Structural and systemic inequities have long contributed to ongoing health disparities, especially within minority communities in the United States. However, the pandemic and

Rodey Wing

social unrest of the past few years have magnified the issues. For example, Latino and Black people were hospitalized with COVID-19 at a rate 2.8 times higher than white people, according to the U.S. General Accountability Office.

Certainly multiple factors are at play, and many drivers of health inequity go beyond the traditional health care system. A lack of access to healthy foods, stable housing, secure jobs and quality education can all exacerbate differences in health outcomes. But while the causes of inequity may be far reaching, we all have a role to play in closing the gap.

Dominique Harris

For retail pharmacies, taking action to improve health equity is not only the ethical thing to do, it’s also smart business. We’ve developed a framework that provides companies with three steps they can take to address health inequities among their communities and provide more value to their customers in the process.

Understand the gap

The first step is evaluating existing initiatives and ongoing business decisions to understand the equity implications. This can help identify potential disparate outcomes and ultimately enable mitigation plans and solutions that provide more value to affected populations. For example, even before the pandemic, many retail chains were reducing their pharmacy hours to lower their costs. Labor shortages have exacerbated the situation and may make some of the hour reductions harder to control. However, the decision to reduce pharmacy hours still has a health equity impact, and understanding it is important.

Here’s how:

• Measure the impact: Consider what populations are most impacted by reducing hours and who will lose access to pharmacy services. Look for the answers to these questions across socio-demographic lines, including race, ethnicity, income and gender. Also, make sure you understand the current needs and outcomes of impacted communities and whether other pharmacies in the area can provide access when stores are closed. It is also important to look downstream to uncover any unintended consequences. Reducing pharmacy hours doesn’t just limit access to drug and pharmacy services; it can also limit access to preventative care, resulting in individuals being sick more often, missing work, and facing decreased income or reduced access to jobs or housing. In addition, losing income can lead to a loss of insurance coverage, which exacerbates health disparities and impacts an important revenue generator for pharmacies. While it’s not the sole responsibility of pharmacies to help people maintain employment, understanding the downstream impacts highlights the holistic effects of a decision.
• Establish equity thresholds: A decision to reduce hours inevitably has downstream effects. That doesn’t mean pharmacies shouldn’t ultimately reduce their hours. Instead, organizations need to consider the financials and other driving factors for the decision in light of the anticipated equity impacts. Establishing a threshold for what level of equity effects and downstream impacts are acceptable can help create accountability and ensure that equity evaluations factor into the decision-making process.
• Identify alternative solutions: Depending on the go-forward decision, identifying and understanding the potential alternatives is an important part of the decision-making process. For example, review the decision in light of the following questions:

– Are there other pharmacies in the area that can serve affected populations when this pharmacy is closed?

– Could free delivery be provided for impacted customers to increase access outside store hours?

Karen Yocky

At the end of this process, reducing pharmacy hours might still be the best overall decision. However, by considering the equity impacts, you can help reduce disparate outcomes and enable mitigating alternatives.

Help advance health equity

Beyond considering the equity impacts of current initiatives and future decisions, organizations should also aim to identify the unique ways they can advance health equity through new initiatives. Much like the previous evaluation, the process begins with understanding the distinct health needs of your communities. That way, you can align your services to positively impact your customers. Here’s how:

• Match your strengths to the community’s needs: Identify the most pressing needs in the communities you serve. For example, say your research shows that your communities face high rates of tobacco and alcohol use, diabetes and obesity. As a retail pharmacy, you may have an existing diabetes outreach program, which positions you to address that need most effectively (versus smoking cessation or alcohol use).
• Tailor your offerings or create new ones: While some of your services may match existing needs, it’s also likely that you may need to fine-tune your offerings — or create new ones — to have more impact. The key is engaging community voices so you can understand what’s required and what engagement has already occurred. For example, you might learn that diabetes outreach programs that remind patients to pick up their prescriptions have been unsuccessful because of high medication costs and limited pharmacy hours. Explore how expanding the outreach program to make medications more accessible (via time and cost initiatives) can create a more significant impact. For example, Walgreens ramped up its efforts to help customers in underserved neighborhoods by providing free delivery and access to Medicare and Medicaid programs.

Laura Bowen

Develop a business case: Developing a compelling business case is essential for creating long-lasting programs. The business case should include traditional metrics such as the investment required, projected financial benefits and net present value. However, health equity business cases should also include the expected health and societal benefits. For example, the benefits might consist of more preventative visits with a primary care physician, improved prescription adherence, fewer hospitalizations, and lower mortality. That said, health outcomes can take time to materialize, so monitoring leading and lagging indicators can help you understand the initiative’s effectiveness in the early stages. Lastly, collecting and analyzing health data is challenging, but don’t wait for perfect data before taking action. You can take bold steps toward health equity even as the analytics improve.

Leverage partnerships to amplify the impact

No company can address health equity issues alone. By partnering across communities, health leaders and businesses, we can find ways to better amplify and scale the impact. For example, partnerships can reduce potential competition in some areas and increase reach by enabling you to prioritize specific geographies and communities while others focus elsewhere.

Partnerships also allow you to share infrastructure, data and technology. This increases the speed to market and enables a more efficient use of resources, maximizing the total offerings to a community rather than developing competing offerings.

The recent health equity initiative by CVS and Uber Health provides an example of an effective partnership. The companies paired up to eliminate transportation barriers that prevent people from accessing health services. The program highlights the connection between health services and transportation and leverages the skills of both companies to address inequity. So, can others create effective partnerships that benefit their customers? Here are a few key elements:

– Establish a shared vision: Ensure all stakeholders are aligned on the partnership’s goals and understand the business case and benefits that the initiative provides.

– Partner within and across the value chain: Pharmacies must partner with other pharmacies and governments to reduce competition and maximize the impact. In addition, partnerships with payors and providers will enable more holistic and compelling offerings than a pharmacy could provide alone.

– Address power dynamics: Create ways to ensure each partner has an equal voice. Stepping outside the status quo to create a more collaborative working model can amplify your impact. For example, trade associations may play an essential role in the future as an objective third party, encouraging partnerships and facilitating coordination.

An imperative to act

Advancing health equity requires us to take a critical look at everyday operations and factor equity into the decision-making process. Identifying new initiatives and collaboration models increases the impact even more.

Across these efforts, pharmacies must continue to ensure appropriate representation among decision makers so that companies don’t work in silos and instead effectively engage the community and those impacted. Success won’t happen overnight. But by making concerted efforts to address each of these steps, we can each do our part to help contribute to a more equitable health ­system for all.

The authors would like to thank Kayla Wilcox for her valuable contributions to this article.

Rodey Wing is a partner in the Health Practice, and Dominique Harris is a partner in the Leadership, Change and Organization Practice at Kearney, a global strategy and management consulting firm. He can be reached at [email protected]. Karen Yocky is a manager in Kearney’s Health Practice, and Laura Bowen is a principal in Kearney’s Health Practice; they can be reached at [email protected] and [email protected].