Although health plans have long been committed to improving health equity, their efforts took on new urgency – and got new levels of buy-in – as the COVID-19 pandemic turned a spotlight on the serious consequences of inequity. We talk with Wellframe Chief Medical Officer Sandhya Gardner and Priority Health President Praveen Thadani about the scope of the challenge and solutions at the patient, practice, community and system levels.
This episode is brought to you by Wellframe.
Melissa Turner 0:03
Hello and welcome to Touchpoints, a conversation about care, connection and costs in the US healthcare system. I'm Melissa Turner. In addition to co hosting Touchpoints, I'm also content director for healthcare and life sciences at SmartBrief. SmartBrief is a publisher of digital newsletters for professionals and creator of this and other shows in our series of SmartPod podcasts.
Doug Harris 0:24
And I'm Doug Harris. I'm a custom content editor for healthcare and life sciences at SmartBrief, where I create content for payers, providers and other healthcare stakeholders. In addition to our work hosting Touchpoints and at SmartBrief, Melissa and I are of course also consumers of healthcare, just like those of you listening. Together in each Touchpoints episode, we'll explore the issues that make healthcare hard for all of us.
Melissa Turner 0:45
We'll also discuss how health plans healthcare providers and their partners in the healthcare ecosystem can make it easier. Thank you for joining us on the Touchpoints podcast.
Doug Harris 1:08
Wellframe empowers health plans to become trusted advocates for members. Their team believes that health plans are in the best position to lead the charge into the world of digital health management. Let Wellframe be your partner in improving member engagement and outcomes. Learn more at wellframe.com/touchpoints.
Doug Harris 1:26
Welcome, I'm Doug Harris, your host for today's episode of Touchpoints. Our topic is building a more equitable health care system and the role health plans can play in that effort. Let's meet our guests. First up is Sandhya Gardner, chief medical officer with Wellframe. Sandhya leads Wellframe's health equity initiative and has significant experience providing clinical leadership at healthcare, education and technology companies. She previously spent more than 10 years working with Medicaid populations. Sandhya also worked with low income mothers as a practicing OBGYN. Welcome, Sandhya.
Sandhya Gardner 1:52
Thank you, Doug. It's great to be here.
Unknown Speaker 1:54
I'm also pleased to welcome Praveen Thadani, president of Priority Health. Praveen's career in health care includes experience managing commercial consumer and government health plan products. Praveen also brings a successful background in services and programs that manage the development of value based provider programs, medical costs and plan innovation. Glad to have you here, Praveen.
Praveen Thadani 2:13
Great to be here. Thank you so much, Doug. I'm looking forward to our conversation.
Doug Harris 2:16
Thanks, everybody. Let's go ahead and jump into that conversation. Health equity was a focal point for many plans before COVID-19. But the pandemic has exacerbated issues related to health equity, and cast a brighter light on them. It has also created new challenges for all stakeholders in health care, including health plans. As healthcare leaders, where do you see the biggest need for change when it comes to health equity? And also what has been the most significant change you've seen? Sandhya, let's start with you.
Sandhya Gardner 2:42
Thanks, Doug. It's an important question. And I would say I think based on my own experience, as an obstetrician, you know, for over a decade and then working in companies in healthcare that have been focused on improving perinatal outcomes. You know, certainly maternal health stands out as a huge segment of the population where we are definitely failing. And where change is desperately needed. We have roughly 50% of the births in the US that are covered by Medicaid, where the equity gap is disproportionately impacting this population. And you know, of course, there are social, economic, and environmental drivers that are associated with the health disparities in this group. And there are factors that include race and gender and provider bias and social determinants of health. And it really extends beyond the duration of pregnancy and birth. The periods that happen before and then after delivery and during childhood are impacted, and they play a role in perpetuating the cycle and have really widespread implications on society. But yet, you know, we're seeing maternal outcomes in the US being really, really poor, particularly given how much we're spending on health care resources. And it's pretty unacceptable when I think about countries like the US, how we can be ranked at the bottom of developed countries, when it comes to maternal mortality, we're ranked 11 out of 11 countries that have similar profiles. And when you dig deeper into the data, you find that Black women are three times more likely to die at birth compared to white women, and over 60% of maternal deaths are considered to be preventable.
Sandhya Gardner 4:10
But with all that great need, there's also signs of progress and change that are happening. I'll give you a good example, the state of California has provided a very powerful example of, you know, hope and change that can happen back in 2006, when they were looking at national statistics around maternal mortality ratios, and the state of California's ratio they far exceeded that and the rates across the country were poor, but California was really at the bottom. They doubled down on efforts to address the issue of maternal health and birth inequities that were fueled by racial and social injustice. And because of those efforts, they saw a 65% decline in maternal mortality while the national rates continued to climb. At the center of a lot of these efforts was the California maternal Quality Care Collaborative or CMQCC. It's an organization that's multistakeholder, and it was born out of Stanford University's School of Medicine. And they partnered with the state of California. And we really kind of had a shared mission of reducing preventable maternal mortality and morbidity in some of the racial disparities that they saw in California. They use research, various quality improvement efforts, statewide outreach, education around combating bias, and they have made a tremendous impact. And on the national front, I would also add that we're seeing, you know, some significant progress around legislation. There's been movements like the Black Maternal Health Omnibus Act of 2021, that has, you know, several different provisions to it, including diversifying the perinatal workforce, investing in community based programs. And then there's been expansion around Medicaid coverage that extends the 60-day window to 12 months postpartum. So while there is a lot of need that's happening, we have certainly seen positive steps and change that's happening,
Doug Harris 6:00
Right, thank you, Sandhya. Praveen, how about you?
Praveen Thadani 6:02
Thank you, Doug. The biggest need for change, I'd say is on the policy side. You know, public health has known about social determinants and inequity forever. And yet, we have chosen not to see sufficient change in this space for the longest time, for decades and decades. Most of what we're doing today is to address personal need and/or social determinants of health. And ultimately, changing the policies that create the circumstances that lead to these unmet needs is what's needed to ensure that we're successful in addressing health equity over the long term, I think we're just beginning to move in this direction. There's a lot of discussion at the policy level, but probably not sufficient action yet. And so I would consider this to be very, very nascent right now. But policy is where I really think we need the most change. From a Priority Health point of view, the most significant change we've made has been around the level of resources devoted to this work. So whether it's around personnel, investment and community action towards achieving policy change, we're active in all those spaces today. Five years ago, very few health plans were intentional about their work in this space. And today, nearly every health plan, including of course, Priority Health, is working very hard to address health equity. It's very specifically on the resource side, we've added actually a health equity subcommittee at our entire system level. So the system is a combination of our care delivery assets, as well as our coverage or financing of health care assets, which at Priority Health, we have a health equity subcommittee at the system level, our integrated system has also added a new Chief Diversity, Equity Inclusion and Social Responsibility officer. And Priority Health alone has had its first few positions with equity in the title that was allocated time and resources for equity specific work now allocated as well. So a lot of change and very, very exciting future for us moving forward.
Doug Harris 7:46
Right, thank you, Praveen, I appreciate that. So obviously, healthcare isn't really any stranger to equity, and then the challenges surrounding equity. We've kind of touched on that a little bit. How do you think the pandemic has influenced the conversation and creating momentum to address inequity? And what does that mean for health plans? This time, let's start with Praveen.
Praveen Thadani 8:05
Sure thing, Doug. So the pandemic I would say, also coupled with the unfortunate events of George Floyd, required that we really accelerate our focus on inequities. In Michigan, the impact on Detroit was so vastly different than the impact on other parts of the state, especially rural communities as well. There's inequity in rural communities as well. So addressing equity was top of mind, especially during a time when the care delivery system, as you might realize, was shut down as well. So whether you're rural or in disadvantaged communities, we want to make sure that we were addressing this, and this was top of mind for us. So I think for health plans, this newfound momentum really required us to look at our ability to understand our members, that was the most critical piece, how do we know our members? And how can we predict and support their needs? That's where data of course plays a very big role. But equally importantly, how do we then communicate with members in a way in a manner through a channel that works best for them? And then of course, how do we invest in innovations that reduce barriers and make healthy living the default choice for all of them. So truly, the pandemic provided a very important catalyst that I think has ignited movement to address the drivers of inequities, at least from a health plan point of view.
Doug Harris 9:13
Great. Thanks, Praveen. So, Sandhya, what are your thoughts?
Sandhya Gardner 9:16
You know, so I would agree with everything Praveen said, and then, you know, I'd also, you know, kind of elaborate on the sort of urgency to act that's happened, you know, because of the pandemic. We've seen sometimes from adversity, you know, you can really kind of create innovation and creative approaches to address some of the issues that were underlying the inequity that we're seeing. And I think one really good example of that has been the influx of digital health and virtual care options that health plans in the broader healthcare system have been able to offer to members. Now, we've had telehealth and digital health management options that existed long before COVID. But they've definitely now become much more mainstream ways of engaging and caring for members. Through necessity. There has been a real benefit to people who were dealing with access barriers and had other social and economic constraints, but it's also given health plans and opportunity to play a much more prevalent role in providing that support. They've been able to offer, you know, critical digital and virtual care services and benefits to address social determinants of health. They've been able to use data as Praveen mentioned, and these new communication channels to kind of proactively identify and educate members about how they can better manage their their health and navigate their care. And they've been able to use the data and the insights so that they can provide resources and kind of the social and emotional support that people need. And most importantly, you know, more importantly, health plans have been able to use the digital channel to really extend this support in a much more scalable way than is possible with some of the traditional face to face and telephonic methods.
Doug Harris 10:46
Thank you, Sandhya, we've touched on this a little bit in the previous questions. Want to dig a little bit deeper on this, though. What actions are you and your teams taking to address health equity? And what lessons can you learn or share from that work for our listeners? So Sandhya, could you give us some of your insights here?
Sandhya Gardner 11:01
Absolutely. I really love this question. So through the Wellframe platform, and some of the member facing care programs that our teams have developed, we're really working every day to enable our customers, which are health plans and their staff, to better address some of the issues of inequity amongst their highest need populations. So as we were, you know, sort of discussing earlier initiatives of access, you know, reliable health information, and support is a really important piece of this. And being able to alleviate some of the traditional brick and mortar access barriers, by delivering this information through digital health channel, you know, offers a really great option. And we do this through a mobile app that our health plan customers are able to provide to members, they're able to access their care managers and clinical staff and healthcare staff via chat at their own convenience, and really circumvent some of the issues of transportation, childcare and work absence that they'd otherwise have to navigate. We're also delivering health education information in a way that's very easy to understand. Regardless of what socioeconomic status or demographic and member comes from, we use plain language concepts. When we're writing our content. And we write everything on a fourth grade reading level. We know that knowledge is power, and if all members are really able to access reliable information in a way that they can actually understand it, that really levels the playing field much more. And then the last thing I would say is around social determinants of health risks and barriers. And what we've done is to embed surveys and clinically validated screeners and assessments within our content in our care programs. And these are tied to an alerting mechanism that informs care teams that meet when members really need proactive outreach and support. And were able to use the data that those members are providing by you know, so the clinical staff at the health plan can better understand what their needs are, kind of proactively offer them help.
Doug Harris 12:49
That's great. Thank you, Sandhya, how about you, Praveen?
Praveen Thadani 12:51
Thank you, Doug. And I'm probably going to be building quite a bit on what Sandhya just articulated as well. But let me first start with you know, what health equity means to us. We think health equity is achieved when each person each and every one of our members has the opportunity to attain his or her full health potential. And nobody feels disadvantaged based on a social position or any socially determined circumstance. So the starting point for us truly is understanding each and every one of our members. So it starts with data. And we already have tremendous access to data on our members. And so we really use the data as a baseline for understanding and addressing disparities. So we're currently building out our population health strategy, giving you this added structure to many ongoing projects. And then how do we stratify the data, which means are we able to understand where differences and outcomes exist, provide context for members by overlaying social information. Because we know all people do not start in the same place and build up tailored interventions to really address differences, we've included things like you know, social vulnerability indices, and a lot of the data that we look at, to ensure that we're looking at all those meaningful parts augmenting our data resources and assets to ensure that we have extra resources and extra data to really understand the members. So let me bring this on with a couple of examples. We have an asthma home intervention program, where we identified a problem with overuse of emergency rooms amongst asthmatic individuals in one of our counties, Kent County, so Priority Health on our Medicaid side through our Medicaid program worked with community partners to tailor and implement interventions for households over 18 months. That intervention included education, to specific improvements in the home related to mold or lead or pests or draftiness, meaning drafts coming in from the outside. And as a result, we actually saw a 61% decrease in overall emergency department visits and a 25% increase in each member's medical spending as well. So very powerful that when you do address some of these social needs, that there is better health and better outcomes and better quality as a result. Another critical example which dovetails very nicely into what Sandhya was talking about as well is what we call our Centering Pregnancy work. So Priority Health is the first insurer in Michigan to support this care model. And Centering Pregnancy is a model of interactive group prenatal care that has proven to positively impact health outcomes and truly reduce racial health disparities as well. So in Michigan, specifically, Centering Pregnancy sites that we are sponsoring are reporting more healthy weight, full term babies, especially for African American patients. And Centering Pregnancy patients spend about 10x of the amount of time with their provider than women in traditional care. So we know that when you do the right things when you focus on prevention, and when you focus on holistic care. And when you begin to remove some of these barriers, the better outcomes and better health surely follows. You also asked about, you know, the lessons that you we can share, I think probably the biggest lesson I would share is health equity is long term work. It's taken us decades and decades of history and inertia in our system that we have to overcome now. So results and impact will take time as well. And as you've heard, from a couple of our examples, you know, you got to start sort of on a use case by use case basis, and slowly build on that work and begin to really reduce some of the disparities that we see in our marketplace.
Doug Harris 16:10
Wellframe empowers health plans to become trusted advocates for members. They believe health plans have the knowledge and resources to support more people across more touchpoints in their health care journey. Wellframe solutions for digital care management and digital customer service empower members and health plan staff to achieve their best in the most wonderfully human way possible. Make sure your members feel confident, cared for and supported by their health plan. Don't miss this moment. See how a digital health management strategy would benefit your plan at wellframe.com/touchpoints.
Doug Harris 16:40
As leaders and being in this environment all the time, I'm sure you both bring a unique understanding of the barriers health plans face in improving health equity, I'd like to talk a little bit about those barriers now. Specifically, what you both identify as some of the greatest obstacles for health plans when it comes to health equity and how plans can successfully navigate them. Praveen, what are your thoughts here?
Praveen Thadani 16:59
Let me start with several items. I'll start with at least three. The first one is really shared vocabulary. So if you were to ask 10 different people to define health equity, you'd likely get 10 different answers. So step one is really talking about it pretty openly and grounding organizations and having a very clear sense of what health equity really means to us. And where we see the greatest gap inside our communities, because healthcare is so incredibly local, you've really got to get zoned in on what equity measures matter most to you, and focus on a few versus sort of trying to boil the ocean. Data is another major major barrier, you've heard me talk about data, certainly quite a bit, it's often very imperfect, and not always at the level of detail or at the individual level that you need. So here, I'd say you know, our perspective is you can't let perfect be the enemy of progress. So we're focused on ensuring that the data that we get is directional, and it points us towards the right community barriers as well as the community resources that will best meet the needs of our of our consumers and members. Third, I would say is measurement as we build on interventions and policies to address health equity requires a really fundamental shift in thinking. So in healthcare, we're very used -- and I've certainly been a part of this ecosystem for over 25 years, and almost all the time get asked a question saying, well, how quickly can you demonstrate an ROI on this? -- so we're very used to creating interventions and seeing fairly quick results, right? So if and when we're successful at this work, and I'm much more focused on the if because when it's not a choice here, the results may not be crystal clear until we keep iterating and keep learning and keep sort of refining the way we operate. So those are probably the top three barriers, what I'd say is there's an overarching barrier as well, which is really focused on collaboration and community alignment. So we know that these barriers are so large, one organization can't do it alone. So we take a lot of pride in what we're doing at Priority Health. I think the needs of our of our very vast and diverse communities really far outweigh the available investment that an organization like Priority Health can make alone. So I think ensuring that we work with other entities, other community organizations to really collaborate and define key priorities in the community in the local community, and tackle each one thoughtfully, purposefully and with sufficient resources becomes really critical, because this is truly is going to take quite a village to get done.
Doug Harris 19:20
Absolutely. Thank you, Praveen, how about you Sandhya, what do you see as some barriers to equity and health care among health plans?
Sandhya Gardner 19:27
It's a great question. And I really love the answer Praveen provided and, you know, I would echo that what we've heard from some of our health plan customers, you know, is around this same concept of data access and insights, really kind of understanding who's in need and finding ways to understand what the existing and the emerging social determinants of health issues are across their members. But we've also seen kind of firsthand with our platform and tool that digital platforms and communication channels can really open up that door to some of those, to get insights and surface ways to better support members, so, really when you know more, you can do more. Another big obstacle is that even when you know, you've uncovered those member barriers, being able to provide the right kinds of resources and services to those members, and really do so at scale, is another really big challenge. I mean, this includes things you know, as basic as being able to provide translation services for non-English speakers along with linguistically and culturally competent information and resources. But, the good news is health plans aren't in a position where they need to solve it on their own, there are ways of navigating it, you know, through many different levers, and one of them is to partner with vendors who are committed to health equity as well, and who are building solutions that can meet the needs of vulnerable populations, so that it's not just, you know, your commercial or Medicare Advantage members that are being supported. The other is around leveraging digital solutions and virtual care options that are helping plans to really increase access and remove some of those barriers. You know, as I mentioned earlier, increasing the capacity of health plans, service lines, and clinical staff. You know, resources are not abundant. And being able to use digital to scale those resources is a really important value add. The other thing that I would call out is around this culturally competent and, you know, multi language translation, many health plans, actually don't have multilingual staff as a resource, despite having a lot of a large percentage of non-English speakers in their population. So making it a priority to really recruit and hire diverse staff, or contracting with vendors that are providing translation services or translated content could be another way of, you know, kind of circumventing some of these barriers. The last thing I would call out is incentivizing health plan staff beyond volume based metrics, and really looking at the complexity of the members that they're serving, and making sure that they're incentivizing, you know, supporting those vulnerable members who oftentimes take longer to support but stand the most to benefit as another big part of that.
Doug Harris 22:02
You both mentioned that health plans cannot go it alone in this effort, it's going to take a collaborative effort. So what can other healthcare stakeholders do, in addition to what you've already mentioned, to help improve health equity? And how can they work with health plans to make things better this time? We'll start with you, Sandhya?
Sandhya Gardner 22:17
It's a great question, Doug. And I think, you know, as we look at the landscape, there are more and more companies and solutions that are working to really break down those silos between health plans and providers and sort of the broader healthcare ecosystem, and working hard to foster better collaboration amongst the people who are actually working for each of those organizations on behalf of the members and the patients. But to truly improve the ability to kind of adequately and holistically care for people, these different organizations need to build a connected ecosystem. And that's providing shared access to those critical member patient data and insights, and offering an easier and more seamless experience and opportunity for members to really engage in their health and navigate the system. There are several healthcare stakeholders and strategies that can work in partnership with plans and really advance equity and access in this holistic care model. Collaborating with risk bearing providers who are paid based on the value of the care that they're providing, and not just the traditional fee for service model, diverse provider networks of federally qualified health centers, IDNs that are committed to providing really holistic care for the uninsured, for Medicaid and Medicare members, and people that are living in rural and urban communities, as Praveen was talking about.
Doug Harris 23:33
Praveen, what are your thoughts here?
Praveen Thadani 23:34
Yeah, I'm probably going to be echoing a lot of what Sandhya has already said. And health plans, from my viewpoint have a very unique ability to really provide the data and analysis necessary to justify investments in interventions. But you and Sandhya are absolutely correct. And you heard me say this earlier, it takes a village. We cannot do this alone. And you know, a we're at a turning point in healthcare where some galvanizing forces are needed. So policy needs to come together and local governments need to come together, the public health system needs to come together. Sandhya said technology. Absolutely. This has to be easy. If we don't coalesce. And if we don't simplify things, if we don't integrate things in our ecosystem, then we're left with the same old same old disintegrated system. Certainly community based organizations for resources, screenings, churches, community groups to provide necessary messaging and space for collaboration. Of course, health systems like us to drive health improvement and promote healthy behaviors and activities. The business community overarchingly is also a very important community, including how employers consume and purchase healthcare as well. So, and even socialization of the business case for addressing health equity, it's going to take all of us the local econ club, the local chambers of commerce, we really have to galvanize around this because this is so important for us moving forward. It fundamentally defines the business viability of the communities in which we live.
Doug Harris 24:53
Absolutely. Thank you, Praveen, I think it's safe to say that COVID-19 has left a lasting impression on all of us. What is the biggest lesson you all personally will carry forward from the pandemic related to health equity. Praveen, what is your main takeaway?
Praveen Thadani 25:05
For me, I love this question. The pandemic has further reinforced, we've always talked about it. But I don't think we've deeply, fundamentally believed it that healthcare truly is local. And if you think about the pandemic, the responses all had to be localized. So healthcare is local is the biggest lesson and one that I never want to de-emphasize in the in the work that I lead. And as Michigan's largest nonprofit health plan, we live work and play in the very neighborhoods that we've been discussing. So truly at Priority Health, it is my responsibility and our leadership team to really reinforce that improving health equity truly is personal, it affects our neighbors, it affects the people that we interact with, and the manner in which we interact in our communities will make a difference. So that fundamental belief that all individuals at a local level deserve the opportunity to be healthy. So moving forward, we must provide the structure and context and the effort necessary to ensure access to health regardless of race, gender, social class, or any other social factors. So for me, the biggest lesson is health care truly is local.
Doug Harris 26:10
Sandhya, let's let you have the last word on this; what will you take away from this time?
Sandhya Gardner 26:14
Well, first off, I love the response that Praveen provided and totally agree with that. For me, as I look at this unprecedented period of time that we've been in, you know, one of the big takeaways is that healthcare is hard and change is slow, but we've got to be open and eager to improve and evolve our system, and really keep the intensity and the focus on reaching health equity, in times of relative stability, and not settle into sort of that complacency or acceptance of health disparities or inertia. Because when you do go through a major stress test, like what we had with the pandemic, we've got to be prepared with strategies and resources in place, so that we're able to withstand it and kind of not put the most vulnerable at even more of a disadvantage. So I guess my takeaway is not being afraid and not delaying or embracing innovation, ways to change and improve the system that we have, you know, whether it involves, you know, virtual care or the next great innovation that's on the horizon.
Doug Harris 27:13
Well, I think that was a great conversation. Once again, Sandhya Gardner is chief medical officer with Wellframe and Praveen Thadani is president of Priority Health. Thanks to both of you for sharing your ideas and experience. It was great speaking with you today.
Sandhya Gardner 27:24
Thank you, Doug. Wonderful to be here. And very great to have the conversation with you, Praveen.
Praveen Thadani 27:29
Thank you. I really enjoyed our dialogue and very much looking forward to having an impact in our communities.
Melissa Turner 27:37
Thank you for listening. We hope you enjoyed today's conversation and learned something too. You can check out SmartBrief's healthcare newsletters by going to SmartBrief.com and hitting the blue subscribe button. Be sure to spread the word and subscribe to the Touchpoints podcast. Finally, a huge shout-out to our friends at the shift.health content network. We'll be back here in a couple of weeks for another episode of Touchpoints.
Doug Harris 28:05
Wellframe empowers health plans to become trusted advocates for members. They believe health plans have the knowledge and resources to support more people across more touchpoints in their health care journey. Wellframe solutions for digital care management and digital customer service empower members and health plan staff to achieve their best in the most wonderful human way possible. Make sure your members feel confident, cared for and supported by their health plan. Don't miss this moment. See how a digital health management strategy would benefit your plan at wellframe.com/touchpoints