Abstract
The COVID-19
Collaboration in a Disruptive Time
Taking a universal health equity approach requires strategic prioritization from leadership and systematic due diligence. As the largest health care provider of Medicaid services in the United States, CommonSpirit Health is uniquely positioned to develop innovative approaches that prioritize health equity in its care of the most vulnerable. A first step toward building a more equitable future is the need to come together and acknowledge a history of institutionalized racism inherent in our current health care systems that systematically excludes certain populations from well-being. Inventorying these barriers is necessary, while concurrently identifying opportunities for innovation and implementing best practices that promote health equity. Successful grassroots solutions should be celebrated, while gaps that may only reinforce inequities need to be spotlighted to bring about necessary change. CommonSpirit Health has established an innovative, interdisciplinary, system-wide executive leadership group called the Vulnerable Populations Council (VPC).
Vulnerable Populations Council
The overall goal of VPC is to set strategy in support of vulnerable populations for CommonSpirit Health and execute programming focused on equitable health care. Council members were intentionally recruited to include senior leaders with strategy, operations, and clinical expertise to highlight an understanding of market nuances and leverage system resources. Foundational to this approach was the use of the World Health Organization's definition of health as “a state of physical, mental, and social well-being, and not merely the absence of disease or infirmity,” 2 a goal that informs our work in building a more equitable health system. VPC intentionally used this definition to view its work holistically, across the care continuum, and to inform the focus of 3 working subcommittees: physical, mental, and social health. This approach is meant to champion intersectionality and holistic well-being. The subcommittee structure focuses on populating its membership with subject matter expertise, on the ground experience, and clinical and community ties. A co-lead from population health is paired with a leader selected for the ability to toggle from systemic issues to granular variations in her/his respective areas. Subcommittee members have an understanding of the current state of initiatives, barriers, and opportunities to promote health equity nationally, regionally, and locally. Each subcommittee uses the same high-level action plan that walks through a logic model 3 process, initially inventorying the current state of affairs to acknowledge gaps, including structures that reinforce exclusion, while also identifying assets and working through solutions with a lens toward health equity.
Focusing on Preventive Care
Although the initial focus of VPC was to provide broad priorities across the care spectrum, the impact of the COVID-19 pandemic on wellness visits and preventive care 4 informed a pivot toward advocating for accessible, equitable, evidence-based preventive care. Inequities in preventive care predate the pandemic, and access challenges have only been compounded by the public health emergency. Additionally, the way our patients are cared for, especially in the ambulatory setting, has been foundationally disrupted as health systems adjusted to facilitate social distancing. Some of these solutions have been successful in improving access while, unfortunately, others have only reinforced inequities. Telehealth solutions in preventive and primary care have been expanded rapidly as one approach. Proactive outreach and patient navigation is needed now more than ever to assure marginalized communities remain engaged in care and technology literacy needs are addressed. 5 Also, low threshold primary behavioral health and addiction care is needed as Americans cope with the compounding challenges of loss, financial and social uncertainty, and illness. These quick care pivots and innovations will be further assessed from a health equity lens and considered for scalability by VPC. This provides an opportunity to permanently improve how we provide preventive care and address some of the underlying drivers of health inequities. This is an example of the work that VPC is able to prioritize as CommonSpirit Health emerges from the public health crisis wiser and more resilient, ready to advocate for equity at the core of its mission as a leading national health system.
Moving Forward
While we offer here a potential solution and road map for a strategic and interdisciplinary executive leadership council to address health inequities, we stress that it is important for health care systems to consider their own unique approaches that support the communities they serve. Solutions that will help us move past the COVID-19 pandemic with a universal health equity lens should be informed by the unique needs and priorities of the communities we serve. No matter what form this work will take, it will require prioritization by leadership, interdisciplinary input, community connections, an acknowledgement of unconscious and institutionalized bias, and a recognition of the opportunity for innovation in this moment of disruption. Our patients, providers, and communities have all found themselves in a place of multiple vulnerabilities: the pandemic has been profoundly challenging, and it has only reinforced inexcusable inequities in our health care system. We now have an obligation to build something stronger and more equitable. Health care is uniquely positioned to be a driver of social change and has a responsibility to prioritize a coordinated response from within its clinical walls and out into the communities we serve.
Footnotes
Authors' Contributions
Drs. Mitton and Urquieta de Hernandez, Ms. Pasupuleti, Ms. Hurley, and Ms. John all contributed equally to the drafting, writing, and editing of the manuscript. Dr. Cole provided critical feedback and assisted with editing the manuscript.
Author Disclosure Statement
The authors declare that there are no conflicts of interest.
Funding Information
No funding was received for this article.