Conversation is over: Health systems are ready to act on inequity

The story of the pandemic is the story of medical racism, disparities and dysfunction dating back centuries. With all this brought to light, confirmed as reality for the first time for many, change is imminent, and healthcare professionals are tired of waiting for it.

But speakers at Modern Healthcare’s Dec. 9 virtual Social Determinants of Health Symposium concentrated on solutions.

Addressing inequity on a national level

From maternal mortality rates, to the opioid epidemic, to climate change and pollution, to homelessness, the Department of Health and Human Services is committed to addressing social determinants of health, said Deputy Secretary Andrea Palm.

HHS plans to build on its work during the pandemic by removing cost and access barriers for testing, treatment and vaccination, and to address systemic inequities in the healthcare industry, she said.

The department is reviving its health disparities council to help develop an equity action plan, setting up an internal equity technical assistance center and undertaking equity assessments of its programs, policies and processes. Eventually, HHS will implement its equity framework on a community level and health system level.

“We need state and local governments along with health plans and private funding organizations to continue building the IT and data systems needed to ensure seamless integration among the providers of medical care, behavioral health and social services,” Palm said.

Bridging gaps: The case for community health workers

A major way to reduce disparities at a local level is for healthcare facilities to employ community health workers as a workforce, as they are considered trustworthy and reflect the demographics they serve in terms of their ethnicity and lived experience with hardship and injustice.

“They take an empowerment approach to their patients,” said Dr. Shreya Kangovi, associate professor of medicine at the Hospital of the University of Pennsylvania. “They’re not telling them what to do. They’re not doing a social needs checklist. They are listening to their life stories and they are asking each person, ‘What do you need to live your best life?’ ”

For many individuals, oftentimes health is not the first priority because of life circumstances and responsibilities they have like trying to pay the bills, feed their family or find a place to live, said Cheryl Seay, a community health worker with Penn Medicine at Home.

She said community health workers support patients in setting goals and working to improve their overall situation, while addressing health needs along the way.

In conducting multiple randomized control trials, Penn Medicine found that community health workers were able to improve a range of outcomes through chronic disease control, cancer screening, better access and quality of care, Kangovi said, leading to a 65% reduction in hospitalizations.

By working with an individual for six months, a community health worker can save $4,200 per Medicaid beneficiary, a return on investment of $2.47 for every dollar spent within the fiscal year, she said.

Penn Medicine assists 50 different payers, providers, public health departments and other organizations across 20 states in developing a blueprint for building and running a successful community health worker program. The organization also created a 12-month executive education program in which C-suite leaders and community health workers have the opportunity to learn from one another, Kangovi said.

Getting comfortable with the uncomfortable: How racism and colonialism impact health

In order for systems of power in medicine to be restructured and for effective changes to be made, healthcare professionals need to understand where those systems began and move forward with steps to dismantle them, said Dr. Rupa Marya, associate professor of medicine at the University of California, San Francisco.

“In every health parameter, you’ll see the same layout of how racism makes itself known in the bodies of people,” Marya said.

Much of medical racism in America began when scientists, to support the economic system of enslavement, painted false and negative images of African-Americans, establishing long-standing medical concepts like biological dimorphism, the belief that Black bodies are profoundly different from white bodies, said Harriet Washington, writer, medical ethicist and author of the book “Medical Apartheid.”

Health systems’ blindness to how similar beliefs about race in medicine still exist today and how oppression drives negative health outcomes remains a large problem, Washington said, which is why it is necessary to codify laws and regulations and construct consequences for facilities that don’t meet specific standards.

Marya said it is also important for those in healthcare to get used to being sued because of how structural racism and illegal practices are impacting the lives of patients in a deadly way.

“This is for the evolution of our culture together. This will actually bring us all better health outcomes as a society,” she said. “This is not about punishing but about recognizing where we have been remiss and being accountable for that.”

To progress, organizations need to move beyond conversations and equity rhetoric to investigate their operations and build a framework to address disparities. Also, established medical journals need to publish information about how history and racism currently affect health, said Abigail Echo-Hawk, executive vice president of the Seattle Indian Health Board and director of the Urban Indian Health Institute.

“But racism makes people uncomfortable,” Echo-Hawk said. “Until we get uncomfortable and get comfortable with being uncomfortable, we won’t see the change that we’re looking for.”

Health systems aren’t waiting for the government to offer solutions

For Jefferson Health, the first step in reducing health inequities was changing its mission from being the best medical center to “we improve lives,” said Dr. Stephen Klasko, the health system’s CEO.

This led to incentivizing employees engaging with the community and creation of the Philadelphia Collaborative for Health Equity, which focuses on moving predictive analytics and population health from philosophical and academic exercises to mainstream clinical care and payment models, he said.

In Detroit, Henry Ford Health System established a multicultural institute focused on research, using internal data on race, ethnicity and language, and understanding how to create interventions that deal with a number of challenging health equity issues and clinical outcomes.

The system is gathering and motivating groups of businesses alongside public officials and community agencies to tackle issues on a quicker timeline, said Wright Lassiter III, Henry Ford’s president and CEO.

“It’s the concept of, ‘Let’s not wait for the federal government, the state government, the county executives to come together and decide that policy changes will flow funding to things that businesses can provide funding for in the short term,” Lassiter said.

Until public health is prioritized on funding, regulatory and legislative levels, Klasko said health systems will continue to struggle and require public and private partnerships to create solutions.

“We sometimes have this view that it’s going to take years and years to solve this,” said Eugene Woods, president and CEO of Atrium Health. “(But) during COVID, I think all of us were making decisions without committees and then putting them into action.”

He said the best way for health systems to hold each other accountable in creating change is peer pressure, and calling out missions centered around only serving commercially insured patients.

“This is definitely not a sprint,” Lassiter said. “This is a journey. But … there’s no reason why you can’t make significant progress in short periods of time if you put the right energy and emphasis on the right things.”