Advancing health equity: The economic impact

In a discussion with Medical Economics at the ACP Internal Medicine Meeting 2025 in New Orleans, Earl Stewart Jr., MD, FACP, explained how advancing health equity isn't just a moral imperative — it's an economic one. Drawing from personal experience and national trends, Stewart emphasized the long-term cost savings of addressing social determinants of health.

“This is not just a moral crusade,” Stewart said. “We’re trying to figure out, how do we effectively operationalize this? How do we effectively help patients have better employment, better transportation, better access to green space where they can exercise, better access to sustainable food options?”

He acknowledged that small practices and health systems alike often struggle with revenue concerns, especially when addressing non-clinical needs. “Addressing the social determinants of health may not necessarily be ideally medically revenue generating,” he said. “But … it helps to save dollars by helping to address the issues that contribute, from a majority standpoint, to a patient’s health outcomes.”

Referencing Tom Frieden’s pyramid on health determinants, Stewart underscored that a patient’s zip code often matters more than the care delivered in a clinic. Yet reimbursement challenges persist. “The Z codes — the ICD-10 codes for social terms — mean nothing,” he said. “They have a lower level of reimbursement through insurance.”

To close that gap, Stewart urged education — not just for physicians but for billing teams. “We need to also educate our billing and coding specialists, our charge capture analysts … to understand how to appropriately guide physicians about coding.”

“Health care expenditures nationwide are significantly improved and decreased when we invest dollars and address social determinants of health,” he added. “We’ve come a long way, but we still have a long way to go.”