Leadership Dialogue Series: Accelerating Health Equity with CHRISTUS Health

00;00;01;04 - 00;00;38;14
Tom Haederle
Is there real health care quality without equity? How do we preserve the dignity of every human being who comes through our doors in 2023? These questions are top of mind for just about every hospital and health system leader and their team to consider. Welcome to Advancing Health. Brought to you by the American Hospital Association. I'm Tom Haederle with AHA Communications.

00;00;39;11 - 00;01;12;20
Tom Haederle
In this Leadership Dialogue series podcast, John Haupert, president and CEO of Atlanta based Grady Health System and the 2023 chair of AHA’s board is joined by Marcus Pesquera, System vice President for Community Health and Chief Diversity officer at Christus Health, headquartered in Irving, Texas. The two leaders discuss how hospitals and health systems can integrate and align diversity and inclusion strategies to achieve health equity, including building community partnerships that improve the health of all individuals and communities.

00;01;13;12 - 00;01;26;14
Tom Haederle
CHRISTUS Health has been very active on this front, and Pesquera shares how commitment to diversity, equity and inclusion has been hard wired into its mission and strategic goals. And with that, let's join John and Marcus.

00;01;27;26 - 00;01;52;15
John Haupert
I'm John Haupert president and CEO of Grady Health System and Board chair of the American Hospital Association. I'm looking forward to our conversation today as we focus on yet another critical issue for our nation's hospitals and health systems. And that is how we field and how we can influence and drive improvements for our patients and communities that accelerate health equity.

00;01;53;12 - 00;02;21;23
John Haupert
For those who know me. You know that I feel strongly about our field's responsibility to address the social determinant of health. Those elements that can act as barriers to health for too many within our communities and that often negatively impact health equity as well as an individual's overall health. I'm pleased to share that just this past Monday, Grady participated in a very important discussion about black health in Georgia.

00;02;22;14 - 00;02;49;04
John Haupert
Our chief health equity officer, Yolanda Wimberly, led a fireside chat with HHS Secretary Harvey Sara. The event was attended by several elected officials and top business leaders in the Atlanta area. H.A. through the Institute for Diversity in Health Equity, is active in helping hospitals make impactful and sustainable change that will increase equity and inclusion both within health care organizations.

00;02;49;14 - 00;03;29;04
John Haupert
While also building community partnerships and enhancing trust in vulnerable communities, improving access to equitable care. I'm very pleased to introduce our guest, an individual who is living this mission every single day. Let me introduce Marcos Pesquera. Marcos is the system vice president for Community Health and the chief diversity officer for CHRISTUS Health. CHRISTUS health is a not for profit health system, including more than 60 hospitals and long term care facilities, 175 clinics and outpatient centers, and dozens of other health ministries.

00;03;29;12 - 00;04;00;08
John Haupert
At CHRISTUS, Marcos leads the integration of diversity and inclusion strategies, cultural competence and community partnerships to impact population health and achieve health equity. Marcos has also shared his expertise with HCA by serving on the Population and Community Health Advisory Committee and also the FDA Leadership Council. Thank you so much, Marcos, for being with us today. So let's go ahead and dive into some questions with Marcos.

00;04;00;29 - 00;04;14;24
John Haupert
Marcos. Let's start by having you tell us a little bit about your roles at CHRISTUS. As I as I say, roles, I know there are numerous roles you play. How have they evolved and possibly changed in recent years?

00;04;15;15 - 00;04;39;20
Marcos Pesquera
Sure. Thank you, John, for having me. You know, I'm always very passionate about this topic and love to to discuss and talk about it, to hopefully move the needle in and progress towards achieving health equity. A little bit about my role. Traditionally, Crystal has had the diversity and inclusion that Chief diversity officer role has been in function for many, many years.

00;04;40;03 - 00;05;07;25
Marcos Pesquera
However, in the last six seven years, health equity took from center stage. And so you can see why is that? I think one of the one of the reasons to me is that I see a direct alignment between I mean, there's plenty of studies, right, showing congruency of patient provider terms of race, ethnicity and folks being able to build trust quicker and health care outcomes related to that and other things.

00;05;07;25 - 00;05;44;18
Marcos Pesquera
But to be able to connect the diversity of our staff, the diversity of of our health care providers to the health care outcomes that work, that our patients are experiencing and also understand the public health thing. So it so it's I see an alignment in terms of DNI as very foundational to this work. And then obviously the community health piece, because we we want to hear from public health partners and they will tell us this is what's happening in your communities where where your hospitals and clinics and other facilities live and care for folks in the community.

00;05;44;18 - 00;06;06;21
Marcos Pesquera
And those are the folks What public health agencies are telling us, it's what's coming through our doors. I mean, community health, these assessments, as you well know, when you look at the public health data and what we find from our patients, there's there's a congruency. There is there's no surprises. We shouldn't be surprised when we see ACA is what our public health officials are telling us is just that.

00;06;06;21 - 00;06;32;11
Marcos Pesquera
Obviously, local data ignites in a fire to really do the work that we need to do to get this going. So so that's how to me has evolved from that connection of having individuals, because representation matters. If your community is represented within your staff, all the way from executives to the health care providers, frontline staff and everything in between, the issues of your communities are going to bubble up to the surface.

00;06;32;11 - 00;06;37;11
Marcos Pesquera
That's that's, that's, that's a need. So that's how I see the connection.

00;06;37;11 - 00;07;01;07
John Haupert
And thank you for pointing that out, because I think in some cases when you have a chief diversity officer who's also looking at community health and health equity, sometimes those two things trade off against each other and one becomes more dominant than the other. But to me, it really sounds like you're doing a good job of Val seeing those roles because both are very important.

00;07;01;07 - 00;07;10;25
John Haupert
You have to have internal inclusion and you have to have a seat at the table and then the team you create has to be working in the community. So thanks for that.

00;07;11;04 - 00;07;32;12
Marcos Pesquera
Yeah, and you know, I would add that why do we exist, right, as health care organizations? We're here to provide care. So everything, including DNI functions, have to have an impact on the way we care for people. You know, minority communities, unfortunately, are overrepresented and vulnerable populations. So So it's a direct relationship, no question.

00;07;33;05 - 00;07;59;26
John Haupert
Yeah, absolutely. So let's start by looking internally. Share with our audience how Christmas engages with your own team members to increase diversity and inclusion. And are there any programs or efforts you feel have been particularly transformative for your organization? Like any aha moments or even a struggle you've overcome to make measurable improvements on the diversity and inclusion front within the organization?

00;08;00;12 - 00;08;32;23
Marcos Pesquera
So we think about this very strategically because I tell everybody diversity, inclusion and health equity doesn't live in this department. It has to be integrated everywhere. So hopefully at some point my job will be not needed. I don't think it's going to happen anytime soon. But but I'm hoping that that will be the goal. So what we do is in terms of strategically aligning it to the rest of the organization, as I look at something, call and I model which is we look at internally, interpersonally institutional and structural.

00;08;32;23 - 00;08;53;12
Marcos Pesquera
Those are kind of four pillars that I look at this work. The first one internally is how do we work with our own associates, in partnership with our human resources partners in terms of getting them the knowledge, getting them the information, working on people's hearts is what I call it. The internal is the internal work that we need to do to understand the issues.

00;08;53;12 - 00;09;17;02
Marcos Pesquera
And then you know, get some passion behind it. Interpersonal is the other piece, which is, okay. Now I want to give you some tools for you to be able to cross barriers, to have difficult conversations across lines of differences, to learn about cultural competence and how to relate to the patients that are different than you in all kinds of different demographics and parameters.

00;09;17;13 - 00;09;53;11
Marcos Pesquera
So that's the interpersonal piece. Institutional is more why does the organization do it? For example, do we have a Health Equity, Diversity and Inclusion Council, which we do, and it's led by our CEO, which we're very, very grateful for that. The other piece is we have a health equity physicians task force that we want to hear from our docs, but primarily doctors that come from historical marginalized communities here, what's happening in the field with their patients and, you know, around things like celebrations, because those those things are important.

00;09;53;11 - 00;10;33;26
Marcos Pesquera
They're very deep. They need focus, but they're very important in terms of of ensuring that there's an education happening on a regular basis. Diversity and inclusion, leadership awards, those are institutional things that communicate loud and clear that this is an important strategy for us to succeed. So that's the the institution of this. And then on the institutional also, we have a strategic map called Connect 2025 in which the organization have about 12 to 14 goals for the whole system, from quality to finance to mission to culture, to patient experience, quality care, etc..

00;10;33;26 - 00;10;57;14
Marcos Pesquera
So we do have a health equity goal in that strategic map, and we also have a diversity inclusion goal. And we also have a community benefit goal. So out of those 12 to 14 strategic focus areas that we have for the system, three of them belong to this area, which I'm super proud of because that again, is a way to integrate this function into the day to day operations.

00;10;57;21 - 00;11;17;04
Marcos Pesquera
So that's the institution. And then systemic is how do we deal with our communities, what our communities are saying about us, how well do we have a listening ear to do? We have like we have a a learning collaborative with 60 different nonprofits that we meet every quarter. We hear from them, they hear from us, and it's a great opportunity for us to stay in touch.

00;11;17;04 - 00;11;30;23
Marcos Pesquera
But that that's this what I call the systemic piece. So it's internal, interpersonal, institutional and then systemic and systemic is how well our hospital function, which within the community, which is the system.

00;11;31;16 - 00;11;58;01
John Haupert
Well, that's great, because I really like the fact that as a system you have incorporated the air and health equity into expected performance measures for team members and for leaders, because I think that says a lot about an organization when they make it a priority, typically when they tie it to performance evaluations and or outcome measures for leaders, that's really great.

00;11;58;19 - 00;12;31;14
John Haupert
So now I want to turn and look externally because we all know that health systems and hospitals can't do all of this, can't do everything to address health equity. We have to have numerous external partners, the patients and communities we serve and that your hospitals serve. Can you share with us your approach to meeting the specific unmet needs of those communities and how you're removing barriers to care and improving access to equitable health care and how partnerships play into that?

00;12;32;11 - 00;12;58;23
Marcos Pesquera
You know what's really interesting, you know, about the new CMS and joint Commission requirements around social determinants and DNI, which has even pushed this work even forward even more so what I see as a community health is assessment. Obviously, we have all this focus groups and we talk to all the stakeholders in the community. We hear that plus the data from our public health agencies are telling us, plus our internal data, all that comes together into an assessment.

00;12;58;28 - 00;13;24;04
Marcos Pesquera
We also have what's called the the Christy's Impact Fund, which is whatever whatever we decide as a system is really critical for us as a result of the community health assessment in this in this case, for us, this three year, this three calendar years, it's going to be heart disease and food insecurity. We try to to say, okay, that doesn't mean we're not going to be concerned about other things, but those are the main two that we're going to focus on.

00;13;24;16 - 00;13;51;05
Marcos Pesquera
And we're able to then, through the community Impact fund, help assist some of our community nonprofits to help us with that. Whether it's okay, let's focus those those resources, those moneys to giving grants to food banks, to giving grants to organizations that are helping us advance heart disease and other things. So so that that's kind of a that's kind of a way for us to hold hands, if you will, and come together and be a partner.

00;13;51;05 - 00;14;10;28
Marcos Pesquera
Not we're not leading anything. We're just being a partner in a roundtable. And that to me is important. I mentioned a little bit about the Learning Collaborative, and that has been, again, super successful in us being able to hear because that's that's one of the things that I think health systems in general have been criticized for, is that have we listened to folks?

00;14;11;12 - 00;14;35;23
Marcos Pesquera
And and I think this provides that venue for us to really do that. So that that's been very important. But I tell you, even in this with the CMS requirements, we were able to to talk to our quality and patient safety partners and said, guys, heart disease and food insecurity. So we want to focus on according to our let's just continue that even through this requirement and, and we were going in that direction.

00;14;35;23 - 00;14;50;14
Marcos Pesquera
So I'm it's very exciting to me to see the community voice impacting what we do in the hospital and then everybody getting in line, aligning, if you will, not getting in line, but aligned getting in line to, I guess.

00;14;50;23 - 00;15;17;20
John Haupert
Yes. Everyone sharing the responsibility, that's for sure. So, you know, I oftentimes get asked and I'm sure you have, too, about the role I question when it comes to investing in health equity and community health. So I'm going to turn that question on you today. How have you successfully made the business case for this work to ensure that it remains woven into the fabric and strategic mission of your organization?

00;15;17;20 - 00;15;47;02
Marcos Pesquera
We are set up a little bit different. I report through mission integration. So the Arrow II is it's already been in terms of creating culture of who we are as an organization. It's been there. So I don't have to really in terms of, of creating a perform a whole business plan and rely on this. I have done that before, but obviously and I can tell you the typical answer would be cultural competence, impact, health care outcomes, decreased healthcare costs.

00;15;47;02 - 00;16;15;01
Marcos Pesquera
When you have a diverse leadership and board that the organization normally performs better financially, which you we all have seen those. But I think the bigger question to me is I have a feeling you were going to ask that. Let me turn that around a little bit. And for us, as health care leaders to think if there is real health care quality without equity, I think that's that's what we as leaders need to be asking ourselves.

00;16;15;25 - 00;16;39;03
Marcos Pesquera
And I think that that kind of that kind of help answer a little bit when we think about our values as organizations. I think for us at Christy's, one of them that that to me is very clear, is dignity. So how do we preserve the dignity of every human being that comes through our doors? And I think that does indeed in our ally is very clear.

00;16;39;03 - 00;17;01;29
Marcos Pesquera
Now, I will tell you that that doesn't mean I don't measure outcomes. We do. We had an equity of care program in which we followed our Medicaid. Uninsured patients from historically marginalized communities will look at their data in terms of hospital utilization and hypertension. And by creating a navigation program for this patients, the length of stay went down.

00;17;01;29 - 00;17;29;13
Marcos Pesquera
The 30 day readmission rates went down, hospital visits went down. So, yes, there's there's a narrow eye there, and I think that's very clear. But we try to approach this work as this is who we are as an institution. Obviously, it needs to make financial sense. And I always I'm a huge advocate of could somebody talk to CMS and hurry up and get the community health workers interventions reimbursed, please, just directly, because there's nothing else to prove here.

00;17;29;13 - 00;17;36;08
Marcos Pesquera
It's so clear that it has such a great impact on patient care. So that's what I would that's what I would answer.

00;17;36;08 - 00;18;01;20
John Haupert
John No, you're absolutely right. The community health worker element within all of this work is critical because the more boots on the ground we have in the community to work with communities on improvement, improving health, the better off we all are because we know the reality is that not every hospital or health system has been as successful or is as far along when it comes to hardwiring health equity into their day to day work.

00;18;02;23 - 00;18;15;10
John Haupert
I know this can be a conversation in itself, but what suggestions do you have for other organizations, any must do's as it relates to improving diversity and inclusion within their organization?

00;18;15;25 - 00;18;49;12
Marcos Pesquera
I would say few things. Number one, I think it has to be hardwire into the mission and into the strategic map of the organization, and you got to have health equity goals and DNI goals and community benefit goals in there. I think that communicates volumes too, to everyone across the organization. The other piece that to me is really important is while I don't report directly to the CEO, I do meet with him on a quarterly basis to give him updates as to how are we progressing in this in the health equity piece and in the DNI piece as well, and community benefits.

00;18;49;12 - 00;19;23;25
Marcos Pesquera
So either direct having having the person or the department either reporting directly or somehow having a connection on a regular basis is important. So that's that to me is a huge recommendation. Have a health equity diversity inclusion Council that has executive representation and folks that can make decisions in it. I think historically in the past, I remember myself having diversity councils that were representative of the staff and this and that's great, but if you don't have decision makers at the table, it frustrates that group.

00;19;24;00 - 00;19;42;27
Marcos Pesquera
And that's in my old experience, even before being here. So having a city council that is is a good mix of executive sponsorship and and other folks as members. It's to me really important and I cannot reiterate enough the connection to the CEO. That's really key.

00;19;42;27 - 00;20;09;04
John Haupert
That's great. That's good. A little follow up to that that I'd like to ask is I personally believe that understanding the social determinants of health that are impacting the communities we serve is really imperative for us to develop our action plans around health equity. What what are those health social determinants that are impacting health negatively in the community?

00;20;09;20 - 00;20;19;17
John Haupert
What is your elevator speech or what would you share with the people? Tune in to this discussion about the need to really focus on social determinants.

00;20;19;26 - 00;20;51;03
Marcos Pesquera
If we want to have the best health care outcomes for all communities, we have to. I mean, we have to go upstream. I think the whole the social determinants such as, you know, lack of access to care or housing or food insecurity or others, we care for patients in a great way, right? But we have no control over what happens once they leave if we don't have it influence and include that discharge after they leave the hospital into the care continuum, they're going to continue to come back.

00;20;51;26 - 00;21;17;04
Marcos Pesquera
And it's that's that cycle. It's going to be very hard to break. So to me, talking about our I talking about wanting to provide excellent quality care, wanting not to frustrate your health care providers, care for those things because they're they're the ones that are going to keep patients healthy outside of the hospital and performance as an institution will go high.

00;21;17;04 - 00;21;33;08
Marcos Pesquera
So to me, absolutely, there's a direct relationship and we have to a to take care of that. And excellent care and quality care doesn't exist without that equitable piece just added to the care continuum. Think, think like there's no division. There is part of what we do.

00;21;34;04 - 00;22;03;28
John Haupert
No. Great. Thank you for that. And that's a great way to wrap up our time together. Marcos, I want to thank you again for joining me today. Your insights and expertise are valued at ACE Community Health Improvement Network and FDA are hosting the Accelerating Health Equity Conference next month, May 16th through 18th in Minneapolis, where you can learn from experts in the field and dive much deeper on these topics that we have.

00;22;04;02 - 00;22;37;09
John Haupert
We have scratched the surface of today to register. Learn more. You can visit WW W dot equity conference dot h a dot org. Thank you for joining us today and I hope you'll be back for next month's leadership dialog.