ACP panel calls for systemwide efforts to advance health equity

Kevin Fiori, MD, MPH, MS, Jamar Slocum, MD, MBA, MPH, FACP, and Earl Stewart Jr., MD, FACP

Health care shouldn’t discriminate. At a panel discussion titled “High-Value Care Strategies to Advance Health Equity” during the American College of Physicians (ACP) Internal Medicine Meeting 2025 in New Orleans, three physician leaders offered their critique and proposals of how U.S. health care institutions must overhaul their approach to equity.

“Equity is a fundamental value, and it could mean numerous, numerous things to different people as well, depending on the context of where they are, who they are,” said Jamar Slocum, MD, MBA, MPH, MACP, an assistant professor of medicine at George Washington University. “For me… health policy or health equity really is about allocating resources to minimize preventable health outcomes between different populations and ensuring that access is fair.”

Barriers and blind spots

Kevin Fiori, MD, MPH, MS, a pediatrician at Montefiore Health System in the Bronx, New York, described a major challenge to advancing health equity: simple knowledge of where systems fall short.

“We have these EHRs which are not built necessarily for research,” Fiori said. They’re not built to get data out easily, in my opinion — that might be my bias or just my experience. And so, we’re left with, ‘how do we figure out where the problems are?’ Because, unless we have the data to figure out where the problems are, how do we address it?”

Fiori said his team has been “trying to figure out where are we doing a bad job, which kind of patients are we failing… where can we intervene?”

At Montefiore, they found one solution: integrating community health workers — Bronx community members who have become full-time employees. Although, getting those roles reimbursed remains a challenge, according to Fiori. “We have been working with New York State Medicaid for the past year… Medicare has been more challenging.”

Partnerships over platitudes

Earl Stewart Jr., MD, FACP, who leads health equity efforts at Wellstar Health System in Georgia, said collaboration is central to making any meaningful progress.

“It is not singular work. It is not work that just one person can do. It is not work that one can just… pat him- or herself or themselves on the back and say, ‘I did that by myself.’ It takes coalition building,” Stewart said.

Wellstar has built partnerships with churches, art groups and federally qualified health centers. “We’re stretching now to not just do so in more urban marginalized populations, but also in rural communities, where there’s always a standardized issue with access,” Stewart added.

Another success has come from Wellstar’s congregational health network. “We partner with faith-based institutions and establish formalized relationships in the communities where we have a health community footprint.”

Redefining the care team

Both Fiori and Stewart underscored the importance of redefining the clinical team to include professionals who address patients’ nonmedical needs.

“Our busy primary care providers… seeing upwards of 30 patients a day… we’re just going to ask them to do one more thing in their busy schedule? It’s a nonstarter,” Fiori said. “So, redefining who’s on the team and what role each team member had… they came in for their… well-child visit… but really the thing on their mind is the fact that… they’re facing eviction.”

For Stewart, addressing the social and political determinants of health is central to being patient centered. “Zip code determines more so what happens to the patient from a health care outcome standpoint instead of just what we do in our examination in our hospitals each and every day.”

Equity has a price tag — and a return

One of the panel’s most persistent themes was that advancing health equity is not just morally correct — it’s financially sound.

“We know that a patient with a social need on average cost our health system $1,700 more per year when you adjust for all other factors,” Fiori said. He pointed to an internal study: “We found that patients that endorsed on social need, they have 5% difference in terms of their show rate at primary care… in this case, translated into 170,000 missed appointments. It was actually $18 million that we lost.”

Stewart also made the fiscal case. “The conversation that will always happen is, ‘well, you know, this may not necessarily be revenue-generating, but it is cost-saving’… our community transformation work had… $500,000 of impact in terms of dollars saved from keeping patients who need to go — who are using their emergency department, in times like these, as primary care.”

Training the next generation

Slocum, who helps shape medical school curriculum, emphasized that institutions must hold themselves accountable: “Our education system, and particularly our institutions, have a social responsibility to the community they serve.”

“There has to be some accountability,” he continued. “How many primary care positions? Where are they going? Are they going to underserved areas as well?”

Policy

“There’s a difference between when we talk about social drivers of health and structural drivers,” Slocum said. “Structural drivers really [are] talking about how our nation governs itself… laws and policies are what [lawmakers] use to really redistribute the power, the wealth, the opportunity for our patients to get to health.”

Stewart advised resilience amid political shifts. “Pause if you must — but don’t stop… Sometimes we have to pause and we have to reevaluate,” adding that storytelling is an essential component of advocacy. “Always have a narrative to get support… when you publish data… have a narrative that goes along in the data that you publish.”

What’s next?

Looking ahead, the panelists identified several must-haves: validated health tech tools, reimbursement reform, education about environmental justice, and community health assessments.

“We’re in an economic crisis when we know our health care system spends $14 less than 4% on public health initiatives alone,” Slocum said. “Primary care and public health are like… separated at birth.”

Fiori offered a final reminder: “We can be part of the problem. We can be part of the solution… Whether we want to acknowledge it or not, the problems are affecting our ability to take care.”