dentzer will describe how a growing number of U.S. health systems now recognize and accept that they must play a dominant role in a process of social and economic transformation to eliminate racism and other forms of discrimination, and place the nation on the road to better health. 

With the 2022 midterm elections already around the corner, Democratic candidates are proposing a range of health reforms aimed at providing universal health insurance coverage.   Some would build on and extend the reforms enacted in the American Rescue Plan in 2021 in the Affordable Care Act; others would go further to create Medicare for All, or a some other single-payer system that would abolish private health insurance.   There are also a variety of competing reforms in between. In her presentation, Dentzer can describe the origins of

“Medicare for All” in longstanding calls for national health insurance; delineate the specific “Medicare for All” and related proposals; discuss the implications for hospitals, health systems, insurers, and individuals; and weigh the political prospects of all of these reforms.   She can also provide an update on Republican initiatives in support of expanding coverage that could continue to affect political and health reform landscapes.

The presentation is based on the book of same name published on Amazon.com. Dentzer was the editor and lead author of the book, which among other features, prefigured the explosion of virtual health care during the pandemic.

Book Reviews:

“We finally have a roadmap to fix the U.S. health care system. Health Care Without Walls is a must read for everyone in health care and for anybody who believes there has to be a better way to care for individuals and communities.” – David T. Feinberg, MD, MBA, Google; former President and Chief Executive Officer, Geisinger Health System

“Drawing on deep research and real examples from around the country and around the world, this study provides a blueprint for how care can and should be delivered in the future. Let’s make it a reality.”  – Ian Morrison, author, consultant and health care futurist

“Health Care Without Walls describes an exciting future state to which the U.S. health care system clearly needs to evolve.” – Robert M. Wachter, MD, author of The Digital Doctor; chair, Department of Medicine, University of California San Francisco School of Medicine

Presentation Description: 

“Imagine a health care system that came to you — a system that met you, as an individual, where you are, in your home, workplace, or community, in part through such ‘virtual care’ modalities as telehealth. Such a system would anticipate your needs and work to keep you as healthy as possible, and view any of your needs to access “sick care” as a possible sign that the system had let you down.   This system would address the upstream drivers of your health status, and yet be as convenient and accessible as other elements of your life that you now take for granted, like ordering online.   Such a system could be called ‘Health Care Without Walls.’

Susan Dentzer can describe current trends and examples moving us toward the vision of Health Care Without Walls, and the public policy changes and private sector measures also necessary to achieve it.   Although there will be many benefits in achieving a far more distributed system of care outside of conventional institutional settings, such as hospitals, physicians’ offices, and nursing homes, a number of payment/reimbursement, regulatory, work force, and human factors issues must be addressed before such a system can be realized.  Dentzer can describe the need for a “21st Century Hill Burton” program to assist many of the nation’s hospitals in transforming into new roles.  In particular, Dentzer can discuss the many implications for the nation’s health care work force; education and training of health care professionals; and in particular, interprofessional education and training to deliver the team-based, virtually enabled care that will increasingly be the norm.  She can offer examples of organizations that are engaging in such efforts, and describe the opportunities that may emerge for research and other partnerships to advance the field.

“Health Care Without Walls: Implications for Primary Care” was the subject of a recent webinar that Susan led for the Patient Centered Primary Care Collaborative.   View and/or listen to recording here at: https://www.pcpcc.org/webinar/health-care-without-walls-implications-primary-care

How key health system leaders are responding to demands for greater equity within their organizations and across their communities.

 Dentzer has a version of the Health Care Without Walls presentation specifically geared to the oncology community and the needs of cancer patients.   She draws on her recent experience in helping to create a Cancer Hospital Home program at Yale-New Haven Health system.