Striving for Health Equity: Antoine Keller, MD

US health policy is poised for significant transformation in the years ahead, Antoine Keller, MD, FACC, FACS, a cardiothoracic surgeon at Ochsner Lafayette General Hospital, and founder of HeartSense, told The American Journal of Managed Care®. While shifting legislative agendas will help drive systemwide change, Keller emphasized that clinicians and providers must ultimately define what is truly valuable in health care. Speaking from his experience in rural care settings, resource allocation is often the biggest piece of the puzzle when it comes to shaping an equitable health care system—for those with cardiovascular conditions and beyond.

Equitable health care can be interpreted in different ways | image credit: lenetsnikolai - stock.adobe.com

“To me, the most important parts of health policy deal with resources and delivering them equitably to the people who need them,” said Keller. Yet, the concept of health equity is often left to interpretation. When it comes to distributing funds, investment, and support, “equity means different things to different people,” he explained. In some interpretations, pursuing equity means prioritizing patients with known diagnoses who are easier and less costly to treat. This approach is efficient; however, it may overlook those with the greatest need.

Keller believes in casting a wider net to better understand where disease burdens lie. In doing so, he emphasized how valuable data collection and analysis are for informing coordinated care efforts. This mission lies at the heart of his organization, HeartSense.

“Reaching the most people is what’s most important to me,” he said. To accomplish this, Keller stressed the need to develop health policy that reflects the prevalence of disease in underserved communities to truly meet patients’ needs and deliver more effective care.

Yet, health care resources are limited. “We can’t treat everybody,” Keller admitted, “although we do a better job in this country than most countries do.” The challenge, then, is delivering care responsibly, strategically, and with empathy, he added. This requires more than adequate funding and infrastructure, but also strong advocacy to ensure high-quality care is equally accessible for underserved communities. “I think that it is really important for our elected officials and policy people to understand that we really, as clinicians, want to take care of people. We want to do it in a way that allows us to take care of everyone regardless of the particular problem we're focused on.”

This challenge is not new. Keller explained how the struggle to deliver equitable health has deep roots in the US, from the Freedmen’s Bureau after the Civil War to modern efforts like the Affordable Care Act. “There have been a number of people who have tried to figure out how to equitably distribute these resources,” he reflected, pointing to historical precedents like President Richard Nixon’s Health Maintenance Organizations and even maritime health care in the nation’s early years. Rural communities can face additional barriers here, as Keller previously mentioned that only 11% of Louisiana’s physicians currently provide services in these areas, with looming health care shortages spelling major concerns for the future of residents’ access to care.1

Policy and health outcomes go hand-in-hand, as legislation often influences the social determinants of health. For example, the discriminatory, long-outlawed practice of redlining continues to have an impact on public health today. Neighborhoods formerly subjected to redlining are more likely to have poorer access to healthy foods, which has contributed to higher rates of high blood pressure (31.9%), obesity (31.8%), type 2 diabetes (11.8%), and heart disease (6%) in these communities.2

What makes the present moment distinct, Keller argued, is the scale and complexity of modern health care—as well as the stakes. As populations grow and chronic conditions like diabetes, heart disease, and mental health needs surge, policymakers must collaborate with clinicians and ground decisions in robust data. As debates about costs, insurance coverage, and value-based care continue, Keller emphasized that health policy needs to be rooted in real-world insights and a clear commitment to equity—however defined—to build a system that meets the needs of all patients.

References

1. OXIHER health priorities: focus on rural health disparities. Healthy State; 2024. Accessed May 7, 2025. https://www.livehealthystate.org/assets/OXIHER-Rural-Health-Article.pdf

2. Heart disease more common in past redlined areas linked to limited access to healthy foods. Niagara Frontier Publications. November 13, 2024. Accessed May 6, 2025. https://www.wnypapers.com/news/article/current/2024/11/13/161517/heart-disease-more-common-in-past-redlined-areas-linked-to-limited-access-to-healthy-foods