You Asked, We Answered: Equity in Healthcare

During our webinar, Serving the Underserved: A Conversation with CommonSpirit Health about Equity in Healthcare, Dr. Alisahah Jackson, System Vice President Population Health Innovation and Policy at CommonSpirit Health, and Royal Tuthill, General Manager of Docent Health at Get Well, discussed how digital technology augmented with community-based navigation services can help effectively engage patients and improve health equity.

We were unable to get to all of the audience questions, and so we’d like to take this opportunity now to follow up and provide more in-depth resources.

Scaling this approach

Q: How can organizations scale this approach to addressing health equity across multiple sites and across so many touchpoints? How do you leverage multiple data sources? 

A.The partnership between CommonSpirit Health and Get Well’s Docent Health was built to be scalable from the beginning. From working with the enterprise to set up ADT and an SIU feed — the live feed from the EMR system into the Docent Health system — to sending out a standardized approach from all 12 facilities every day, the project was implemented with growth in mind.

This is an effective approach. There’s an upfront lift to make everything uniform across facilities and systems, but the end result is a seamless integration and highly successful reporting based on standardized data.

Q. Do you think an organization can successfully address health equity without an executive who holds formal responsibility over the program (such as a VP of Health Equity or Diversity, Equity, and Inclusion)?

A. The CommonSpirit Health and Docent Health partnership has been supported at the highest ranks of both organizations from the beginning, but there are multiple executives at CommonSpirit Health whose responsibility, mandate, and charter focus specifically on health equity. Without a champion devoted to these kinds of causes, there are often numerous concerns and pressures faced by executives, and nuances and subtleties can be missed.

Q: What does “bidirectionally” mean when referring to communication within the Navigator program?

A. In the case of Docent Navigators, bidirectional engagement is counted when a patient responds to at least one text message or picks up the phone and completes a conversation with a Navigator (rather than declining to talk or simply receiving a voicemail message).

Engaging management in health equity efforts

Q: What is the cost of health disparities? 

A. According to the Kaiser Family Foundation, health disparities cost this country approximately $93 billion in excess medical care costs and $42 billion in lost productivity per year. It costs more in the long run not to address health disparities — financially, socially, and on both a community and national level.

Encouraging patient engagement

Q: How are you able to engage individuals by getting them into the database, responding to the reminders, and acting upon the reminders? Are incentives used?

A. We do not give out extrinsic incentives like gift cards. Instead, Navigators deliver value from the first outreach, so users are motivated to continue engaging with the platform. 

Navigators are trained to understand patient needs, look for social determinants of health, and offer resources that are helpful and personalized to an individual’s specific situation (rather than providing a homogenous response). It’s all about building trust — and the Docent Navigators do that in spades.

Q: How do you get your community base in rural communities?

A. Docent Navigators work in their own communities. In fact, Dr. Jackson attributes many of the positive results seen in the partnership as stemming from strong, effective in-person community support and the commitment to hiring people from the communities that they are serving.

Q: Where should health organizations start? Do we focus first on addressing health equity within our organization, creating more SDOH-related services, or jump straight to external partnerships? How might you prioritize?

A. For a health system, it “starts at home,” as so many great efforts do. A focus on health equity more broadly requires cultural and strategic buy-in from executives. In addition, it requires alignment at all levels. No program or partnership will work well without leadership and support from the get-go. 

With this partnership, the tone and approach has been set from CommonSpirit Health’s CEO, Lloyd Dean, who has drawn on his lived experience to seek change. 

It’s an example of true commitment to the topic — those within the health system have to believe in the mission, or they’ll get distracted by the need to secure other outcomes. This is why it’s so helpful to have an advocate on the executive team or an engaging partner. The right partner can help a system see what is possible and work together with those in charge to highlight a program’s successes.

Q: What have been some of the most significant outcomes since the start of the partnership?

A. 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%.

Keeping health equity front of mind

Q: Have you seen the impact of bias in derailing or supporting health equity endeavors?

A. Implicit bias can be a dangerous thing. When implementing technology to address things like SDOH and other factors, it is important to ensure that the technology itself does not introduce bias. This could occur during development (if that relies on biased datasets) or during deployment of artificial intelligence and machine learning. 

One of the best ways to prevent this is to develop algorithms using representative data from the start and ensure they perform correctly for the target audience so as not to further drive inequities.

Q: How can you overcome the technology gap that underserved communities have struggled with (e.g., lack of WiFi or internet service, etc.)?

A. The Docent Health platform relies on SMS and phone calls rather than apps and similar formats. According to the Pew Research Center, while smartphones are very common in this country (with 85% of Americans owning one), nearly all Americans (97%) own cell phones of one kind or another. 

By connecting with people on the devices they already own, you can reach the widest swath of people in need of resources and services.

Q: Other than technology, is there any face-to-face contact with the Docent Navigators? 

A. Docent Navigators do not meet face to face with patients. Their engagement is entirely virtual, delivered by SMS or phone call. However, what sets the Docent Health model apart from other services is its ability to intelligently recognize when escalation is needed. 

If a patient answers in a certain way to an SDOH screener question, for example — indicating that they are interested in learning more about support in the areas of transportation, food insecurity, or home safety — a human Navigator will step in to answer the question and ensure needs are being met. 

The scalable nature and human element of the Docent Health platform ensures that as many patients as possible can get the resources they need while creating space and time for the Navigators to reach out to those who need additional support.

The process works — in the CommonSpirit Health partnership, the average number of texts exchanged with an individual patient is 7 to 8 texts. This is a bidirectional engagement much higher than simple outreach and answer. CommonSpirit Health’s patients are being heard — and they’re better for it.

The bottom line

We hope this answers many of your additional questions from our recent webinar. To watch the webinar in its entirety, please visit the Serving the Underserved: A Conversation with CommonSpirit Health about Equity in Healthcare page.

For more information, learn about Get Well’s Docent Health platform and navigation services.