Entering HLTH (pronounced “health”), an annual conference focused on the business of health—from healthcare startups to government agencies and insurance companies—feels as overwhelming as healthcare itself. Ten thousand attendees bustle through an expansive conference and exposition space at The Venetian in Las Vegas, neon lights and baroque excess serving as a backdrop for networking, dealmaking, and sharing learnings.
Since its inception in 2018, HLTH has focused on elements of the healthcare industry and served as a connective tissue for health payers, providers, employers, and investors seeking solutions to improve health outcomes, and the technology companies, vendors, and experts offering them. Movement towards value-based care, however, as well as reckonings around the root causes of healthcare inequities, like structural racism and economic injustice, have created demand for more equity-oriented conversations. Accordingly, HLTH has expanded to include Impact Programs, conference tracks focused on issues such as cultivating health equity, centering patient experience, and promoting gender parity in healthcare.
In an opening plenary titled “Leading for Change: Driving Structural Change to Advance Health Equity,” Greg Adams, CEO of Kaiser Permanente, discussed the institution’s attempts to address healthcare disparities, particularly over the past three years. “Where we need to go as healthcare and where we need to go as a nation…we need a new story. It is in honoring and owning and understanding years of systemic racism and the Black and Brown experience,” he shared.
Reflecting on hard truths, Adams also issued a call to action to attendees.
I struggle with the fact that we’ve gone through the worst pandemic that we’ve ever seen in modern lifetime, and we got through it…But it did not work well. There were major fractures that we saw. And for a lot of reasons, we’re not talking about that. We’re not talking about our financing system. We’re not talking about the lack of funding for our public health system. And we’ve got to get there. I heard earlier that there’s the ability and the power in this room to change the world. And I think we, the people that are here, have got to own that opportunity and lift our voices.
Over HLTH’s four-day conference, this question of how those with power in the healthcare system engage with equity, advocacy, and change loomed large.
Hot Topics in Health Equity
A number of themes were featured in multiple sessions across HLTH’s three Impact Program tracks, all of which focused on populations that have experienced lack of access to and mistreatment by the traditional healthcare system.
The first of these themes was reproductive health, including maternal and birth health equity. From a conference-opening video that articulated the healthcare risks posed by the recent Dobbs decision, to a plenary with Planned Parenthood CEO Alexis McGill Johnson, abortion and reproductive rights took center stage.
In a session co-hosted by HealthTech4Medicaid, an advocacy collective of stakeholders interested in bringing innovation to the Medicaid ecosystem, and RHIA Ventures, a nonprofit venture fund that supports equity-focused sexual, reproductive, and maternal health companies and policies, attendees explored the history of structural racism in healthcare and the application of racial equity frameworks to reproductive health.
Providing historic context that was rare elsewhere at the conference, Dr. Crystal P. Tyler, Chief Health Officer at RHIA Ventures, took participants through an analysis of the healthcare harms that Black women have experienced over the centuries, from medical experimentation on enslaved women to forced sterilization. Erika Seth Davies, Chief Executive Officer at RHIA Ventures and founder of the Racial Equity Asset Lab, an organization focused on bringing a justice lens to capital structures and processes, then shared a framework and reflection questions for moving reproductive and maternal health organizations from a “color-blind” to an equity-focused framework—pushing attendees to think about where they sit on this political spectrum. Adimika Arthur, Founding Executive Director of HealthTech4Medicaid, then led a discussion of the ways that public policy and convening intersect with these issues.
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The second recurrent theme was behavioral health, an issue that has long been a priority for advocates and public health leaders but has recently gained traction in private industry as well. Companies focused on mental health and well-being were a significant, new presence at HLTH. They included well-known names like Calm and Headspace Health. In a series of talks titled “Scaling Mental Health, But Not at All Costs,” health plans, pharmaceutical companies, and venture capitalists acknowledged the importance of behavioral health solutions that expand access to a finite number of behavioral health professionals and reach populations who face significant barriers to accessing those solutions.
Margaret Laws, the CEO of HopeLab, a social innovation lab and impact investor focused on the intersection of tech and youth mental health, asked panelists their thoughts on what is ahead for mental health technologies. “There’s been a huge proliferation in this space. A lot of passionate founders, many with lived experience,” she shared. Speakers agreed that platforms which take a creative digital approach that centers community, content creation, and engagement present a unique opportunity, particularly for young people needing mental health support.
The third theme was data privacy and protections. Though the conference centered technology, several speakers pointed out the potential risks that data collection, data algorithms, artificial intelligence, and more could have on populations that already experience health inequities.
Missing Perspectives and Future Directions
Despite the plethora of conversations about health equity and patient-centeredness, actual patient perspectives at HLTH were limited. Few panels, and a limited number of founders and vendors on the expo floor, featured the voices of people with lived experience of inequities, their experiences of healthcare, or their views on how the various companies present and solutions showcased at the conference were impacting their health journeys.
Patient advocacy groups, social movement organizations, and community-based organizations—significant driving forces behind reproductive justice and mental health awareness and policy change—were largely absent from the conversations. Several panelists, reflecting a frustration with government processes that is common in technology-dominated spaces, mentioned their desire to push for policy reform of everything from telemedicine access to social services reimbursement. Connections to community leaders and patients outside the private sector who have experience in mobilization and power building could help ensure that companies and policymakers are accountable to the public.
Many conversations at HLTH touched on the need for change but did not delve into fundamental questions about healthcare in our country. Returning to Greg Adams’ call to action, the challenges of our healthcare system, magnified by the pandemic, require us to examine our assumptions about what different solutions can do. For example, investments in technology-enabled services to connect housing-insecure patients to healthcare may be crucial in the short term, but how does such investment connect to public and private investments in housing infrastructure more broadly? A payor may decide to pay for patient transportation to the clinic or provide a food benefit for its hourly employees—but what about investing in the local built environment or providing more robust wages?
Despite a focus on innovation, few participants drew from examples of creative alternatives to healthcare delivery, financing, and policy, such as healthcare cooperatives, BIPOC-led wellness spaces, and patient capital vehicles. The solutions presented by these alternatives, many of which have been in place for decades, address the health equity barriers that many HLTH attendees are tackling, such as access to healthcare professionals or customized patient messaging. They also address the underlying causes of poor health, from inequitable resource allocation to the disconnect between patients who have experienced systemic oppression and a healthcare system that misunderstands or perpetuates those harms.
At a session titled “Investing in the Patient: What Technologies are VCs Interested In?”, moderator Morgan Cheatham of Bessemer Partners, a venture capital firm, described the current status of private financing for healthcare solutions. “Our industry has blossomed over the last several years…We know that last year, 2021, was a banner year for venture investment in digital health. We eclipsed $29 billion of investments.” Later, he reframed this milestone for the panelists. “I kicked off our discussion with some stats around the market. But let’s be clear, that’s not to say that venture capital financing is the right metric by which we should be evaluating our success in healthcare.”
Indeed, HLTH and its attendees continued to circle the unknown: How will the trillions of dollars coursing through this complex healthcare ecosystem—driven in large part by our choice in the United States to treat healthcare as a business—move the needle on healthcare outcomes? What impact can those shifts have without broader systemic reforms to address racism and poverty? And what role will healthcare stakeholders, who are committed to both a mission and a financial imperative, play in advocating for those reforms?