As the COVID-19 pandemic exacerbated existing health equities, health systems nationwide have implemented a series of initiatives to reduce disparities.
This compilation features guidance from 13 leaders at 13 systems who shared insights with Becker's via email.
Question: What is the single most important initiative that has been implemented in the last year to further health equity in the communities you serve?
Editor's note: Responses were lightly edited for clarity and length.
Cheryl Wolfe, MD. Vice President and Department Chief of Women's Health at Spectrum Health (Grand Rapids, Mich.): The Spectrum Health Women's Health service line leaders believe the best way to address racial disparities in maternal health is to embed diversity, equity and inclusion in our strategic goals. Our strategic pillar, "We will be our patient's fierce advocates and champions for health equity," reflects the work we do daily to address and eliminate health inequities in the maternal space. We have metrics around reducing severe maternal morbidity on the Spectrum Health System health equity dashboard that are reported up to the Board of Trustees. We also have two multidisciplinary service line committees that address the needs and concerns of our committee.
Consuelo Wilkins, MD. Senior Vice President and Senior Associate Dean for Health Equity and Inclusive Excellence at Vanderbilt University Medical Center (Nashville, Tenn.): The single most important initiative that has been implemented to further health equity in the communities Vanderbilt University Medical Center (VUMC) serves is the VUMC and Vanderbilt University School of Medicine (VUSM) Racial Equity Plan. The Racial Equity Plan stems from a racial equity task force established in 2020 by VUMC and VUSM leadership. The plan transforms and embeds equity across the VUMC enterprise and VUSM and is a roadmap for how to combat structural racism. While leadership for the task force and plan development came from VUMC's senior vice president and senior associate dean for health equity and inclusive excellence, accountability for implementation of actions in the plan sits with leaders and teams across the institution. One of the many focus areas of the plan is health equity, including a focus on eliminating racialized medicine. Other health equity initiatives include improving the quality of patient race, ethnicity and language (REAL) data, antiracism training for VUMC's workforce, improving collection of data on social drivers of health and creating and refining policies and practices to address health inequities among VUMC's patients, workforce and communities.
Dan Roth, MD. Executive Vice President and Chief Clinical Officer at Trinity Health (Linovia, Mich.): At Trinity Health, our mission calls on us to redesign and rethink processes and services in ways that make it easy for our patients and communities to achieve their health goals. Our redesign has focused on how we must truly integrate clinical care and social care into one model of care. Over the past year, we began adapting care models to ensure clinicians proactively identify social needs of our patients, including active outreach and partnerships with community-based organizations within underserved communities and communities of color.
We are dedicated to furthering health equity through services that allow our patients to engage with our care teams in ways that are convenient for them. This includes using virtual care and telehealth for patients without access to transportation, strengthening equity data collection and reporting through existing and emerging technology, and promoting optimal health for those who are poor and vulnerable in the communities we serve by connecting social and clinical care, addressing social needs, dismantling systemic racism and reducing health inequities.
Daniel Varga, MD. Chief Physician Executive at Hackensack Meridian Health (Edison, N.J.): While Hackensack Meridian Health has embarked upon a number of health equity initiatives over the last year, our collaboration with the New Jersey Department of Health, the office of the governor, and multiple community organizations to ensure the broadest possible distribution of COVID-19 vaccine to our communities has to stand out as our most ambitious. Whether we were manning the megasite at the Meadowlands [sports complex], retooling our physician practices to become vaccination sites, working with NJDOH on education to address vaccine hesitancy, or partnering with places of worship to create vaccine access points (to mention just a few examples), HMH was a proud collaborator with our colleagues state-wide in confronting the massive logistical effort required to get "shots in arms" across New Jersey and to do so while leaving no population behind. This work, in parallel with our continued outreach into the community to screen for social determinants that create barriers to care for our most vulnerable populations, affirms HMH's fervent commitment to addressing healthcare inequities across New Jersey.
Elsie Taveras, MD. Chief Community Health Equity Officer at Mass General Brigham (Boston): Our "one thing" actually lies in the collective strength of a multipronged approach. Mass General Brigham United Against Racism (UAR) is a long-term, multimillion-dollar commitment to address the many impacts that racism has on our patients, employees and our community. We are taking measurable action across our entire healthcare system to dismantle racism and learning as we go. We are increasing diversity and establishing an antiracist culture for our leadership and employees; building more equitable patient care through research and quality improvement; and improving health outcomes by first measuring and acknowledging our inequities, then working with community leaders to develop internal and external advocacy programs and initiatives. There is no silver bullet to addressing health equity — but every lesson learned moves the dial forward, especially if a whole system is moving forward together.
Francesca Gany, MD. Chief of the Immigrant Health and Cancer Disparities Service at Memorial Sloan Kettering Cancer Center (New York City): The Integrated Cancer Care Access Network (ICCAN) Equity Platform at Memorial Sloan Kettering Cancer Center is one of the most important initiatives that has been implemented to further health equity in the communities we serve. Serving thousands of cancer patients across 14 treatment sites in New York City and Long Island, ICCAN is a comprehensive, multilevel, community-engaged, patient-centered cancer outcomes resource network. ICCAN's extensive network of community workers, social workers and patient navigators help patients access services from more than 350 community-based organizations.
The ICCAN Equity Platform utilizes a multilingual transdisciplinary team, a mobile health unit, community and healthcare systems partners, and evidence-based strategies to address inequalities in cancer care and improve patient outcomes among underrepresented cancer patient populations. The program helps patients' complete cancer care and addresses quality of life obstacles such as language barriers and food insecurities. In fact, a recently published randomized controlled trial showed that the ICCAN Food to Overcome Outcomes Disparities (FOOD) program's food security interventions significantly improved cancer treatment completion rates and quality of life. The ICCAN also promotes access to patient-centered cancer care by connecting patients to shared-decision-making, precision medicine, and comorbidity and psychosocial care.
Jason Purnell, PhD. Vice President of Community Health Improvement at BJC HealthCare (St. Louis): This year, BJC launched a comprehensive community health improvement strategy designed to correct decades of disinvestment in a significant part of the St. Louis region. It's a complex and layered strategy to address the social determinants of health by closing gaps in income, access to healthy food, prenatal and infant care and school resources. BJC has initiated multiple projects in each of these critical areas, most notably through doula programs, food outreach initiatives, and a landmark investment project to transfer a portion of BJC's savings from out-of-state banks into local financial institutions strategically located in under-resourced communities. This financial re-allocation moved investment dollars to Black owned and/or led financial institutions in targeted ZIP codes of disinvestment, where communities will directly benefit through home or business loans and job creation. Financial security is a medical intervention and a meaningful step toward achieving health and well-being for all.
Julia Iyasere, MD. Executive Director of NewYork-Presbyterian Dalio Center for Health Justice (New York City): We launched the Dalio Center for Health Justice in fall of 2020 with the aim of better understanding and addressing the root causes of health inequities. We have a goal of setting a new standard of health for our patients, our team members and the communities we serve. Through the center, we invest in research, education and programing, and advocate for policy change to drive measurable improvements in health outcomes for all. One of the most important initiatives we launched within the last year to further health equity in the communities we serve was our "One Decision For Us" national vaccine campaign. We know that Black and Brown people — and those in communities like ours who have been disproportionately impacted by COVID-19 — have had (and still have) questions about the different vaccines and want to learn more before making the decision to get vaccinated. In partnership with the Harlem Children's Zone, William Julius Wilson Institute and spoken word artist Justice Davis, this campaign focused on empowering Black and brown communities with the information and understanding they need to make the decision to get vaccinated for their loved ones and the communities in which they live. In addition to launching "One Decision for Us," the center also hosted several community virtual town halls in collaboration with community and faith-based organizations to provide fact-based and science-based answers to questions from the community about the COVID-19 vaccines.
Sarah GiaQuinta, MD. Senior Vice President of Community Health and Equity at Parkview Health (Fort Wayne, Ind.): Initiatives that improve access to healthy, affordable foods have been key in furthering health equity in the communities we serve. Parkview's community nursing and well-being teams witnessed an increase in the number of families struggling to access healthy, affordable foods throughout the pandemic. In response, these teams worked together to distribute healthy food and fresh produce harvested from the Parkview Community Greenhouse and Learning Kitchen.
Building on these initiatives in 2021, our team created healthy food boxes containing shelf-stable food items and produce for distribution to vulnerable families. Each box was designed by a registered dietitian to include three meal kits with recipes, information on local food resources, as well as feeding and food storage tips.
Parkview is also expanding its produce prescription program, Veggie Rx. This program has already grown from serving fewer than 30 families in 2019 to enrolling over 100 in 2021. This year, the team received multiple USDA grants to support the program's expansion. The funds will help Veggie Rx serve close to 1,000 individuals over the next three years and increase the value of the monthly vouchers that participants use to pay for fresh produce at area farm markets and grocery stores.
Sherri Neal. Chief Diversity Officer at HCA Healthcare (Nashville, Tenn.): In 2021, HCA Healthcare established the Health Equity Council to oversee the advancement of our commitment to health equity. The council analyzes data related to patient outcomes, identifies opportunities to reduce disparities and explores opportunities for cross-sector collaboration and community engagement to address root causes of health inequities. Our expanded partnership with March of Dimes to improve maternal mortality and morbidity outcomes in the U.S. will continue to make a positive impact both within and beyond the walls of our hospitals.
Shiva Bidar-Sielaff. Vice President and Chief Diversity Officer at UW Health (Madison, Wis.): When COVID-19 vaccines started to become available to the public, UW Health worked not only to distribute vaccinations to as many patients as possible, but the health system took specific, meaningful steps to ensure vaccine access was equitable. The health system used ACO shared savings to fund community health workers (CHWs) specifically from the Black/African American, Latinx and Hmong communities and created a workflow within Epic for CHWs to identify medically homed patients, then proactively called them to answer questions and offer COVID-19 vaccine appointments. The UW Health COVID-19 vaccine community health workers reached over 4,300 unique patients from March 2021 through June 2022.
Stormee Williams, MD. Vice President and Chief Health Equity Officer at Children’s Health (Dallas): Children’s Health heavily invests in research and data to understand the health inequities that exist for our patients and the communities we serve. Our robust efforts to track, measure and analyze existing inequities allow us to understand the disparities that exist and close the gaps. As an organization, collecting accurate data from patients about their race and ethnicity has been an essential first step for us to better understand the families we serve, ultimately enabling us to reduce these disparities and improve quality of care for these individuals.
In the past few years, we have standardized how we collect race, ethnicity, and language (REaL) data from our patients in a self-reported fashion across the Children’s Health system. We created a robust training program to teach our team members why collecting this information is critical for comprehensive patient care and support them in disseminating the new process to develop a sustainable quality assurance approach. Training started as live sessions and eventually moved to virtual to reach more team members across the system. REaL data helps us to be mindful of the patient’s culture, to use their preferred language, and to provide safe, high-quality, culturally competent care. Trained team members are now proactively gathering information during pre-registration or scheduling.
More than collecting data, we are hoping to provide holistic care that fits the unique needs of our patients and their families. In the past year, we have focused on standardizing a process to screen for social determinants of health (SDOH) –economic and social conditions that affect a wide range of health and quality-of life-risks and outcomes. These conditions include health literacy, social support, food insecurity, transportation, housing, and other factors that can cause barriers to optimum health. Our standardized process tailors clinical recommendations for individual patients, eases communication between clinical teams, facilitates patient families’ referrals to community resources, tracks progress of patients’ identified needs over time, and provides structured data to inform population and health outcomes research.
Tiffany Capeles. Chief Equity Officer at Intermountain Healthcare (Salt Lake City): We have been talking about health equity for many years now within healthcare, and while awareness is on the rise, the responsibility in achieving health equity lies with all players in healthcare: insurers, manufacturers, pharmaceutical, and technological organizations providing software solutions to health care organizations. Today, health systems are still having to customize EMRs to allow for the capture of whether or not interpreting services have been delivered during patient care. This is something that should be the default and standardized within EMRs. Improving services provided to persons with limited English proficiency has been a public discussion since Clinton’s Executive Order 13166 in August 2000. There is no reason that the medical record systems utilized across healthcare do not automatically solve for the data capture of limited English proficient services at every encounter or even key points of service, such as admitting, consent, diagnosis, treatment, and discharge. Yet, health systems like Intermountain Healthcare, and select others, that are committed to eliminating health disparities have prioritized and invested dollars in customizing electronic medical records to capture, measure, and track the consistency of linguistic provision. This measurement and tracking roll right into our culture of safety and quality so we can hold ourselves and one another accountable. While there is so much we can do by implementing new programs to address health disparities, sometimes we need to dig deeper and address the systemic issues that contribute to inequities. It is a concerted, collaborative effort, and all partners are needed at the table.”