Conversations around diversity, equity and inclusion have intensified over the past year and a half. But a lot of the underlying issues around outcomes and the impact of COVID-19 on populations of color are not new to the healthcare industry. Dr. Alisahah Cole, system vice president of population health innovation and policy at CommonSpirit Health, joins the Check Up to talk about the ways that organizations can tackle diversity, equity and inclusion in a more comprehensive way.
The Check Up: Dr. Alisahah Cole of CommonSpirit Health
Modern Healthcare: Hello, I'm Matthew Weinstock, managing editor of Modern Healthcare. Thanks for tuning in to the latest edition of the Check Up. Conversations around diversity, equity and inclusion have certainly intensified in almost every aspect of our daily lives over the past year and a half. But a lot of the underlying issues we're discussing in healthcare these days around outcomes and impact of COVID-19 on populations of color are not really new to the industry. The spotlight really just seems to have intensified over the past year. Major questions facing industry leaders now are, can they use this time as an opportunity to tackle some of those lingering challenges? I'm excited today to be joined by Dr. Alisahah Cole. She's system vice president of population health innovation and policy at CommonSpirit Health, a national health system, to talk about the ways that organizations can tackle in a more comprehensive way diversity, equity and inclusion. Alisahah, thanks for being with us today. We really appreciate your time.
Dr. Alisahah Cole: Thank you for having me, Matthew.
MH: So let's talk first about this broad concept of, you know, health equity disparities. I know I've heard you in some other settings talk about how these issues weren't new, right? It's just magnified the spotlight on some of the challenges we're facing. And I know in a recent interview, I heard you talk about the numbers aren't even new. You know, we're looking at maternal and infant mortality, those numbers sort of replicate what we're seeing on the COVID front. So maybe you could just frame this into into a broader context for us.
Cole: Yes, thank you. So I definitely believe that the events over the last year that include, of course, the COVID-19 pandemic, but also a lot of the social justice reckoning that has been happening because of the events of George Floyd and Breanna Taylor, and kind of all of that happening at the same time has definitely put a magnifying glass, if you will, on a lot of these disparities that exist in all sectors, but particularly in healthcare. So you know, on one hand, I think it's really good to have this national intentional focus on these issues. And it's really what we're doing at CommonSpirit is how do you take that momentum and really operationalize it. It's one of the terms I like to use all the time, because there are some really tangible things that organizations can do to look at this work, what they're doing in this space, and actually speak to outcomes. And I think that's where we are, as a country. We want to move beyond the awareness that these things exist and actually move into, what are the things that we're doing to improve the outcomes?
MH: So let's talk a little bit about that, operationalizing these things. You joined CommonSpirit in June of 2020, coming from atrium health, where you spent a lot of time in North Carolina. So you move from a regional system now to a system that's operating in I think 26 states or something like that.
Cole: Twenty-one states.
MH: Twenty-one states, thank you. So how do you tackle this issue at a national? How's that changed for you to tackle it on national level? And you've got markets that are big, small, rural, urban, at CommonSpirit.
Cole: Yes, no, thank you. That's a great question. And, you know, my previous responsibilities at Atrium did have some of that, issue as well, even though it was a regional health system. It was over three different states, and, you know, rural, urban everything in between. And so I think the way that we look at it, and the way that I look at it is a couple of different ways. One is there are some things that should be standard, standardized, when you look at data, how you collect data, how you analyze it, you know, those are things that should be consistent across the entire enterprise or the entire organization. And so that's one of the key steps that I think every organization can look at, one, just what kind of data are you collecting? Are you even looking at your population, in your quality measures, and your safety measures, etc, by race or ethnicity or gender or the intersection of all of those things? I always say, especially in this day and age, it's not a lack of data. There's so much data out there. It really is, how are you looking at and how are you analyzing it? So, that's some of our first work is really standardizing how we collect the race and ethnicity, language, sexual orientation, gender identity data across every care delivery site. And then, you know, once you're collecting that data in a consistent way, how are you analyzing it? So being able to look at your quality measures, look at your patient satisfaction scores, your teammates satisfaction scores, you know, you want to make sure you're taking care of your staff and your frontline clinical workers who are providing this care on a daily basis. So, you know, data standardization, I think, is critically important. You know, there are definitely some process measures that can be consistent when we talk about in the clinical space. In family medicine, doctors still seeing patients, so how do we make sure we're providing the evidence-based clinical care guidelines in a consistent way across all of our care delivery sites. That's something from a clinical standpoint that we're definitely committed to. So again, there are certain things that should be standardized. But at the same time, especially in a large national system like ours, we have to recognize that there are local market differences. And we have to give our leaders the opportunity to have that autonomy to make decisions based on some of those local market dynamics. And so, when you think about your community engagement work and your community benefit work, well, that's a key area where what's happening in Phoenix, Arizona, or what the community needs are in Phoenix, Arizona, may be different than what the needs are in London, Kentucky, for example. And we are in both of those of those areas. So being able to allow for that assessment, making sure you understand your local community, and then allow for the autonomy to do that community engagement and community health work specific to the market is really important.
MH: I'm curious, are there opportunities where in Arizona, you see something working, that you can modify to work in a market like a Kentucky?
Cole: Yes, yeah. So that's a very great point. And I do think that's one of the benefits of an organization of our scope and our scale is that you can very easily identify those best practices and share. And in that sharing, it may be okay, well, that piece of that program will work well in our market, but maybe not that other piece. So one of the areas that we have seen that work extremely well is something that we call our Total Health Roadmap, which is a program that actually embeds community health workers into primary care practices. And so the community health workers become a part of the care team, they're an extension of that primary care provider. And one of the things that they are doing consistently and in a standard way is the collection of the information around social determinants of health. So those patients are all being screened. They're being screened in a standard way with a standard form. And we're analyzing that data in a consistent way. But again, in some markets, for example, in California, housing insecurity is a big need in other markets it's food. And so the interventions and the resources that we're needing to make sure we're connected with and we're able to connect our patients to are different. And so that's just one example of you know, this program was started in one market. And we were very quickly able to say, there's great benefit here, and how do we scale and apply this into other markets?
MH: Yeah, it's interesting. I'm curious too, really, if you think about it industrywide, one of the biggest challenges the industry has had for years on this front is that data collection piece, which you talk about, you know, probably much more than I do, in fact. So you're doing a lot of it at the CommonSpirit level. I'm sure you're doing it at Atrium. How do you get to that industrywide level of standardization of data collection? So there's a level playing field across all of healthcare, and you don't have these pockets where people are doing it right and people are collecting insufficient data.
Cole: Yeah. That's a great question, Matthew. And if I had the answer to that, I would probably not be in the position that I'm in right now, because there's still so much work to do in that space. I do think that this is an area where policy is really, really critical. And that is fortunately an area that at CommonSpirit, we have a very robust public policy and advocacy team to help us guide these conversations at all levels. So you know, at the local, legislative level, the state level and the federal level. So I think agreement around this is important. And I definitely feel that right now in this time, all of these different industries and organizations are saying, yes, it is critical that we look at this data, we collect this data, and we are really moving into how, and not necessarily the why. So there's a lot of conversation that's happening in that space. And I'm optimistic that that's going to really help to push the conversation around standardizing this work at a national level.
MH: Dovetailing off of that a little bit, one of the things that's come up in a couple of these Check Up interviews around diversity, equity and inclusion is the idea of a lot of places using machine learning or AI, and whether we're sort of embedding structural racism into those technologies. And so I'm curious if you have concerns about that, and how you think the industry needs to address some of those biases that may get sort of factored into those algorithms?
Cole: Yes, no, that's definitely a critical conversation. And one, I think it's just the recognition that that exists, right? And so being really thoughtful about any of those tools that you're looking to use. You have to make sure you have that lane of thought, if you will, at the front end. So one of the things, for example, that we looked at in regards to our patient navigation services, when you're thinking about, how do you bring on new partners, new technology tools and resources that aren't going to unintentionally create a disparity. And so one of the things from a patient navigation standpoint, we wanted to do something that was virtual and provide a virtual service. And quite frankly, when COVID hit we needed to, right? Instead of looking at solutions that only provided a kind of FaceTime, Zoom where patients needed a smartphone or Wi-Fi, we ended up going with a solution in our patient navigation for our maternity patients, which was text based. You know, text and phone call, because majority of people in this country do have access to that sort of technology, they have a cell phone, they're able to text, they're able to pick up a phone and have a conversation. And so, at first it was, but why aren't you guys going with a FaceTime, Zoom sort of a platform? And that was intentional, we wanted to make sure that we could reach our most vulnerable populations. And we knew that this was a better service solution for them.
MH: Right. There's so much emphasis on that high end of high tech that you sometimes forget that not everybody is at that level of technology solutions, which sort of pivots me leads into the last question I want to ask you about which goes to COVID vaccines. I know CommonSpirit has done a lot in the front of migrant farm workers, homeless populations, obviously, populations that may not have access to some of the technology you're talking about. So can you talk about what you've done to get vaccines to those populations in particular?
Cole: Yes, thank you, Matthew, this is one of the things that I have to say, I am so proud of our organization in our efforts to make sure we've had equitable vaccine distribution. So one of the things I would say was just really being connected with our communities, understanding what the needs are, we have an amazing Community Health Division that has that local market connection and is able to very quickly get that information up, right? It has to be this kind of bidirectional communication. And so we were able to really determine market by market, what was what was some of those needs, as it relates to our vulnerable populations, and then pivot quickly to address those needs. So, you know, you mentioned the fact that we actually went out to more migrant farm workers in some of our California markets where there was a huge population and a huge need there. You know, we took our staff to them, having this expectation for people to always come to us is not necessarily a real expectation anymore in the healthcare industry. And so how do we take care of more directly to our patients? We did that with our senior populations and went to some assisted living facilities and, you know, other long term care facilities to provide the vaccine. And then partnerships, I think, really working with our community partners, and some markets we partnered with historically Black colleges and universities and provided mass community vaccine events to those students. Into the communities that they serve, we partnered with the United Way, and so I just can't stress enough the partnership aspect and being able to have that connection. And I think as it relates to the vulnerable, making sure that you have trusted partners who are already serving in that community was a key area. And the other thing, I will just say to that one of the things that we heard from our providers was that, you know, I know that this is a community that may be hesitant around getting the vaccine, but I myself as a provider, I'm not comfortable or I don't know how to reach out to that community. Can you help, right? And so we actually created a hesitancy outreach toolkit that really focused on different populations. So, you know, there's been a lot of national talk about communities of color and hesitancy. But the reality is, we are seeing hesitancy in our rural communities. Politically affiliated groups had hesitancy. So we had a lot of different communities that were dealing with this, and our providers were like, how do we reach out? And so we created a toolkit that actually gave talking points to the providers. You know, we did the research to say, in this community, having the conversation around getting the vaccine helps us get back to normal, was a better way to address it versus getting the vaccine keeps you safe and keeps your family safe. So those are just some of the things that we did to be able to support our communities, our patients, and again, our staff that was taking care of patients every day.
MH: Yeah, you've obviously been very busy in the in past year, almost a year now that you've been there at CommonSpirit. When I think, you know, we could talk for hours with you about some of the things you're rolling out, but we won't be cognizant of your time. We definitely appreciate you taking some time to share some of your experiences at CommonSpirit. We'd love to circle back with you in the future about how some of these things roll out going beyond, hopefully post-pandemic.
Cole: Yes. Well, thank you, Matthew. I appreciate the time would love to come back. This has been amazing, and I look forward to talking again.
MH: Thanks so much. And I'm Matthew Weinstock with Modern Healthcare. Be sure to come back next Monday for another edition of the Check Up.
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