Integrated approach to care seen advancing health equity

Close collaboration by physicians, nurses, clinicians and staff across the nation’s largest nonprofit integrated health care system is key to Oakland, Calif.-based Kaiser Permanente’s success in reducing health care disparities and advancing diversity and inclusion, says Ronald L. Copeland, M.D., Kaiser Permanente’s senior vice president and chief diversity and inclusion officer.

That success has earned Kaiser Permanente the 2017 AHA Equity of Care Award. The award recognizes outstanding efforts among hospitals and health care systems to advance equity of care to all patients. The AHA will present the award to Kaiser Permanente July 27 at the AHA Leadership Summit in San Diego.   

Kaiser Permanente combines a nonprofit health plan with its own hospitals, clinics and affiliated Permanente physicians’ groups to serve more than 11.8 million members. Value-based payment and accountable care structures – coupled with good information – drive efforts to deliver better patient care at lower cost. The health care organization closely coordinates primary, secondary and hospital care; emphasizes prevention; and uses sophisticated electronic records and computer systems to achieve results.   

“Because of our integrated model, we are not hindered by fragmented systems or incomplete data,” Copeland says. “We can execute at a higher level because of this increased collaboration. Without this system, we would be unable to gain traction on some of the challenging issues we are addressing.”

In the early 2000s, Kaiser Permanente began to collect data on patients’ race and ethnicity. It compared its information to the quality measures in the Healthcare Effectiveness Data and Information Set (HEDIS) – a tool used by the vast majority of America's health plans to measure performance on important dimensions of care and service.

In 2010, the health care system launched its Equitable Care Health Outcomes – or ECHO – initiative to collect and analyze data on disparities in health care outcomes for ethnic and racially diverse populations within its membership.

The program helped Kaiser Permanente focus on clinical and culturally responsive care strategies to achieve early success like closing health care disparity gaps in hypertension management for African-Americans and in colorectal cancer screening for Hispanic patients. The organization also has eliminated disparities in survival rates among Kaiser Permanente patients who had colon cancer, and in mortality and medication rates among HIV-positive African-American and Latino patients.

“We found that, when integrated within a health care delivery system and viewed through the lens of pertinent analytics and criteria, we can stratify the data to create a window to the health patterns of individuals and groups of people to see how many facets of their background apply to their health,” Copeland says. “We can intentionally use data to identify and prioritize vulnerable populations.” 

But achieving health equity depends on much more than the health care a person receives, Copeland points out. “It will also require tackling the root causes of ill health and inequity, including racism, injustice and poverty,” he says. 

As part of that effort, Kaiser Permanent last year invested more than $37 million to support programs designed to address socio-economic factors that contribute to poor health in more than 50 communities across its regions.

Kaiser Permanent has a long history of maintaining a diverse and inclusive workforce. It was the nation’s first health care organization to have a racially integrated hospital in the 1940s. Nearly half of its board members are minorities or women. It also continually promotes supplier opportunities for minority businesses throughout its organization.

“Diversity and inclusion is in our DNA,” Copeland says. “We treat it as a strategic asset that is fully integrated in our organizational business strategy. It is not incidental to what we do, but at the core of everything we do.”   

Copeland believes the AHA’s #123forEquity Pledge to Eliminate Health Care Disparities can raise awareness in the hospital and health system field that providing equity in care is not just the right thing to do. it’s the smart thing to do. Nearly 1,500 hospitals and health systems across America have pledged to improve the collection and use of race, ethnicity and language preference and sociodemographic data; cultural competency training; and diversity in leadership and governance.

“When you achieve equity to eliminate health disparities, you’re providing high-quality care,” Copeland says. “When you manage disparities and chronic care on a proactive basis, you are improving care outcomes and bringing the cost of care down by preventing illness rather than just providing care once it occurs. And if you take on the social determinants of health by neutralizing and mitigating the negative health impacts of where people live, you are improving total community health.”

In addition to award recipient Kaiser Permanente, the AHA named four health care organizations as Equity of Care award honorees. They are Cone Health in Greensboro, N.C., Rush University Medical Center in Chicago, Moffitt Cancer Center in Tampa, Fla., and Advocate Health Care in Downers Grove, Ill.

The Equity of Care award’s winners and honorees can spread lessons learned and progress toward achieving health equity, Copeland says. “We hope our achievements in this area provide models for similar improvements across the health care field,” he says. “It is crucial that organizations that share our priorities and goals in this area work together to share what we have learned and leverage our successes in order to effect swift and sweeping change.”