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Rolling up your sleeves again may offer you the boost you need for the holidays and start to the new year.

With the spread of COVID-19 continuing to rise, millions of Americans are getting their booster shot as a way to further protect themselves from illness. The Centers for Disease Control and Prevention (CDC) now says Americans 16 and older should get a booster. They are recommended at least six months after receiving the second Pfizer-BioNTech or Moderna vaccine and at least two months after the one-shot Johnson & Johnson/Janssen vaccine.

This time around, people can choose the brand of booster they want to receive based on their preference or what’s most easily available to them. Some may opt to get the vaccine brand that they originally received, while others may prefer to get a different booster. The CDC now allows for this type of mixing and matching of booster shots – and remember that boosters, like the primary COVID vaccines, are free of charge whether you have insurance or not.

Why is it important for many Americans to get a booster now?

According to the CDC, new evidence shows waning protection against mild and moderate COVID disease after people are fully vaccinated for several months. Getting improved immunity is critically important now as we head into the holidays and winter months in which people are much more likely to gather indoors and be near each other.

The new booster recommendations do not mean the vaccine is not working. The two-dose Pfizer or Moderna vaccine, or the one-dose Johnson & Johnson vaccine are still effective at reducing serious cases of COVID — including the Delta variant. They also continue to reduce hospitalizations and death.

In addition, it’s important to note that the CDC still considers someone fully vaccinated two weeks after their second dose of the Pfizer or Moderna vaccines, or two weeks after a single dose of the Johnson & Johnson vaccine.

Where can you get a booster?

The vaccine – both as a booster and as an initial series – is available in health clinics, doctors’ offices and major retail pharmacies, including Walgreens and CVS. Minnesotans are also heading to special COVID vaccine clinics being held at elementary schools, community centers – even the Mall of America (MOA) where the State of Minnesota has created a community vaccination site. MOA is offering vaccinations for 5-11 year-olds, primary series doses to ages 12 and up, and boosters to ages 16 and up. Walk-ins are welcome and appointments can be made here.

The State of Minnesota also recently announced that as part of its Celebrate Safely, Minnesota  campaign, roughly 35 state school-based vaccination clinics for ages 5-11 will begin offering booster shots to parents of children receiving their first or second dose in December and the first week of January. Additional 5-11 vaccine clinics will begin offering boosters as planning continues.

If you have questions about whether the COVID-19 vaccine, including the booster, is right for you, contact your health care provider. To find vaccination providers near you, visit vaccines.gov. The Council has also teamed up with the Minnesota Hospital Association to provide information on childhood vaccinations, including the COVID vaccine, as part of a Best Shot for a Great School Year campaign.

 

MILI Academic Director Pinar Karaca-Mandic

Being a nonprofit health plan means bringing wellness that is in reach for everyone. That was the topic of a recent Medical Industry Leadership Institute (MILI) webinar with Minnesota Council of Health Plans CEO Lucas Nesse, Medica CEO John Naylor and HealthPartners CEO Andrea Walsh. The CEOs, along with MILI’s Academic Director, Pinar Karaca-Mandic, had an engaging conversation sharing the variety of ways nonprofit health plans support the overall wellness of Minnesotans — from maternal and infant wellness to food security and education programs. Watch the video to learn more about how Minnesota’s nonprofit health plans put the community first.

 

By the Minnesota Council of Health Plans and the Minnesota Hospital Association

Just in time for the kids’ holiday break, the Centers for Disease Control and Prevention (CDC) has formally recommended the COVID-19 vaccine for children as young as 5.

The added protection comes at a crucial time as most schools are back to in-person learning and millions of families are preparing for holiday travel and festive gatherings. By choosing to get your children vaccinated – which is free of charge, regardless of your insurance status – you:

The U.S. Food & Drug Administration, which gave the authorization for the shot for kids 5-11, said data show no adverse effects on the children. The vaccine was also found to be nearly 91% effective in preventing symptomatic COVID in this age group.

In an effort to get shots in arms, health plans and health systems are updating their COVID-19 vaccine outreach with specific information for families about how to get their kids vaccinated in Minnesota. For example:

UCare launched a new telephone outreach effort, targeting unvaccinated families with updated COVID-19 vaccine information regarding kids and teens. New messaging and FAQs have also been added to the health plan’s website and social channels. UCare is also sponsoring a series of educational videos translated into multiple languages to reach more diverse Minnesota communities.

HealthPartners is using email and text messaging to encourage families to schedule their children’s COVID-19 vaccination appointment. The organization is also using social and traditional media to promote appointment scheduling and to answer frequently asked questions.

Medica is encouraging childhood and youth vaccinations with information in its member, employer and broker newsletters and on its social media channels. The organization also will provide updates in the COVID section on its website and is planning a targeted email campaign to families with children of relevant age.

Meanwhile, Blue Cross and Blue Shield of Minnesota will utilize its blog as a source of vaccination info, as well as reach out to members via email to support youth COVID vaccinations.

The new vaccine is available in health clinics, doctors’ offices and major retail pharmacies, including Walgreens and CVS. Parents and kids are also heading to special COVID vaccine clinics being held at elementary schools, community centers – even the Mall of America where the State of Minnesota has created a community vaccination site.

If you have questions about whether the COVID-19 vaccine is right for your child, contact your child’s health care provider. Additionally, you can visit the State of Minnesota’s COVID-19 Response page to learn more about the vaccine for kids. To find vaccination providers near you, visit vaccines.gov.

 

By the Minnesota Council of Health Plans and the Minnesota Hospital Association

If there is one lesson we’ve learned about preventable illnesses in Minnesota in recent years, it is this: Don’t mess with measles. Measles is highly contagious and can be serious — even fatal. More than 100,000 people die from measles each year worldwide; most are under the age of five.

The good news: measles is preventable. And with most schools back in session full time and in person, you’ll want to make sure your child is up to date with this important vaccination. Like COVID-19, measles is caused by a virus. The measles vaccine has been around for more than 50 years, and it’s been so effective that the United States declared measles “eliminated” back in 2000.

Unfortunately, measles outbreaks still occur in the U.S. and are on the rise. The year 2019 saw the most U.S. measles cases in the last 25 years. In 2017, Minnesota experienced its worst measles outbreak since 1990, with almost a third of the patients who contracted the infection needing hospitalization.

So, what’s behind these concerning trends? Experts blame myths and misinformation. Here are the facts: Vaccines do not cause autism spectrum disorder, infant immune systems are strong enough to handle current vaccination schedules and there’s no risk of getting measles from the vaccine, either.

Like with several other vaccines, the CDC reported a drop in MMR (measles, mumps and rubella) vaccinations in 2020 compared with previous years, as more Minnesotans reduced participation in preventative care during the COVID-19 pandemic due to stay at home orders, health concerns and other factors.

Without the vaccine, children could be exposed to this highly contagious virus. Among people exposed to measles, studies show 90% will become infected if they’re not vaccinated. Measles is spread through the air as infected people breathe and cough. Measles can lead to pneumonia, brain damage, deafness and even death.

Symptoms of measles typically appear 10-14 days after exposure. Your child might have a fever, dry cough, runny nose, sore throat, inflamed eyes, diarrhea, ear infections and a blotchy skin rash. Often the inner lining of the cheek may reveal tiny white spots with bluish-white centers on a red background.

A Three-for-one
The measles vaccine is combined with vaccines for mumps and rubella (MMR). Children usually receive their first shot when they are 12-15 months old and again when they’re between four and six. In 2020, during the first months of the COVID-19 outbreak, Minnesota health officials reported a 70% drop in MMR vaccinations.

Today, hospitals, clinics and other providers have implemented new safety protocols to reduce the risk of in-person visits. Some providers are choosing certain days of the week for well-child visits, while others are also placing families in exam rooms immediately after check-in to avoid contact with others. Others are using drive-through clinics and specialized outreach programs. For example, many providers are working closely with key stakeholders in Minnesota’s Somali, East Asian and East African communities to share information and answer questions about these important vaccines.

These measures help families access preventive care and critically important vaccinations. Talk to your doctor about the MMR vaccine and whether your kids are up to date on their immunizations. COVID-19 is still with us, which means preventative care—including vaccinations—can help keep families and communities healthy.

 

By the Minnesota Council of Health Plans and the Minnesota Hospital Association

With most schools in Minnesota back in session, your student may finally be settling into that familiar, in-person school experience. That’s no small task, given the challenges families have faced with COVID-19.

But have you also thought about influenza, also known as the seasonal flu? Like COVID-19, the flu can cause serious illness, require hospitalization and lead to death. As kids gather in schools and more activities move indoors as the weather cools, it will be critically important for children, as well as adults, to get their flu shot.

Lesson 1: Impact of Influenza

Most adults and children as young as six months can get a flu vaccine. People most at risk of getting influenza include older adults, young children, pregnant women and those with chronic conditions like heart disease, diabetes, and asthma.

The flu shot, also available in a nasal mist, stimulates the immune system to recognize and attack the influenza virus. The vaccine is updated each year to provide the best match against the current virus strains. Recent studies show a well-matched vaccine can reduce the risk of flu illness by 40-60% in the overall population. Flu season in Minnesota typically lasts from October through March.

Given that COVID-19 is still a threat in Minnesota and elsewhere, getting the flu shot is more important than ever. That’s because hospitals and their intensive care units – many already experiencing an increase in patient visits due to the busy summer season and the COVID Delta variant – would likely be stretched more if influenza became widespread. Experts worried about such a “twindemic” scenario playing out last year. Thankfully, it never materialized, as U.S. flu infections were the lowest ever – thanks in part to the widespread use of masks.  However, there are renewed concerns about a resurgence of the flu and a subsequent twindemic this year, as mask-wearing has declined.

Influenza causes many of the same symptoms as COVID-19, including fever, headache, cough, sore throat, muscle aches and fatigue. In severe cases, the flu can cause pneumonia, bronchitis, ear and sinus infections. People with asthma could have an asthma attack and those with chronic congestive heart failure can be at risk of a heart attack.

But that’s not all. The flu can also weaken your body’s immune system, which could make you more vulnerable to COVID-19.

Lesson 2: Kids and the Flu Vaccine

So, are kids getting their flu shots? According to CDC estimates, just over 66% of children between the ages of six months and 17 years received vaccinations during the 2019-2020 flu season. That’s up from 62% two years earlier, but it still means more than 30% of eligible children are missing out. The good news? The flu vaccine is considered preventative care, which means it’s usually covered by your health plan through an in-network provider at no cost to you.

Flu shots are also widely available. You can visit your regular doctor, or you can get it at most pharmacies, clinics, retail clinics, public health offices – even many dental offices and workplaces.

Still on the fence about the flu shot? Maybe these facts will convince you to roll up your sleeve:

Talk to your doctor about the flu vaccine and whether you and your kids are up to date on this vital immunization. COVID-19 is still with us, which means preventative care – including flu shots – can help keep families and communities healthy.

 

By the Minnesota Council of Health Plans and the Minnesota Hospital Association

With COVID-19 transmission among students being a top concern this school year, it’s imperative that parents do their homework to give their kids the tools they need to stay protected.

According to the Centers for Disease Control and Prevention (CDC), this means getting kids 12 and older their COVID-19 vaccine. While fewer children have been stricken with COVID than adults, kids can still be infected with the virus, become ill from COVID, as well as transmit it to others, the CDC reports.

The CDC recommends the COVID vaccine for both kids 12 years-plus and adults, as immunization is key in protecting against serious illness and ending this pandemic. Children 12 years and older are able to get the Pfizer-BioNTech COVID-19 Vaccine. Clinical trials are underway to evaluate the safety and efficacy of vaccines in younger children. Pfizer and BioNTech recently announced that the COVID vaccine is safe and appears to generate a strong immune response in a clinical trial of children 5 to 11. This age group may be eligible for vaccination by the end of the October.

Getting kids their COVID vaccine is especially important now, as pediatric hospitalizations are reaching record numbers nationwide. And with most schools going back to in-person learning, doctors and health officials fear that hospitalizations among kids may increase as the new Delta variant could drive COVID transmission higher.

The CDC says that parents should get a COVID-19 vaccine for children 12 and older as soon as they can. Some facts you should know, according to the CDC’s COVID-19 Vaccines for Children and Teens page, include:

COVID-19 shots are also widely available. You can visit your regular doctor, or you can get it at most pharmacies, clinics and retail clinics and other locations. The State of Minnesota COVID-19 Vaccine Connector is another tool that helps Minnesotans find out when, where, and how to get a COVID-19 vaccine.

Also remember that health plans cover the COVID-19 vaccine without charging members a copayment or coinsurance.

Talk with your doctor about getting your kids the COVID-19 vaccine as well as making sure they are up to date with their other immunizations. Staying healthy and protected against preventable illnesses will help ensure your child’s success!

 

By the Minnesota Council of Health Plans and the Minnesota Hospital Association

School’s back in session, and if you are like most parents, your kids are starting the year with full-time, in-person learning for the first time in what seems like forever.

As we continue to battle COVID-19, it’s become increasingly important for students to be caught up on vital immunizations. This includes vaccines that can protect them from COVID-19 if they’re 12 or older, as well as other immunizations that can guard kids of all ages against serious illnesses.

According to the World Health Organization (WHO), 23 million children missed out on basic childhood vaccines in 2020, the highest number since 2009 and 3.7 million more than in 2019. Up to 17 million children likely did not receive a single vaccine last year, reports the WHO. Here in Minnesota, a June CDC report also showed significant drops in several vaccines for young children.

As a result, children and some adults are missing some of the most important and beneficial vaccines of our time, including the measles, mumps, and rubella (MMR) vaccine; the flu shot; vaccines for polio, chickenpox, and whooping cough; and the COVID-19 vaccine. Now, with Minnesota schools back in session and the COVID-19 Delta variant still a major threat, the race is on to make up for lost time.

Minnesota health care systems and nonprofit health plans are taking extensive and innovative measures to ensure that vaccinations are easier and more accessible for everyone as we continue to endure this pandemic. They are using every viable communications tool – from telephone to Twitter – to encourage families to get back on track with vaccinations.

Many of these efforts started over the summer, but they take on even greater urgency now that students have returned to their classrooms. Catch-up strategies like these will help reduce the risk of an outbreak of a vaccine-preventable disease. Also remember that health plans cover recommended immunizations without charging members a copayment or coinsurance when provided by an in-network provider.

So, if you haven’t done so, talk with your doctor about getting your kids up to date with their vaccinations. Staying healthy and protected against preventable illnesses will help ensure your student’s success this school year!

For Natasha Smith, Head of Diversity, Equity & Inclusion at Sanford Health, equity has always been personal. From a family of Mexican-American immigrants, she understood from a very early age what a difference equitable systems make for vulnerable populations. Natasha has used this life experience to help build the processes and systems necessary for Sanford to be the premier provider of equitable health care in rural communities. The Council recently caught up with Natasha to learn more about the health equity journey at Sanford.

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QUESTION: How long have you been with your organization and what’s been your journey to your role?

ANSWER: I have been with Sanford Health since March, coming to the organization with a background in corporate social responsibility and corporate philanthropy. Prior, I oversaw the philanthropic efforts of the Wells Fargo Foundation for a few states here in the Midwest and much of that work was centered around nonprofit partnerships that provided programming that benefited marginalized communities. I worked to create leadership buy-in and a strategic plan to shift the organization from ‘check writing’ to ‘problem solving’; cultivating and supporting grassroots, BIPOC-led initiatives to combat systemic inequities. Coming from a family of Mexican-American immigrants myself, I understood from a very early age what a difference equitable systems and focuses make for underserved and under-represented populations. I’m excited to be in the health care space now, focusing on equitable outcomes in our workforce and in our communities.  

Q: Disparities in health care have always existed, but in your view, how have recent events – like the COVID-19 pandemic and the murder of George Floyd – impacted health equity work and where it is headed?

A: I believe that the pandemic exacerbated existing disparities and accelerated the need for organizations like Sanford Health to expand response. It was important for us to partner with organizations outside our walls to reach patients and provide care how and where they felt comfortable receiving it. We know that the pandemic has not impacted all populations equally, and as such, not all populations will rebound equitably. Demographics that had existing barriers to employment, quality child care, access to food and transportation were disproportionately set back by the COVID-19 pandemic. After social uprising in 2020, employees who previously may not have been directly involved in equity work are increasingly reaching out to ask how they can be a part of the solution within our organization and in their communities. There is ample opportunity for us to seize this moment and enhance education and awareness as a trauma-informed organization. Additionally, public health work has taken a main stage as we work swiftly to educate these disproportionately impacted populations on the safety and efficacy of the COVID-19 vaccine and continue to encourage folks to seek routine, preventative care amid this uncertain time.

What are some of the biggest barriers you see in delivering equitable care and what are steps that health plans can take to better connect with BIPOC communities?

A: There are barriers to accessing care such as transportation and interpreter services that health care organizations can continue to work at combating. Sanford Health Plan as the MCO for North Dakota Medicaid expansion, has been providing transportation to Medicaid recipients to lower barriers and increase access to care.  Allocating appropriate resources to interpreter services and increasing intercultural awareness at the point of care will increase the trust we build in BIPOC communities. We are working to expand commitment to understanding social determinants of health to address the social conditions that produce patterns in health equity, and this really starts with educating our workforce on the importance of collecting this data and building trusting relationships with our communities of color and other marginalized demographics.

Q: What specific initiatives (committees, taskforces, work groups, cabinets, etc.) have been created at your organization to address health equity? And given these initiatives, what progress has been made in terms of making care more equitable?

A: At Sanford Health, one initiative that I can share focused on maternal-fetal outcomes by combating anemia in pregnancy. We found that access to iron rich foods and gaps in resources for iron supplements increased risks of post-natal hemorrhage, particularly with our Native American populations. Additionally, we are looking to increase awareness and education around inclusive health care as we work with the Transformation Project, a South Dakota based nonprofit serving the transgender population to provide a joint summit. This summit will focus on being an inclusive health care provider and improving outcomes in the LGBTQ+ community by driving comfort and inclusivity at the point of care. In late 2020, Sanford Health also provided a $3 million donation to Feeding South Dakota and other rural food banks across the Minnesota footprint to combat food disparities amid the pandemic. We are finding such passion in our markets around this work from our clinicians and leaders.

We have also increased focus on identifying and addressing social determinants of health and launched initiatives in our markets to build a partnership with food insecurity organizations to meet our patients’ needs beyond the medical needs that present themselves in our clinics.

Q: What role do you see partnerships (with the community, with the state, with others in the health care ecosystem, etc.) playing in advancing health equity efforts?

A: As mentioned above with the Transformation Project, partnering with nonprofits serving marginalized communities is key to building sustainable relationships that drive trust and allow our organization to take on a problem-solving role in our communities.

Q: What role does organizational culture and diverse staffing play in health equity? How can health plans use cultural competencies to improve health outcomes?

A: We know that when our workforce represents the diverse communities that care is provided in, health outcomes for diverse communities improve. Having diverse representation in our care providers and other patient facing roles is critical to achieving quality of care for BIPOC communities. Additionally, working to staff our organization holistically, in a way that reflects the community, creates a sense of belonging and loyalty. When everyone sees the organization as a place to thrive and build a career, we are enriching our community and increasing access for our employees to reach their full potential.

Q: Distrust in the health care system continues to be a huge challenge when it comes to health equity, which has been laid bare by lower COVID vaccination rates in communities of color, but impacts other care, also. How do we rebuild trust in BIPOC communities?

A: I think we touched on many of the key initiatives that can drive trust in our communities, to include BIPOC communities. Partnering with organizations that serve under-represented populations, building a workforce that represents the unique communities we provide care, and taking exceptional care of our care providers are all ways we can work to systemically build trust in our backyard and be the premier provider of health care in rural communities.

Bukata Hayes

Bukata Hayes, Vice President of Racial & Health Equity for Blue Cross and Blue Shield of Minnesota, has spent two decades advocating for racial and social justice. His role at Blue Cross was specifically created to serve as an advisor and partner, helping leaders identify and execute initiatives to effect lasting change and apply a racial and health equity lens to every aspect of the organization. The Council recently caught up with Bukata to get his thoughts on the health equity journey at Blue Cross.

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QUESTION: How long have you been with your organization and what’s been your journey to your role?

ANSWER: I joined Blue Cross and Blue Shield of Minnesota as Vice President of Racial & Health Equity at the end of March. My work with diversity, equity and inclusion has spanned 20 years in systems large and small, including the nonprofit sector, K-12 schools, higher education and rural communities. And while I just recently reached the official 90-day milestone at Blue Cross at end of June, I’m no stranger to the organization as I’ve been active with the board of directors for the Blue Cross and Blue Shield of Minnesota Foundation since 2014.

My parents have had a tremendous influence on my journey.  My father was a pro-Black civil rights activist with a strong commitment and connection to community. And my mother modeled endless strength and persistence, even on the loneliest of roads. My mom was the only black woman in her classes to become a respiratory specialist. My parents believed in leading with humanity. And throughout my career, I’ve often been drawn to organizations and initiatives in their infancy and advocating for causes long before it was trendy to be having those conversations.

Before coming to Blue Cross, I served as the executive director of the Greater Mankato Diversity Council since September 2006. Before that, I served as the coordinator of the Multi-Ethnic Center at Bethany Lutheran College in Mankato, the first-ever position of its kind at the college. I’m also involved in numerous community and civic organizations, including the Mankato Chapter of the NAACP (executive committee); the Martin Luther King Jr. Commemorative Board, Mankato (president); the Steering Committee for Police Reform, Mankato; Mayo Clinic, Mankato Hospital Board; and the Blandin Foundation Board of Trustees.

Q: Disparities in health care have always existed, but in your view, how have recent events – like the COVID-19 pandemic and the murder of George Floyd – impacted health equity work and where it is headed?

A: We can no longer not center race in health equity work. Historical exclusion based on race has woven complex, systemic problems that can only be effectively addressed by looking through that same lens. COVID-19 laid bare the consequences of persistent inequities.

George Floyd’s murder, death by asphyxiation due to a knee on the neck, was in many ways the physical manifestation of the figurative existence of Black and Brown folks in this state, making it clearer than ever that we need to address and uproot what we have allowed to happen in our society. We must continue to acknowledge the historical roots of such tragedies and commit to undoing the residuals of systemic racism within our organizations, institutions and communities. And not just within policing, but in every corner of American life from health care to housing to income and more.

Responding to the symptoms hasn’t solved anything. The ground is fertile to focus on upstream issues and true systems change. As part of our overall business strategy, Blue Cross has made racial and health equity a blue chip, creating an enterprise-wide Racial and Health Equity Plan.

The plan’s central tenants are to:

Q: What are some of the biggest barriers you see in delivering equitable care and what are steps that health plans can take to better connect with BIPOC communities?

A: The growing linguistic and cultural divide is perhaps the most visible barrier in health care. We need to embed language access in a way that helps people navigate the complexities of health care.

Core to the larger problem is our lack of understanding of both the historical roots of inequities as well as the full range of complicit behaviors that have allowed inequities to persist. We can’t change what we don’t confront or don’t fully understand. Health plans need to connect and partner with BIPOC communities, engaging in the gray area even when it’s uncomfortable and the path forward is uncertain. It’s vital that we approach these conversations with the full humility that we alone don’t have the answers.

Q: What specific initiatives (committees, taskforces, work groups, cabinets, etc.) have been created at your organization to address health equity? And given these initiatives, what progress has been made in terms of making care more equitable?

A: A central component of Blue Cross’ antiracism pledge was to listen to and learn from Black, Indigenous and communities of color (BIPOC communities) about how racism impacts health outcomes, what Blue Cross can do dismantle systemic racism and how the organization can work in solidarity with BIPOC communities to create a healthier and more equitable future.

Working Marnita’s Table to conduct a listening tour this past year has been powerful. Marnita’s table is a Twin Cities nonprofit dedicated to closing gaps across differences by amplifying the voices of BIPOC communities, the economically disadvantaged, LGBTQ+ and others left unheard in policy and community decision making.  In total, we connected with 150 community members and what we learned helped us identify priorities so we can make changes where it is most needed.

Based on the feedback participants provided, six key priorities for Blue Cross to consider emerged:

We have also taken a stand against systematic discrimination in our health care system on behalf of our transgender and non-binary members. Since 2016, Blue Cross has dedicated significant resources to establishing a new standard for excellence in transgender care and service. We refined our benefit and policy communications to ensure they offered clear guidance on gender-affirming services available to our members. We made our written and spoken language to members more inclusive, meaningful and respectful of the LGBTQ community.

Blue Cross also created the role of gender services consultant to provide personalized, affirming guidance to our transgender and non-binary members and their families, helping them navigate care and coverage questions, connecting them to health plan benefits and helping them find the right doctor.

Q: What role do you see partnerships (with the community, with the state, with others in the health care ecosystem, etc.) playing in advancing health equity efforts?

A: The community has the answers. The only way forward is to share power and partner. Being part of the solution requires a humble posture cognizant of how we contributed to the problem and then lifting up the solutions identified. Because of the sheer number of Blue Cross members in our state, we can often play the role of a convener, drawing organizations to the table where we can make progress together.

Q: What role does organizational culture and diverse staffing play in health equity?

A: Who we are as an employer is directly connected to our ability to impact health equity more broadly. Working to get it right on the inside allows us to show up genuinely with our stakeholders, opening the door to mentor or be mentored since we’re on this journey together. My role was specifically created at Blue Cross to serve as an advisor, bridge builder, strategic leader and partner, supporting leaders across the organization to identify and execute initiatives to effect lasting change and apply a racial and health equity lens to every aspect of the organization.

Q: Distrust in the health care system continues to be a huge challenge when it comes to health equity, which has been laid bare by lower COVID vaccination rates in communities of color, but impacts other care, also. How do we rebuild trust in BIPOC communities?

A: The roots of health care system distrust are deep, emanating from the history of medical malpractice against Black and Brown people in this country. From experimentation on enslaved women without anesthesia, to more than 3,000 American Indian women being involuntarily sterilized by the Indian Health Service, all the way to Henrietta Lacks whose cells have enabled more than 70 years of medical research and advancements even though those cells were cultivated without her consent.

Resolving centuries of distrust takes time, transparency, and consistency. However, such distrust is not solely down to historical trauma. Our ongoing contemporary issues with systemic racism, discrimination and unequal access to quality health care actually threatens to be the bigger barrier to overcome for many BIPOC communities as that is their lived experience. That is why it is crucial we build relationships and are transparent and accountable to the communities, sharing resources, power, and building our own cultural competencies to be better advocates and providers of health. And this has to be the norm, not just when there is a global pandemic, and vaccine to distribute.

 

 

Dr. Julia Joseph-Di Caprio

Through their work together at UCare, Dr. Julia Joseph-Di Caprio, Chief Medical Officer for UCare, and Pleasant Radford, Jr., Health Equity Officer for the health plan, are creating bridges that will bring about better care for diverse populations. The health plan is looking at everything from provider engagement to their internal functions to ensure health equity for members. The Council recently caught up with Julia and Pleasant to get their perspective on UCare’s health equity journey.

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QUESTION: How long have you been with your organization and what’s been your journey to your role?

ANSWER: Julia – I’ve been with UCare since 2018 as SVP and chief medical officer. My health equity journey started even before I went to medical school in that I recognized early on that caring for people is connected to the way in which they live. Then as I went through medical school and began working at Hennepin County Medical Center, now known as Hennepin Healthcare, we knew that our work would only be successful if we address more than what was happening in the clinical context. It has only been more recently that I and many others have understood that structural racism (racist policies, procedures, systems) causes disparities in care and outcomes. Also, at UCare, we are fulfilling our role in addressing the social drivers of health and anti-racism within our work and with our provider partners.

Pleasant – I’ve been at UCare as the Health Equity Officer since 2020. I have always been fascinated at the fact that the United States spends a lot of money on health care, but our health outcomes are not much better than many other countries. My interest in health care began as a child because my mom was nurse, and so I got a chance to see her love for that work and the empathy she had for the patients she treated. My original plan was to be a medical doctor, but then I decided to take some time off before going to medical school to explore the world. Peace Corps was that opportunity. In that, I learned so much about public health. I realized in that small time that community plays a huge role in your health. I decided after that to focus more on the public health side instead of going to medical school. The jobs that I’ve had have really been a connective thread across that. Now, in my role at UCare as the Health Equity Officer, I’m leading this work to ensure that we are thinking of health and racial equity at a systemic level by working with and for communities to address their needs.

Pleasant Radford, Jr.

Q: Disparities in health care have always existed, but in your view, how have recent events – like the COVID-19 pandemic and the murder of George Floyd – impacted health equity work and where it is headed?

A: Pleasant – What we saw was greater cognitive dissonance between the idea of America and the reality of America. Many of us believe that America is the land of the free – that it is just, fair, and equitable. In fact, what we saw last year was the reality that America is not just, fair and equitable for everyone. I believe the murder of George Floyd served as the pinnacle where people realized: “I cannot believe that this is America.”

With COVID-19, people really saw the frailty of our health care infrastructure and how important public health is to improve the health of our communities. The pandemic allowed people more time to practice introspection and decide on what we need to change this. Both of these events – COVID-19 and George Floyd – impacted health equity because people now see how structural racism is a root cause. It is important for us to see the role that racism plays in healthcare, the role we play in enabling that system, and how we can start to change that system – the policies and procedures – to achieve health equity for all.

Julia – It wasn’t enough for people to say they were suffering from structural racism. People had to see someone murdered on camera before people would say “this is a thing.” I do believe the pandemic and its disproportionate effect on folks did advance the cause of addressing the structures that drive these impacts. I think the impact of the murder of George Floyd did accelerate things. I think our challenge now is to make this work even more sustainable over time. What I also reflect on is that, even for organizations like UCare that has years of partnerships with communities, some leaders are asking us about our commitment. We have to go with humility and recognize that many people have been advocating and doing this work for years, and we have to make sure that we take our direction from them. I also think we must honestly say that this is a curved path and there will be retrenching. I think we must recognize that even with all that happened over the last 15 months, we are not a point yet where this work is sustainable, and we need to build sustainability.

Q: What are some of the biggest barriers you see in delivering equitable care and what are steps that health plans can take remove those barriers and better connect with BIPOC communities?

A: Julia – I’ll speak to some of our core health plan work as it relates to ways in which we can remove barriers. For instance, with our work with providers, we will expect improvements in advancing health equity. I can see plans continuing to evolve and deepen that work including requirements around the diversity of the workforce in our partners. I could see core health care functions used to drive health equity.

Pleasant – Trust. I cannot emphasize that enough. There is a lack of trust in the health care system. That’s a huge barrier. If you are not able to trust the providers and the health care system to help in your journey toward optimal health, then it becomes difficult to stay healthy. Another part that I think is important to state is that health equity is a process and an outcome. We never completely “arrive” at health equity. We are constantly learning and re-learning. One barrier is that we often see it only as an outcome – we don’t respect the process that it takes to get there. You are going to make mistakes along the way. It is important to acknowledge those mistakes, say you’re sorry and continue to grow.

Q: What specific initiatives (committees, taskforces, work groups, cabinets, etc.) have been created at your organization to address health equity? And given these initiatives, what progress has been made in terms of making care more equitable?

A: Given the large number of members UCare serves who are most at risk of facing inequity, this work is embedded across many work groups, committees and subcommittees throughout UCare. 

Q: What role do you see partnerships (with the community, with the state, with others in the health care ecosystem, etc.) playing in advancing health equity efforts?

A: Pleasant – Partnerships are extremely important. It was one of the main reasons why I joined UCare. We have such a strong history of partnerships with the community. As I think about health equity, partnerships are the foundation of that. I believe partnerships help evolve and broaden our reach to strengthen our impact. As organizations, we see things through a certain lens, but it is not the only lens that will solve a problem or create a solution. Partnerships are key so that we leverage the unique assets and strengths we have to offer. They also allow us to contextualize health care and health equity within communities so that we better understand what is the right solution to reach optimal health. Partnerships teach us humility. We don’t know everything, so they allow us the learning and dialogue that must take place. Ultimately, our partnerships make us stronger in our work.

Julia – Some examples of partnerships include our work with the Minnesota Medical Association, funding their initiative to improve health equity, and Stratis Health, funding their work on their Culture Care Connection website. It is designed to help health care professionals by providing tools and resources to help them be responsive and supportive of the diverse patients they serve.

Q: What role does organizational culture and diverse staffing play in health equity? How can health plans use cultural competencies to improve health outcomes?

A. Pleasant – Organizational culture is so important. It undergirds how we operate, think and create policies, processes, and procedures for employees. As we think about health equity and culture, it’s important that our culture reflects the communities that we serve. We have to ensure that we have the right people in the right conversations to make the right decisions. When we make the wrong decisions, it costs time, money and lives. A diverse staff improves our work, our culture and the health of our employees and members.

Julia – The COVID vaccination development is a prime example of how quickly systems were able to adapt to the pandemic and provide care using significant technologies like ECMO and other things. That makes what happened last year so stark. You wonder if people brought the best thoughts to bear around the social drivers of health and advancing racial and health equity, would last year had been such a disgrace? Because that came from years of not addressing what we knew needed to be addressed. We need to bring the best minds to bear, which means diverse thinking, like we have for other health issues. If we brought that same thinking to bear in terms of advancing health equity, we would be able to solve it.

Q: Distrust in the health care system continues to be a huge challenge when it comes to health equity, which has been laid bare by lower COVID vaccination rates in communities of color, but impacts other care, also. How do we rebuild trust in BIPOC communities?

A: Pleasant – We have to combat a deficit-based mindset. If all you see are the stereotypes of an individual or community versus looking at them from an asset-based perspective – in the sense that they have a lot to offer and we can learn a lot from them – this will be a barrier. We have to ask ourselves: How can I be humble and engage in a dialogue with this person so we can offer equitable care? It will be important to take those steps so that we can continue to build that trust in our communities of color.