Minnesota’s nonprofit health plans are placing a renewed focus on health equity, recognizing how pervasive health disparities are in our state. Health plans are looking at everything from workforce diversity and training to ways in which they can better deliver care and access to communities of color. Over the next few weeks, the Council will be highlighting their efforts through Q&A interviews with health plan leaders. We start with Cara Broich, Medica’s Senior Director of Quality and Clinical Advancement.
QUESTION: How long have you been with your organization and what’s been your journey to your role?
ANSWER: I have been with Medica for 29 years. Prior to working for Medica, I was a Cardiovascular ICU nurse. Throughout my tenure at Medica, I have worked in various roles focused on quality and population health. My role in health equity came naturally out of my interest to improve the health of our members and communities. I lead the Health Equity Workgroup and Health Equity Leadership Subgroup at Medica.
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: Although health inequities have always existed, the COVID-19 pandemic and the murder of George Floyd took our focus on these inequities to another level. Now it is much easier to get the support needed to move initiatives forward. On one hand, it is disheartening to realize that it took a video recording of a man’s murder, and a pandemic, to really enable us to gain traction on these initiatives.The level that our initiatives have been elevated to, and the support we have received from across the organization, and our board, has been overwhelming. I am excited to see how our work will address health inequities in our community.
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: There are multiple issues that hinder the delivery of equitable care. One of the biggest is that the medical community hasn’t focused on it. Historically, most medical studies were conducted on white males and medical guidelines were developed around those studies. We need to take a step back and look at guidelines and policies with an equitable lens. When we find that a guideline, policy, or practice has directly or indirectly contributed to the development of a barrier, we must take action and make changes. Where changes are made, our BIPOC community leaders will need to be informed about how the changes may have a positive impact on our diverse citizens. We must show that we are taking action in order to gain the trust of members of communities who have been marginalized for generations.
Another barrier is the availability of data. We do have race, ethnicity and language data for our Medicaid population, however for the Commercial, Medicare and individual business, data is extremely limited. This forces us to use generalized data from other sources. To truly be able to improve care, we need to be able to measure what is going on within a population and then work in partnership with the BIPOC community to address the issues. Connecting with community organizations is truly the key to improving care. Medica has hired staff to focus on community partnership, but again, the data is lacking for non-Medicaid populations. I can use data to identify the issues, but it is critical to work with the BIPOC community to develop ideas on how to address the issues. Only in partnership can we improve health inequities.
Q: What specific initiatives (committees, taskforces, workgroups, 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: Medica formed a Health Equity Workgroup in June of 2020. The workgroup is focused on Medica’s Health Equity mission to assist our members in attaining their highest health potentials. We are committed to health equity, which holds that no person be disadvantaged from achieving their potential, as a result of barriers. We consider the many characteristics that make people unique – such as race, ethnicity, gender, sexual orientation, abilities, age, socioeconomic status, or veteran status – because any of these differences may be the basis for disparities in health care access, experience and outcomes. The workgroup is made up of people from across, and at all levels, of the company. The principles and commitments that guide our health equity work align with four areas of focus; they include:
- Leadership and decision-making
We will seek diversity in our representation and engagement to guide our work and decision-making at all levels of Medica, including our work group and leadership activities, and in our decision-making, policy and program development.
- Data practices
We will expand our data collection efforts, where appropriate, to guide necessary health equity interventions and evaluate our health disparities reduction efforts.
- Policies and procedures
We will examine our policies using an equity lens and make policy changes needed to promote equity, reduce health disparities, and eliminate barriers or unintended impacts on historically underrepresented and/or marginalized groups.
- Access and outcomes
We will review and develop policies and care models that improve access to care and community resources that meet our members’ diverse health-related social needs and preferences.
We decided to start by taking a tactical approach to health equity and have addressed many small areas first:
- Volunteered our staff to the Minnesota Department of Health to complete contact-tracing phone calls during the height of the pandemic.
- Reached out to our membership groups that were most affected by the pandemic to ensure they had their needs met and provided resources if necessary.
- Expanded the scope of our Network Access and Availability committee to ensure Medica offers sufficient, equitable and culturally competent provider access and availability across the member demographic groups it serves.
- Expanded the Quality Improvement and Care & Utilization Management committees to include a focus on health equity.
- Added specific health equity goals to both the Quality Improvement and Care & Utilization Management 2021 work plans.
- Developed a health equity rubric to evaluate Medica’s policies and procedures to ensure they are not hindering health equity. As policies come up for review, we are using the new tool to conduct the evaluation.
- Conducted a deep dive into the diagnosis of hypertension to test new data related to social determinants of health, race, ethnicity and language. This enables us to not only focus on a common disease state, but also test out new data sources. We are in the process of developing interventions based on our findings as well as expanding our data collection sources.
- Modified the criteria used in Medica Foundation grant process to further expand the evaluation of proposals based on their impact to health equity.
- We are partnering with a clinic that serves mostly underserved populations to assist them in their COVID-19 vaccine efforts by providing volunteers.
- Following the murder of George Floyd, we reached out to our members who lived in affected communities to assist them in obtaining health care and prescriptions.
- Reached out to our Medicaid enrollees to assist them with scheduling COVID-19 vaccinations and arrange for transportation.
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: No one organization can solve the problems, however, if we work in partnership we will be able to work toward a solution together. These are very complex issues that involve all aspects of health care; from the way medicine is practiced to social determinants of health to trust issues. Through partnership with the State, health plans, providers and community organizations, we will make progress.
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: Organizational culture and diverse staffing play a very important role in health equity. It brings forward diversity of ideas and opinions that lead to better, more equitable decisions. In an effort to reduce health disparities, you must truly understand the diverse communities that are impacted. The best approach to understanding these communities is to immerse yourself in their culture and allow that culture to weave itself into the fabric of the company’s practices, policies and behaviors. Employee cultural competency plays a critical role in improving health equity. It allows staff to understand where various members are coming from and what needs they may have. It allows for empathy. It also emphasizes that diversity of experience and ideas is a good thing, which leads to creative problem solving.
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: Truly partnering with the BIPOC community is critical. We need to work with the trusted organizations within each of the communities to improve health equity. This needs to be a true partnership – not the health care system telling them how to solve the problems but really listening to their needs and working together to solve the issues. We must acknowledge how the mistrust has developed, own our contributions to its evolution, and take strides to gain the trust that we will need to be successful. We all must realize that this trust must be earned and may not be easily obtained. We must commit to taking action based on what we hear from our BIPOC communities.