It’s no secret that health inequities are a rampant and costly problem in the US—the National Institutes of Health estimated that racial health inequities cost the US $451 billion in 2018.
Health systems are trying to address the inequities in a number of ways, from using data to help identify and find solutions for disparities to diversifying workforces. In Dallas, Steward Health Care, a private for-profit health system that is physician-owned, has taken a different approach: hiring Marisela Marrero as SVP of healthcare equity and diversity, equity, and inclusion (DE&I).
Marrero, who previously served as Steward’s VP of operations and president of several hospitals in the health system, stepped into her current position in March 2023, and is the first person to hold the role. According to Marrero, Steward created the job because addressing healthcare inequities improves care quality and lowers the cost of care.
“Nobody can really argue with having better healthcare at a lower cost,” she told Healthcare Brew. “Addressing healthcare inequities is the single most impactful thing that I could do to enhance our healthcare system.”
And since she’s held a number of administrative roles across Steward—which owns 33 hospitals in eight states—Marrero said she has “a full picture and perspective of what we need to do in this country in order to close the gap.”
The day-to-day of tackling inequity
Marrero, who also previously worked as an ER physician, said her primary goal at Steward is “to make sure that we increase access to care, specifically in communities that are underserved.”
What that translates to in her day-to-day life is lots of calls with insurance companies, she said.
“I participate on all contracting calls and meetings with the insurance companies to make sure that both the [insurance] rates and the language in the contracts are equitable, meaning that they can’t pay us less because our hospitals and our patients live in zip codes that are underserved,” Marrero said. “I build a clinical, a financial, and a legal case to why the proposal that I’m giving them makes sense, and should be positive for both parties.”
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This is a challenge, she said, because “the traditional way of negotiating contracts—anywhere in the country—is by just looking at the rates that are in front of you” rather than taking into consideration other economic factors a hospital may be facing, like rising labor costs.
“When you just look at the number, you’re going to end up with a higher-cost, lower-quality system, which is what we have in the US,” Marrero said. “We by far have the highest healthcare spending per capita in the world, and we are not even in the top 45 countries when you look at outcomes, access to care, [and] technology all put together. We are really upside down, and the reason why that has happened here is because folks have just focused on a number.”
When she’s not on the phone with insurance companies, she’s meeting with government officials and community groups to advocate for more funding to support patients on government insurance. Most of Steward’s hospitals are in underserved areas, which means a high proportion of the system’s patients are either on Medicare and Medicaid or are uninsured, she said.
Her career “end goal” is to “enact legislation that’s going to lead to a more efficient, higher-quality, and lower-cost healthcare system in this country,” Marrero said.
“We have a lot of work to do—not just at Steward, but really in this country—to make things better,” she said.