ACHE Roundtable: An Executive Discussion About Health Equity and Population Health

Hospitals have been working diligently to reduce health disparities in their population health quests. One way they have been doing this is by focusing on health equity, with some healthcare organizations hiring directors of health equity or assigning other roles to the task. Three CEOs share their insights on what needs to be done to achieve health equity in their hospitals and communities. 
Healthcare Executive: What role does health equity play in population health? 

Sadau: It’s critical, and at CHRISTUS, we do not separate them. One of the key indicators of longevity and quality of life is understanding where individuals live, what their challenges are and how we can optimize their health. Our ability to look at performance metrics through a health equity lens is critical to meeting the needs of special populations. This is key to ensuring we achieve health equity and influencing healthy outcomes through population health initiatives. 

Pullin: Health equity or the lack thereof has a tremendous correlation with population health. Life expectancy can vary significantly from neighborhood to neighborhood, even when they’re only a short distance apart. A person’s ability to access and afford healthcare services can have a direct impact on his or her health outcomes. The same also holds true for health literacy, in that exposure to it empowers people to take ownership of their own health or to advocate for their needs.

As a health system CEO, I believe we should be responsible for creating communities of wellness, and we shouldn’t limit our scope to caring for the sick or treating diseases. We have to establish meaningful, ongoing care relationships that help identify health issues sooner or prevent them from happening. 

Bolano: When we talk about population health, we’re usually talking about it from an insurance perspective and managing a certain population to keep them healthy. When we look at health equity, we look at those who are disadvantaged, who are either underinsured or have no insurance. That brings health equity to the forefront and influences our operational efforts to address systemic injustices in our communities. Population health can play a role in addressing these needs through innovation, such as creating a social care hub, staffed by community health workers who link social care need to clinical care outcomes. It is important to note that innovation is not always associated with new technology, but truly understanding the issue you are trying to address.

I’m as equally invested in in our outreach programs as I am in our other medical services because they all contribute to the same end goal, and that’s keeping people healthy.

- Dennis W. Pullin, FACHE, Virtua Health

HE: What population health and health equity initiatives are your organizations working toward? 

Pullin: At Virtua, we prioritize food access, and I think we’ve made some significant inroads in a very short period of time. In two of the counties we serve, roughly 12% to 15% of the residents don’t know where their next meal is coming from. Our Eat Well Food Access Program consists of three components: (1) A mobile farmers market that provides fresh produce year-round; (2) two food pantries, which we call “food farmacies,” in underserved communities; and (3) an Eat Well Mobile Grocery Store, which has only been in operation for a couple of months, but the feedback has been overwhelmingly positive. Through these programs, we directly address access and affordability, and we try to address health literacy by making our shopping experiences teachable moments. We have registered dietitians who discuss nutrition and offer recipes so shoppers can fully enjoy the healthy offerings we provide. Our aim is to reduce the prevalence of chronic disease by creating these avenues of healthy choices.

: Population health and health equity initiatives are at the foundation of our strategy. Our mission—to extend the healing ministry of Jesus Christ—and our calling over 150 years ago in establishing CHRISTUS Health was made in relationship to caring for those who are sick or in need. Keeping that mission and calling alive and rich is our legacy, and it’s ingrained in our DNA. That’s one of the key things that continues to drive us. 

We are also employing care navigators and community health workers to help us address social issues that prevent marginalized or vulnerable communities from experiencing health and wellness. 

Additionally, we established a physician health equity task force that looks at quality metrics by race and ethnicity, which is helping us design and integrate a social determinants of health assessment tool into the clinical process. This means that in the near future, physicians will have information readily available to help them address socioeconomic barriers to wellness. In addition, we have incorporated health equity, diversity and inclusion modules into our medical staff training curriculum, as well as in grand rounds and continuing medical education programs. 

We are also working to increase COVID-19 vaccine trust among minority populations and are collaborating with faith-based organizations to deliver vaccines locally. 

Bolano: Our Community Health and Well-Being Department, in partnership with our medical group and clinically integrated network, focuses on population health and health equity. Through this department, we provide social care hubs, in which community health workers help people address their social needs so they can get the clinical care they need. However, no one can do it by themselves, so we are always looking for partnerships in the communities we serve to make sure we are collaborating with people who have the same missions and goals. Through partnerships, we can mobilize an entire community.

The No. 1 issue for us is affordable housing, and we have three signature community projects around affordable housing and homelessness. We are also involved in Housing First, which is a program specifically for the chronically homeless and a way to get them permanent housing. 

Part of our mission statement is that we’re a compassionate and transforming healing presence in the communities we serve. Ensuring we’re meeting that goal for those in need is part of how I lead every day.

- Odette Bolano, FACHE, Saint Alphonsus Health System

HE: How do you as CEOs lead your population health and equity initiatives? What is most important for you to ensure success in leading these initiatives? 

Pullin: To me, it’s a matter of establishing priorities. I’m as equally invested in our outreach programs as I am in our other medical services because they all contribute to the same end goal, and that’s keeping people healthy. Sometimes I think people categorize community-based programs as ‘nice to haves’ instead of essential, and that’s simply not our philosophy. At Virtua, our brand promise is about being here for good. It’s a simple expression, but it informs the way we approach every project or initiative. I think that really contributes to our ability to advance meaningful change. 

Sadau: I believe for diversity, inclusion and health equity to get the presence they need, the CEO must be seen as the leader, the voice and the encouragement, as well as the provider of resources for the organization. For example, I chair the CHRISTUS Health Equity, Diversity and Inclusion Council. 

What’s important for me is always learning. We learn more every day in this area, and we can’t wait to do things until we think we have the perfect solution. We just continue to implement, learn, make changes as needed where we fall short, and then move ahead. That’s something we’ve learned over time: To be proactive and to take action because you are making an impact. Maybe it’s a small one, but you’re starting to make an impact.

Bolano: Part of our mission statement is that we’re a compassionate and transforming healing presence in the communities we serve. Ensuring we’re meeting that goal for those in need is part of how I lead every day. Additionally, having a vice president of community health and well-being on my president’s council who is very much involved in our strategic decisions around that space is one way I ensure the success of what we’re doing. With her at the table, she is always reminding us of our commitment to the poor and vulnerable and the work that she’s doing with her team.

HE: How are your organizations measuring progress in their efforts around health equity and population health? 

Sadau: We stratify the utilization data we collect about the community by race, ethnicity, age, language, gender and, of course, payer mix by ZIP code, to really determine where we put our focus in communities to ensure the vulnerable are taken care of. We collaborate with community organizations to ensure our patients have access to a safety net of providers that can partner with us and meet other social needs.

Bolano: For population health, we are focused on having a dashboard that keeps us honest about what the key indicators are and whether we’re managing the health needs of a population. We look at our clinical outcomes and whether we’re closing the gaps of care we’re aware of from a population perspective. 
From a health equity perspective, we are committed to the community needs assessment, which we do every three years, and implementation of an action plan derived from that assessment. The assessments help us determine whether we are adequately addressing what we see as the top three or four most critical health equity issues. 

Pullin: We regularly assesses and analyze our data, but I think this can be a challenge with these types of programs. For our food access program, we have some statistics, but it’s all survey-related. It’s vital that we think of these programs as businesses, not in the sense of making money, and that we are vigorously maximizing our efficiency and effectiveness. Initially, we have to measure the success of these programs by whether they are helping to create communities of wellness and improving health literacy instead of their return on investment. Those are the ways we start to measure our progress. It’s not always immediately a matter of dollars and cents. 

I believe for diversity, inclusion and health equity to get the presence they need, the CEO must be seen as the leader, the voice and the encouragement, as well as the provider of resources for the organization.

- Ernie Sadau, FACHE, CHRISTUS Health

HE: What are recommended steps that healthcare leaders can take to realize health equity in their population health initiatives?  

Bolano: It’s important to involve those who are most affected by health inequities to understand the circumstances that are affecting them and to show that you support them in trying to overcome these issues. We meet with leaders in the Black and Latinx communities, and we have an advisory council for the deaf and hard of hearing to help us understand issues they have when they’re trying to access healthcare. The purpose of the council is to assess what we are doing well and adapt where we can improve access and care. 

Sadau: In my view, all healthcare organizations should participate in the American Hospital Association’s #123forEquity Campaign to Eliminate Health Care Disparities pledge. Being vocal about that with your board and throughout the organization is key. That’s not going to solve the problem but making that pledge is very important.
I also believe you have to establish a process that is measurable, including data systems that are readily available, to start tracking and trending population segments. It is vital to manage that data to understand the demographics and how to stratify it from utilization patterns in the community, such as disease prevalence by race, ethnicity and other social determinants.

Pullin: I think as health systems and healthcare leaders, we have to look out for our own workforce and acknowledge their needs. At Virtua, we increased our minimum wage to $15.15 at the end of 2018. That’s more than double the U.S. standard, which is $7.25. Why did we do this? For one, we wanted to be a desirable place to work and to attract top talent in the competitive greater Philadelphia region. Furthermore, we recognize that a higher minimum wage represents immediate benefits to employees. 

Healthcare institutions are quite often the largest employer in a region, and they can have a tremendous impact. I think if health systems lead by example, it advances population health throughout the region. So, we have to focus on our own, and I think it cascades from there as we go out into the community. 

There are many approaches organizations can take to strengthen the degree to which health equity factors into their population health initiatives, whether they focus on affordable housing or food access or create departments, groups and positions dedicated to health equity initiatives. No matter how population health initiatives are deployed, it is essential that CEOs prioritize health equity’s role in these efforts, and that organizations have performance metrics in place and strong community partnerships are formed. Equipped with these key components, healthcare organizations can better position themselves to ensure their efforts to create healthy communities extend to everyone in their care—even the most marginalized and vulnerable. 

Lea E. Radick is a writer with Healthcare Executive.

The Bottom Line

The following components will help organizations to achieve greater success in their health equity and population health initiatives: 

  • CEO engagement in and prioritization of health equity within population health initiatives.
  • Routine community needs assessments to ensure the voices of those in need are heard and understood. 
  • Reliable and accurate methods of measuring and analyzing data to determine where to invest resources and whether efforts are working. 
  • Partnerships with community organizations to help fill gaps in care. 
  • A willingness to try, to learn and to adapt.