Delivering on the Promise of Health Equity in Inequitable Times

Pregnant person looks at smartphone

Where a person lives, learns, works, and plays can account for as much as 80% of their health outcomes. These social determinants of health (SDOH) form the backbone of health and wellness, and CommonSpirit Health, the largest nonprofit health system in the United States, understands that better than most organizations. Health equity is core to CommonSpirit Health’s mission, particularly to the idea of improving the health of the people they serve, especially those who are vulnerable. But it’s no short order.

Operating more than 130 hospitals across 21 states, CommonSpirit Health brings an empathetic approach to care with the goal of addressing the needs of underserved populations and improving health equity. To navigate this clinical care transformation, the health system is leveraging digital health technology, including some tools many people might find familiar.  

Goal: Navigating with empathy to improve health equity

CommonSpirit Health and GetWellNetwork’s Docent Health have partnered since 2016, and one of the key aspects of the work we do together is collaborating to lower barriers to engagement. Accessing health information should be intuitive and — perhaps most important — convenient. Important components of reducing barriers include:

  • Engaging broadly: Using the most widely used channel of communication allows for the greatest reach into a community. SMS messaging is accessible to anyone with a cell phone, doesn’t require a data plan or Wi-Fi, and is used by nearly 100% of the population. 
  • Delivering empathy: Starting from a position of understanding, particularly in communities where there are systemic barriers to healthcare or historical mistrust, can help garner greater engagement. 
  • Augmenting technology: Technology alone won’t reduce barriers to engagement. Deploying community-based navigators who are reflective of the communities and culture can help bridge important gaps in outreach to underserved communities and can help establish trust. 

Community-based navigators guide patients through the complex health system and direct people to community resources, preparing them and educating them on health topics. These navigators can help screen people for SDOH and for mental health, referring them to services that are either part of the health system or that may be available in their communities. The navigator foundation is for all people but it becomes extremely important when trying to reach underserved populations.

When using navigators to address SDOH, empathy is particularly important. A person’s SDOH are their lived experience. Those determinants are the things that they are dealing with on a day-to-day basis, so conversations around those concerns must be thoughtful and appropriate. 

Similarly, when introducing a digital technology that is meant to focus on an underserved population, attention must be paid to ensure the technology can and will be used by the intended audience. Using SMS is one way to address challenges to digital access and digital literacy

Goal: Achieving health equity in outcomes

The COVID-19 pandemic placed a spotlight on health inequities, but many people within the healthcare industry were not surprised. What is happening with COVID-19, where minority populations are seeing disproportionately higher rates of COVID-19 infection, hospitalization, and death, isn’t any different than what is seen across other areas, such as maternity outcomes. Black and African-Americans are more likely to die during pregnancy than those in all other racial/ethnic groups.

Engagement studies have demonstrated that communities of color don’t engage with services as high as other populations. With this in mind, CommonSpirit Health focused on use of community navigators in addition to the digital technology component of its work with Docent Health to ensure patients were engaged with its services. 

The result: As of August 2020, more than 10,000 birthing people have received outreach since the program launched in December 2020. CommonSpirit Health saw similar bidirectional engagement among all people engaged, with a 66% engagement rate. Black and African-American people also have a 66% engagement rate, while Hispanic people have an even higher engagement rate of 72%.

Outcomes for improving health equity

According to Dr. Alisahah Cole, System Vice President of Population Health Innovation and Policy at CommonSpirit Health, these positive results stem from strong, effective in-person community support and the commitment to hire people from the communities that they are serving. 

Goal: Leveraging SDOH data to address health inequities 

Navigating the healthcare system can be complicated, even if resources are readily available. But if a patient does not have easy access to resources, the challenge is amplified. Innovation and technology — and the data that enables — can help make the care delivery system more accessible and easier to navigate. 

SDOH — those non-clinical factors that affect a person’s health — have a significant impact on health outcomes. Digital technology helps providers to efficiently and effectively collect SDOH data to improve care delivery.

A technology platform like Docent Health enables healthcare systems or providers to connect with patients over time and build a 360-degree profile of each individual patient. This can include screening for SDOH, mental health needs, community needs, and personal preferences. The data collected establishes an understanding of where a patient lives and can inform as to whether they are at a higher risk from a SDOH perspective. 

With a holistic understanding of who the individual patient is and what resources or services they need, a patient can be connected to the right resources, digital applications, clinical services, or community services at the right time. This could mean connecting them to a pediatrician, to a portal, to a food or housing service, or a doula program depending on their needs. Docent Health’s platform is designed to increase health literacy and self advocacy, connecting patients to the resources that deliver better health outcomes. 

CommonSpirit Health also uses this SDOH data to help drive business decisions. For example, if there is a significant number of patients screening positive for food insecurity, the health system can partner with and invest in organizations that are addressing food insecurity. Establishing those community partners is key to successfully addressing the evolving needs of all communities and especially in traditionally underserved communities. 

With the shift to value-based care, providers — along with health plans and health systems —must change the way they approach care delivery. People often have barriers to achieving their best health, and under a value-based care system, payment is based on the health of a patient. 

Using digital technology and artificial intelligence can help health systems understand the patient and the community where they live and then provide them with the appropriate resources or services.

The bottom line

Although there is no question that all health organizations believe improving health equity is important, getting leadership buy-in and engagement is critically important. But it’s worth it. The results speak for themselves — engaged patients, those that feel their needs are being both heard and met, are also those that begin to trust providers and seek out further care when needed, improving health outcomes on a patient and population level.

There is also a financial imperative to consider. Health disparities cost this country approximately $93 billion in excess medical care costs and $42 billion in lost productivity per year, according to the Kaiser Family Foundation. It’s not financially sustainable to continue to deliver care the way that we do right now. The cost of not addressing health equity is far more expensive than any line item in a program like the one implemented at CommonSpirit Health and other organizations across the country.

From improving health to lowering costs, an investment in health equity is an effort worth making. The partnership between CommonSpirit Health and GetWellNetwork’s Docent Health is a good example of using digital health technology — along with the human element — to do just that. 

Learn more about how hospitals and health systems can use technology to improve care quality and access for all in our on-demand webinar, Serving the Underserved: A Conversation with CommonSpirit Health about Equity in Healthcare.