I AM A Black physician who has practiced in the operating rooms and intensive care units of Boston’s academic medical centers for over 10 years. Countless patients from facilities of Steward Health Care — which filed for bankruptcy protection on Monday — have been transferred into my care, many of whom are missing basic life-saving medical therapies. For patients receiving treatment at Steward hospitals, daily worries include securing food and shelter. The poor standards of care and crumbling Steward infrastructure are added challenges members of already stressed communities simply cannot endure. 

As state regulators evaluate a deal between Steward and UnitedHealth to sell only Steward’s network of physicians, they have an opportunity to deliver on the promise to hold Massachusetts to a higher standard. However, to avoid making mistakes that could jeopardize the economic and physical health of some of Massachusetts’s most marginalized communities, they must apply an equity framework as part of the assessment.

In recent Senate hearings, the New England Medical Association, an organization for which I serve as director of policy and advocacy, detailed how the opposing priorities of health care institutions and private equity endanger access to thousands.

Among those affected are the 70 percent of patients covered by Medicare and Medicaid, many of whom are either Black or brown patients. Hospitals provide time-sensitive specialized care for patients associated with heart attacks, strokes, or complications during pregnancies. They are also an important mediating structure for communities of color. They make significant economic contributions as employers and purchasers of local services. They are frequently critical anchor institutions responsible for improving the social determinants of health and community wellbeing. 

The pandemic devastated a disproportionate number of people of color in Massachusetts. In the intervening years, state agencies and legislators have documented unstable health care access and poor quality service – including economic instability and neighborhood environment – as significant contributors.

Despite Massachusetts being among the 10 healthiest states in the country, Black women are almost twice as likely to die during pregnancy or within one year postpartum. The urgency to address health disparities is such that the Massachusetts Department of Public Health recently published a strategic plan through which to advance racial equity. 

The Black maternal death rate is tragic and embarrassing. Reversing the trend requires immediate expanded access, improved care coordination, holding hospitals serving mostly patients of color to the highest quality indicators, and eliminating funding disparities that contribute to private equity acquisition.

People tend to seek care close to home, so how can we expect improved maternal outcomes if key community hospitals are closed – especially for residents who struggle with transportation?

The Steward hospitals must remain open, but they must do so as part of a network prioritizing quality, health innovation, community investment, and care integration. Closing the health equity gap demands as much. 

It’s also important to note that many health care consumers do not have access to full and accurate information about the quality of physicians, hospitals, or services — or the appropriate tools for using that information.

Report cards reflecting quality among health care providers have existed since the mid-1980s; however, in a survey of adults with chronic conditions, only a quarter were aware that such information was available. Only one in 10 adult patients surveyed uses such information to compare hospitals or physicians, with little clue that facilities are outdated, staffing is under-resourced, and fundamental equipment is lacking. 

Some may argue that care traditionally provided in the hospital setting should be moved into the community, and perhaps a buyout of the physician network by UnitedHealth would facilitate that movement in our state. Indeed, centering care around preventative health is critical for cost control and improved longitudinal outcomes.

Several countries in Europe have engaged over the last decade in reform efforts to reduce reliance on hospital-based service delivery. Many also have approaches and mechanisms to reduce patient referrals from primary to secondary care. However, several studies have already demonstrated that Black and Latino patients receive fewer referrals to specialists. 

With the implicit bias and racism in health experienced by people of color who walk every day through the doors of health care facilities, are we adequately equipped for such a transition? Each decision about the future of a hospital, birthing center, or other point of access is an opportunity to build trust. For Black patients, that must include trust that leaders dare to make decisions to address the structural racism in health care. 

Achieving health equity requires a fundamental shift in who makes decisions about policies, programming, and how we show up in communities. Allowing UnitedHealth to cherry-pick the physicians’ group will benefit only its goal to control the flow of primary care throughout the country.

Improving the health of our most vulnerable residents requires that we improve access to primary care services but this is independent of the need for acute services. We now have an opportunity to reimagine care in our state. Let’s seize it. We must boldly enact measures that save lives and establish our Commonwealth as a true model of equitable and quality health care for all its residents.

Sharma E. Joseph is assistant professor of anesthesiology at Tufts University School of Medicine and an anesthesiologist and critical care physician at Tufts Medical Center. She also currently serves as director of health policy and advocacy at the New England Medical Association.