Aligning Health Equity and Community Health Goals

00;00;01;05 - 00;00;35;16
Tom Haederle
If anything good could be said to have come from the COVID 19 pandemic, it could be the light had shown on the gaps in access to quality care in our nation. As one expert notes: in health care, a rising tide does not lift all boats, and we need to be much more strategic and intentional about making sure everyone has equitable access to safe, quality care.

00;00;35;19 - 00;01;04;29
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Today marks the start of Community Health Improvement Week, a time to highlight hospitals and community organizations working together to enhance health. Some of the best work going on in the field right now was highlighted at the AHA’s Accelerating Health Equity Conference in mid-May, where more than 900 health care leaders gathered to share insights and analyze trends.

00;01;05;02 - 00;01;27;29
Tom Haederle
One encouraging takeaway from the conference: we are seeing more than ever before a greater alignment of community health goals with equity goals, now woven together as strategic plans instead of being treated like separate concerns.
In this podcast, two AHA experts talk about what this means: where community health and equity goals are headed and what are the driving forces behind the movement in 2023.

00;01;28;05 - 00;01;40;22
Tom Haederle
Nancy Meyers is vice president, System Leadership Innovation. She's in conversation with Dr. Chris DeRienzo, AHA senior vice president and chief physician executive.

00;01;40;24 - 00;02;15;16
Nancy Myers
Hello and welcome to this Advancing Health podcast. I'm Nancy Meyers, vice president of Leadership and System Innovation at the American Hospital Association. It's Community Health Improvement Week, an annual recognition week during which we honor the people working in partnership to improve the health and well-being of individuals and communities. Today, I'm joined by Dr. Chris DeRienzo, AHA senior vice president and chief physician executive, to talk about the trends that we're seeing in the community and population health field and how we can support you on your journey.

00;02;15;17 - 00;02;17;00
Nancy Myers
So welcome, Chris.

00;02;17;02 - 00;02;18;25
Chris DeRienzo
Nancy, thanks so much for having me.

00;02;18;27 - 00;02;41;05
Nancy Myers
So I want to start by talking about where we were just a few weeks ago. We were gathered in Minneapolis for our Accelerating Health Equity conference, which brings together people working in population and community health as well as diversity, equity and inclusion. So when you were there, Chris, what were some of the key takeaways or inspiration that you heard from speakers or attendees?

00;02;41;07 - 00;03;09;23
Chris DeRienzo
Well, Nancy, as you know and as your listeners will hear, this was my first time getting to attend the accelerating Health Equity Conference. And I was blown away by the sheer volume of people across this country, really frontline leaders in in community health and in in the health equity space coming together who are all committed to this shared purpose. And hearing their stories about during sessions and all of the in-between conversation that it really was almost like like family coming back together.

00;03;09;23 - 00;03;37;12
Chris DeRienzo
Because, you know, we know that that we've only really just begun the work of getting folks back together in-person. And so when these folks see each other and they're able to celebrate the successes that they're seeing within their neighborhoods, that's what really can help scale their efforts nationwide. And so, frankly, at the top of my list was just being being able to see the frank joy in people's faces as they got to talking to folks who many have known for years.

00;03;37;18 - 00;04;01;04
Nancy Myers
Yeah, it did feel like a family reunion of sorts. And that just we had about 900 folks there. And as you said, talking about the tactics that they're using that are working to advance equity and health in their communities, but also really just validating for each other as well what they're still finding that they need to work on.

00;04;01;06 - 00;04;27;05
Nancy Myers
So it was a great time. And over the past few years, we've seen that shift towards aligning population health with equity or health equity work and the incorporation of those priorities into hospitals' strategic plans. So, you know, as a clinician, as a physician executive, how are you seeing that integration play out? What areas are coming together from your perspective?

00;04;27;08 - 00;04;51;22
Chris DeRienzo
Yeah, that's exactly right. And I think it was prescient of AHA years ago to bring those to historically separate groups and conferences together, the folks working in community and population health and those who are working within the diversity, equity, inclusion and belonging space, because it really is a continuum of work together. On the hospital and health system side,

00;04;51;24 - 00;05;15;06
Chris DeRienzo
you know, there is no work in community health without health equity. The system I came from before joining AHA was a system based in Raleigh, North Carolina, a community health system that serves a significant proportion of the underserved population within our community. And when we would sit down to do our community health needs assessments, we had to bring those folks from the community to the table.

00;05;15;08 - 00;05;45;19
Chris DeRienzo
And that wasn't something new when I started there, that had been going on for years. Because when you are sort of that core pillar of health within a community, it means that you have to be able to speak to and serve everyone. And so the work that that you do with your homeless population, the work that you do recognizing that vaccination efforts during COVID, for example, were not reaching equitably into each zip code. That is is a perfect blend of community health and health equity.

00;05;45;19 - 00;05;55;24
Chris DeRienzo
And as I've now joined the AHA and I get to see these efforts not just within one community, but nationwide, it gives me a lot of hope for for the future.

00;05;55;26 - 00;06;21;27
Nancy Myers
The work of quality improvement or patient safety have to involve an equity component because there is no such thing as quality care without equity, without it being equitable care or safe care without it being safe for everyone. What are what are you seeing in terms of how hospitals are incorporating that equity lens into those kind of more traditional clinical lines of improvement?

00;06;22;00 - 00;06;43;15
Chris DeRienzo
You know, I think for the first generation of our work within patient safety, which was sort of I would tag back to as that seminal "To Err is Human" report, we have assumed as clinicians that as we work to standardize care processes and and work on things like patient safety culture, that a rising tide would lift all boats.

00;06;43;17 - 00;07;08;00
Chris DeRienzo
And I think what's become clear through that time is that's just not the case. We know that that without the data to help us understand where each boat is starting from, we can have no clue as to exactly how much we are closing the gap that now reams of evidence shows exists in health outcomes across various domains of health equity.

00;07;08;01 - 00;07;38;28
Chris DeRienzo
So step one has been to get the kinds of access to data and analytics needed to surface those challenges. And in the health systems that I've worked at that has been a decade long challenge in and of itself. I've only really now just begun to see health systems who have the standardized inputs on, you know, what we would call the social determinants or social drivers of health, even basic like race, ethnicity, age, zip, gender, gender identity.

00;07;39;01 - 00;07;57;27
Chris DeRienzo
Those are not standardized uniformly across the country. And in part for good reason, that when you talk to the big national EMRs is they say every state has different state level requirements for how to to capture those variables. And so until you get a standardized input, it's hard to then get to standardize outputs. But some folks are getting there.

00;07;58;00 - 00;08;19;20
Chris DeRienzo
And we now know that as part of the inpatient quality reporting rule last year and CMS is expecting us to begin collecting a uniform data across social drivers of health. And once you have that uniform in, you can then begin understanding the outs. So when it gets down to the clinical care, being able to then start asking questions around that data.

00;08;19;20 - 00;08;45;12
Chris DeRienzo
So if you look at, for example, differences in maternal morbidity, outcomes that are divided by race and ethnicity, it's not enough to just say, oh, look, we see there's a difference in outcomes. Have to be able to ask the next question, which is why, what, what's driving that outcome? And I think across the country we're only just beginning to have the infrastructure in place to be able to get to that next level question.

00;08;45;14 - 00;09;13;24
Nancy Myers
And, you know, at a conference a couple of weeks ago, one of the speakers that we had was Brian Smedley, who right after To Err is Human came out. We then saw "Crossing the Quality Chasm." And then the third report in that series, which was issued in 2003, was "Unequal Treatment" that really outlined where we were 20 years ago in terms of differences in care delivery and then health outcomes.

00;09;13;24 - 00;09;47;10
Nancy Myers
And while we have made some strides over that time and certainly have had the data revolution, that's allowed us to understand differences more clearly, one thing that he really pointed out is that we still have a long way to go to move that needle and really make sure that the care that we're delivering and the health outcomes that we're producing or helping produce are equitable across all groups of our patients who trust their care to us.

00;09;47;13 - 00;10;24;14
Chris DeRienzo
You know, we have miles to go before we sleep for sure, right? And it's not just the data. The data is table stakes to be able to understand what's driving any challenging outcomes. There's been a whole cultural conversation that needs to happen within a clinical care team because you risk if you begin surfacing data that shows disparate outcomes by things like race, gender, ethnicity, zip code, you risk the clinicians responding instinctively and saying, Oh, you think I'm biased in favor of or against these groups and in general, But that's probably not what we're talking about here.

00;10;24;17 - 00;10;45;09
Chris DeRienzo
We're not talking about overt bias. Sometimes there's unconscious bias that may be driving things, but there are also other aspects of care delivery that we're learning. We need to begin coaching clinicians on how to engagee with that data. And then the crucial third leg of that stool is is so what do we do with it, right?

00;10;45;09 - 00;11;12;26
Chris DeRienzo
If we if we can see a delta in outcomes by race and one of the drivers of that is social drivers that that have to do with neighborhood status and access to transportation ... only now are we in a place where we're beginning to see access to reimbursement resources that can help drive community level actions that historically have not been within the construct of a hospital or health systems reimbursement mechanism.

00;11;12;28 - 00;11;25;02
Chris DeRienzo
So that sort of it leads to a question, Nancy, that I think is more within your bailiwick, which is: as we're beginning to see these kinds of clinical evolutions, how are you then seeing that play out within the community health space?

00;11;25;04 - 00;11;52;27
Nancy Myers
So I think that there are a couple of things. One, in general, you know, after the last three and a half years that we've been through as a country and within health care delivery, one of the things that we've been seeing at the national level is a de-siloing of our understanding of social needs and social drivers of health and the strategies around them.

00;11;52;28 - 00;12;23;23
Nancy Myers
So at one key area, for example, if you think of a Venn diagram with three circles that are increasingly being seen as intersecting more and more  - traditionally in health care, we've looked very differently at the care we deliver to our patient populations versus what we do as employers to support our team members versus how we work with communities around our community assessment and improvement planning.

00;12;23;26 - 00;13;14;09
Nancy Myers
And what I've heard from more and more folks across the country is that those three areas of influence of our employees, who are our first community, of our patients, who we are entrusted to support, and then for our broader community, that those areas need to really be operating in a much more strategically integrated way, and that the data that we gather from employees and understanding what their social needs and social drivers of health are versus our patients versus our community, that if we put that information together, we actually have for all of our populations a much better and deeper picture of assets that exist in our communities and therefore among our employees and among

00;13;14;09 - 00;13;44;16
Nancy Myers
our patients and needs. So I think that's been really exciting. I've seen a lot of health systems that are really looking at their HR structure and saying the folks that are working in these three areas should should be working side by side as part of an integrated team. And we're also seeing the recognition that community partnership and community health status should become a much stronger foundational part of a health system's overall strategic plan.

00;13;44;17 - 00;14;24;08
Nancy Myers
So I think from a macro level, that's really exciting. The other thing that we've been focused on over the last year with working with many of our members and other partner organizations is updating guidance around that specific activity of how to do a community health assessment. And what does that look like in 2023 and beyond? More and more hospitals have taken up this practice, some because they're required to and others even though they're not required to are still doing it on a regular basis and in partnership with their public health departments and other community based organizations.

00;14;24;10 - 00;14;54;05
Nancy Myers
We're seeing some trends there where folks are really going deeper to address the social drivers of health, and they're using different types of data sets and more current data around housing structures in their community, around the climate impacts on their community, around other built environments. So that's really positive. I think we're getting deeper into where we as organizations can make an impact on health overall.

00;14;54;08 - 00;15;26;15
Nancy Myers
We're also really seeing that community health assessment and the partnerships that flow from it and are part of the generation of it become a much more critical part of how hospitals are working with their communities on all sorts of issues. Hospitals and health systems who had strong community partnerships in place prior to COVID were able to respond much more quickly and efficiently to the pandemic as it rolled through our country.

00;15;26;17 - 00;15;43;29
Nancy Myers
than health systems who needed to go out and forge new partnerships. So I think just a valuing of that activity and of the ecosystem in general is something else that we're seeing that is a positive effect of what we've been through over the last three years.

00;15;44;01 - 00;16;13;13
Chris DeRienzo
That you bring us back right to where we started, right? That it really is is all about integrating that sort of quilt that is as historically been thought about as individual patches into one network fabric of care, an ecosystem of care that helps us get at these challenges that we know exist across across health equity and outcomes in a way that doesn't limit us to just one model of thinking or one geographic place of care.

00;16;13;14 - 00;16;14;29
Chris DeRienzo
I love it. 

00;16;15;01 - 00;16;45;25
Nancy Myers
That's a great point, Chris, and we are working with partners at the national level to help develop out a national ecosystem for health. We're really interested in hearing from our local hospitals and health systems and their community partners about what we can provide for you in the way of resources. We do have several things on our website, including information about great partnership tactics, whether you're working at the community level to impact health or at the patient care level.

00;16;45;27 - 00;17;11;26
Nancy Myers
And we also have a community, the AHA Community Health Improvement Network, that you can join together and get updated resources from us on a regular basis. Thanks, Chris, for the conversation today. And really on behalf of Chris and myself and everyone at AHA, we want to thank all of our listeners for the work that you're doing every day to support the health and well-being of the communities and the patients that you serve.

00;17;11;29 - 00;17;42;07
Nancy Myers
We invite you to share in this CHI week conversation by visiting our website: AHA.org/chiweek. Add your voice to the conversation on social media using hashtag CHI week and explore all of AHA's community and population health resources on our website at AHA.org. Be sure to mark your calendars too, for next year's Accelerating Health Equity Conference. We will be getting back together May 7th through 9th in Kansas City, Missouri.

00;17;42;10 - 00;17;56;03
Nancy Myers
It'll be a wonderful week and we hope to see you all there. Thank you.