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Peeling back the layers around health equity

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What is health equity?

Imagine a world where everyone has equal access to affordable, quality health care — when and where they need it. That's health equity. By working together, we can remove barriers and close gaps in care to make health equity a reality for all people.

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The crisis of health inequity: Our challenge to solve

COVID-19 brought health inequities into stark relief. This pandemic brought to light significant disparities in healthcare access and outcomes. Disparities that have always been there. Health inequities are not due to individual choice or random occurrence, but instead are a result of poverty, structural racism, and discrimination. These disparities cannot continue. During the pandemic, payers, providers, employers, and government came together to meet the need. COVID-19 was a year long crisis, and our industry rose to the challenge to protect the health and lives within their communities. From remote monitoring to reimbursement. And from drive-through testing to telehealth. The industry became a champion of innovation and empathy. Health inequity is a risk as great as any of it, but we have the tools, the partnerships, and the will to address it together. We can address this bias in our own organizations, by listening to the diverse voices within, and building the teams that best connect to the people we serve.

We can build a consumer experience that eradicates seen and unseen barriers, creating ecosystems that meet people when and where they need us. We can build the intelligence and relationships capable of continually improving clinical outcomes until they are in fact equal. This is our industry challenge to solve. We are working across our country to identify where health disparities are occurring. We are embedding health equity in every decision we make, and every product or service we deliver. Health equity is at the very core of our mission, to help people live healthier lives, and help make the health system work better for everyone. We invite you to join us in this effort.

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The crisis of health inequity: Our challenge to solve

Let’s come together and build a health care experience that meets the needs of all — community by community.

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Guidebook

Driving toward health equity

See how Optum is improving access and expanding resources to achieve better health outcomes for all.

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Video: How Can Health Care Leaders Create Lasting Change?

Chris Denson:

Welcome once again to the Fast Company Most Innovative Companies Summit. My name is Chris Denson. I'm going to be moderating this amazing panel. Today, we're going to be talking a little bit about health equity and some of the gaps when it comes to inclusion and diversity and what healthcare providers and healthcare services are doing about it. Thank you to our friends at Optum, and, of course, the team at Fast Company for putting this together.

Chris Denson:

I'm joined today by an illustrious panel, and I use that word very intently, Karoom Brown, Global Chief Growth and Strategy Officer OptumServe; Dr. Anjali Bhagra, Medical Director Office of Equity, Inclusion, and Diversity at the Mayo Clinic; and Dr. Seanelle Hawkins, President and CEO of the Urban League of Rochester. Thank you all for joining us.

Chris Denson:

I guess, for starters, one of the things that I admire about you all is that you're leaders in your respective fields, and as we look out into the healthcare ecosystem and we start to see what leaders are able to do and capable of doing to bridge the gap for health equity, what sorts of things are you seeing that individuals should be taking into consideration to bridge the gaps at least from a leadership perspective? Karoom, I'll start with you on that one.

Karoom Brown:

From a leadership perspective. I see companies actually starting to really pay attention to where the curve is going, and there's been a bunch of things that have heightened it. The response to COVID, COVID has really shown health disparities, health inequities, and some of the imbalance in how many folks are hospitalized of different backgrounds and in particularly brown and black communities.

Karoom Brown:

What I've seen is leaders from a company leader perspective, United Healthcare Optum, we've set up a whole health equity board. We've set up a committee where we're actually looking at real change and how do we impact how we deliver care differently. How do we support our customers differently but also how do we support our constituents, whether it's diverse suppliers, diverse companies?

Karoom Brown:

Then you have folks that are really leaning in, and I'll use myself as an example, making sure that I'm a part of the diversity and inclusion internally in the company, making sure I'm supporting health equity from a diversity of thought and diversity of perspective. I think in order to make, for us to make real change, we need to change the way we look at problems and also who's helping us answer the problem.

Karoom Brown:

It's hard to address health equity in a community you've never been a part of you. You haven't grown up in a poor community, it's hard to understand that there are not healthy foods in those communities, that nutrition is a big part of the factor, that access to good care because the strong and good doctors and some of the better doctors do not want to come and work in those communities. How do we change that? How do we change the root cause and environment?

Karoom Brown:

But part of it is leaders being able to step up like me that grew up in those communities and be able to say, "I understand what's different." I understand what good healthcare is now because I'm fortunate to be able to afford it, but I also understand what it is to grow up 20 years in poverty and have not fair access and not equal access to healthcare, and that the simple doctors and providers that are in my neighborhood that I grew up in are not the same as the doctors that are in better neighborhoods, because that's where you tend to draw the higher concentration of better professional doctors, health care education, food, and nutrition.

 

Karoom Brown:

So, I look at root cause, and then I look at us as leaders. How do we get that? How do we hire differently and hire different expertise that can address the problem, not just trying to take the same folks with the same education that haven't experienced it and try to solve that problem? So, that's the beginning of what I see, but what I'm really excited about is whether it's federal government entities, state government and local entities, or private firms, I've seen a very large concentration now on health equity and providing care.

Karoom Brown:

Even when it comes to COVID, we do a lot of testing and vaccinations. A lot of the governors, the local health officials are really concentrated on making sure fair and equitable distribution of vaccines, fair and equitable distribution of testing, and even coming up with creative solutions like mobile capabilities to go into communities that are hard to reach. So, those are some of the things I've been excited about to see leaders and folks really jumping forward in the space and trying to change where we are.

Chris Denson:

Very well-stated. Thank you. Thank you. Dr. Bhagra, same question. Curious as to your perspective on this.

Dr. Anjali Bhagra:

Yeah. Thank you, Chris. First off, I want to really express my enthusiasm at being able to share some thoughts with the exemplar group here, and thanks to Fast Company for prioritizing this discussion. I think that strong leadership on behalf of Fast Company and talking on leadership imperative, I really want to build on what Karoom shared earlier. I personally feel there is space and room for advocacy, there's room for revolution when we need it, and there is always room for strong leadership.

 

Dr. Anjali Bhagra:

When it comes to healthcare and leadership, in addition to everything that Karoom so eloquently shared about root cause and just the systemic and pervasive nature of disparities and the need for a multi-dimensional approach, what I would love to highlight is how there is need for strong leadership. When I'm talking of leadership, I really look at it through the lens of business development. Now more than ever, I feel it's time for healthcare leaders to make equity a strong part of their strategic plans.

 

Dr. Anjali Bhagra:

As we build strategic plans, certainly we want to make sure fiscally we are coming up with strong plans. I also want us to look at everything through a lens of equity, because without that, we wouldn't be able to address the inequity and the disparities at the level that we wish to. One example of such a priority is at Mayo Clinic we recently declared our board of trustees committed $200 million to eradicate racism. To me, that's where the rubber meets the road.

 

Dr. Anjali Bhagra:

Yes, we know this. There is a philosophical, intellectual, historical... We have all these awarenesses, but we really need action plan where we hold ourselves accountable. I'm in a space of building more accountability on part of our leadership, and when I say leadership, it's not just a top down approach. It's bottoms up as well. This is not work that needs to be or should be done by an office sitting in a periphery of some organization. This is exactly where, Karoom, to your point, everybody needs to lean in. This is work that needs to be done with the people and not for the people.

 

Dr. Anjali Bhagra:

I think that there needs to be a very solid, fundamental understanding of, yes, there's need for a very strong strategic plan, business plan around equity efforts, and then there's need for engagement of this work to be done with the people, not just for the people. What I just shared, the $100 million commitment that we have on behalf of Mayo Clinic, these are efforts addressed towards our patients for disparities, equity initiatives within the practice, towards education, and finally towards our staff and community. It's a triple-facing initiative that addresses need for equity for our staff, patient, and communities.

 

Chris Denson:

Thank you. Thank you. And Dr. Hawkins, I think, from your perspective, it's almost working on both sides of the equation, right? On one hand, you're representing the Urban League and also bridging the gap with health care providers. What are some of the expectations you have for healthcare leaders?

 

Dr. Seanelle Hawkins:

Sure. First of all, thank you for this opportunity, but I'm expecting leaders to call out the root cause for what it is. Racism is a public health crisis. That's the root cause, racism. So, when we talk about health biases, systems change, we have to look into these practices and scan for the inequities and make the change. I'm looking to leaders to articulate the vision, and everybody needs to work the vision together.

 

Dr. Seanelle Hawkins:

As you mentioned earlier, this is not just a top up approach. It has to be every one, all inclusive plan. So, you have to talk about, "What is America, what is my state, my city, my organization look like if we have evidence of health equity?" What does that look like? Communicate that vision and work the vision.

 

Chris Denson:

Thank you. Thank you so much. You talked a little bit about scanning for inequities, which leads me to this idea of data and analytics, especially in healthcare systems. We have so much information, but I'm curious as to how we can use these tools to bridge the gaps and to develop more equity. Karoom, I'll start with you on this one as well, just in terms of what sorts of technology tools and how are those being reimagined to help bridge the gaps that we see.

 

Karoom Brown:

So, I'll start with the reimagine piece. We have to go back to our datasets. The technology is there. Data analytics, advanced, predictive analytics, science, when you look at genomics and things of that nature, but we have to go back and look at the data source. So, where are we getting those data sources from? It's easy to say technology can do a lot of things, but if it's not built on the right foundation of data, then therefore the output that you're getting won't be correct.

 

Karoom Brown:

So, are you collecting the input from folks in those communities, the communities of interest, community leaders within those blocks, folks that the doctors that have been treating those patients that can tell you what's different? What have they experienced? And then also, I think science is a big part of it, not just technology. Data analytics, we have invested a lot in our business in data analytics, and we continue to evolve that by looking at the data sets and making sure we're inclusive of all data and the right data.

 

Karoom Brown:

But science is also a part of it. You start looking at genomics, DNA. There has to be a correlation between the DNA in the ancestors of black and brown communities that have struggled year-over-year on nutrition, have lived in poverty because of racism, slavery, and the things that you say, "Oh, that was 350 years ago." Well, it was for 350 years. If you have one culture that all they did was smoke cigarettes, for example, for 350 years, you got to imagine that that DNA is altered in a way where its health impact is going to be different than those that didn't smoke cigarettes for 350 years. So, put that in perspective.

Karoom Brown:

If you think about slavery and the fact that slaves weren't afforded nutrition, so for 350 years, they eat scraps. They eat the leftovers. They eat whatever they can muster up on the plantations, but not eating right for 350 years. Then you have poverty after that, that also took out your ability to feed your kids, to give them the right nutrition, to teach them what the right nutrition was, what good doctors look like.

 

Karoom Brown:

For a while, even after slavery, and you have segregation of doctors. You can't go to the good doctors. You go to the best doctor you can possibly go to, and that's not good enough, or you can't even afford to go to those doctors. You're not taking care of your teeth. You're not taking care of your heart. You're not taking care of your body. You're eating foods that are served in your community that are high in sugar and sodium. Those things have an inadvertent effect long-term on the DNA of these minority communities that struggle in health care.

 

Karoom Brown:

So, we can look at the root cause and say, "Okay. Yes. It is racism. Yes, it's slavery." But the question is, now that you know that and you can really dig deeper, how do you change the course or speed? How do you make the next 300 years better eating, better living, better access to care? How do you incentivize doctors, the right doctor? You just talk about technology and data analytics. How do we look at the pool of where the best doctors are claimed to be in the country and the correlation of that in the underserved communities?

 

Karoom Brown:

What's stopping the doctors? And how are we using that technology and analytics to say, what will it take to get the better doctors, the better healthcare into these communities to make it equal for all? If it's cost or if it's incentive that you need to motivate people to work in those communities, or if it's working with community leaders to say, "How do we create green zones?" Green zones that say regardless of crime rate and anything in those communities, how do you make it safe for doctors of all kinds to go in those communities that understand those communities, but also can afford to be in those communities because the pay is equitable?

Karoom Brown:

So, I think there's a lot of things, but I think the first thing you look at is technology and analytics. How do you drive the science behind that as well and drive better care and treatment through real analytics that are based on foundational data that come from the communities, that come from the patients of interest, that come from the doctors that have been serving those communities for decades, not just the brains that are outside of those communities, trying to understand those communities better?

 

Chris Denson:

I love that you touched on this almost like an intangible data point, which is psychology. The things that we learn, the habits that we learn, and it's hard to measure, especially when it comes to tools and data and analytics. Dr. Anjali, I'm curious as to your take on data points and analytics and the tech tools behind the efforts of institutions to bridge these gaps.

 

Dr. Anjali Bhagra:

Yeah. No, Chris, thank you for including this question. I want to build on what Karoom shared earlier. To me, data is destiny. There's no doubt that for us to make change at the level that we wish to make change, we've got to rely on big data because we need to make and we want to make big change. Now, big data comes with a flip side of bias within the data and issues around ethics, confidentiality. How do we respect all of that?

 

Dr. Anjali Bhagra:

I think the other opportunity that we have is technology. In addition to leveraging data, along with analytics that can inform us with in-time plans to address disparities, the fact that we can combine all of this and utilize machine learning to address populations that we haven't really been able to reach because of inaccess to those segments, Karoom, to your point, to a marginalized population. So, I think there are big issues that we need to address as we harness data, and bias is one of the biggest ones. We want to make sure that we use as much as possible data that's de-biased and that's inclusive, that truly represents the population that we wish to leverage its information on.

 

Dr. Anjali Bhagra:

The second, I would say, is teams that work on data analytics need to be diverse. If you have a group, an over-representation of one demographic working on these data analytics tool that is not going to serve us right, because that's where there's a pooled impact of unconscious biases. So, in order for us to create those unbiased data sets, we want to make sure our teams are diverse and our teams are very inclusive. I just want to make sure as we harness data we pay attention to what the issues around bias and access are, leverage technology to improve access of healthcare to populations that we are not traditionally reaching right now.

 

Dr. Anjali Bhagra:

One thing that at Mayo and I know many other healthcare institutions are very particular about, and that's data privacy. I think that we cannot talk enough about that. That's an imperative for us, and we have several teams, including our teams of AI scientists, ethics, our own team of equity and inclusion, working collaboratively to make sure we protect the data of our consumers who place so much trust in us.

Karoom Brown:

Chris, I just wanted to jump on with Anjali said that, when you talk about data ,and we talked about the quality of the data, biases have an impact but also unconscious bias. Sometimes you can mean well, and look at COVID. When we first started looking at folks said, "Okay, well, how do we simply get testing in underserved communities, in black and brown communities." But the equation wasn't that simple.

 

Karoom Brown:

An unconscious bias could be you assume everybody has a car like you do. You assume everybody has access to the internet like you do, so therefore you can go on and schedule your tests and drive to that testing location. But dive in a layer deeper and have an unbiased but a actual data fact that says not only are they having trouble to getting the testing near those communities, but they also need easy access. Are you located close to public transportation? Are you putting it in a place where it's walking distance to high density apartment builders and things of that nature?

 

Karoom Brown:

So, the data sometimes, and how you use the data, we're learning as we go into health equity, you have to be conscious of the unconscious bias. The folks that tend to be the brains behind the operations in healthcare tend not to live in those locations and therefore can't truly come up with the data in a fully unbiased nature. Therefore, that's where it comes in where we need that diversity of thought and experience added to the technology to make the data analytics do what it's supposed to do.

Karoom Brown:

I hope that the folks that are listening to us take that into consideration, making sure that the data is not based on biases on unconscious bias, and you inadvertently as good as your intentions are, you're still leaving out a population or leaving out a solution because your data's not built on the foundation of those communities and what their challenges really are.

 

Dr. Seanelle Hawkins:

Karoom, I think that's where the partnerships are so important because having a group like the Urban League at the table helps to remind you of that because we're focused in on the populations that we serve. We're looking. We're scanning for unconscious bias. We're scanning for how this impacts the people that we're looking to impact.

 

Dr. Seanelle Hawkins:

Also, I wanted to say that with the data, it's important to make sure that the data is broken down into layman's terms, so that those that are impacted by the data understand the data. We can't forget that. The people with the lived experience have to have the understanding so that they can begin to make changes, and not only that, also use their voice to advocate for the change that we all seek. So, it's important not to dismiss that, but I think partnerships are critical to our success to achieving equity in health.

 

Chris Denson:

And I was going to say to that point, when you look at data, there's also an important data point which is the data that you do not have. So, when we talk about access and not having the tools or a different level of access to technology, from your perspective Seanelle, what efforts are you seeing to bridge the gap and give access, put these tools in the hands of the people that need them most.

 

Dr. Seanelle Hawkins:

Yeah. You know what? I saw this with the access to the COVID vaccine. There was a great idea to have the website available, and people can just click on. It didn't work like that because there were so many people that didn't have access, not only to the technology, but didn't know that you had to click 100 times, get yourself in a waiting room, then go back, click... No one has the time to do that or even to understand it.

 

Dr. Seanelle Hawkins:

So, one of the things at the Urban League of Rochester, we partnered with our medical provider, Trillium Health and said, "Look, you have the vaccines available. We will have people call us." We partnered with our local radio station. I went on the radio station and broadcast, one, information about the vaccine, provided that education to the community, and those that wanted it called. We received thousands of calls.

 

Dr. Seanelle Hawkins:

That helped our partnership with Trillium because the Urban League was the trusted partner. We worked with Trillium Health, and they were able to get folks vaccinated. Those are the things that we have to think about when you think of technology being a great idea, but some people need just a good old phone call. We have to remember that, and that's why partnerships are critical for us creating access.

 

Chris Denson:

Very, very good. When it comes to social determinants, we've kind of touched on them, but how should we better understand those? Maybe it's not data. Maybe there's getting out in the neighborhoods like Dr. Hawkins just suggested. What are some strategies and things you see in terms of, again, removing some of those social determinants?

 

Karoom Brown:

First is you get to understand what they are and, I mean, truly understand. It's one thing to say, "Oh, it's poverty. They're poor people that can't afford it." It's another thing to understand what the poverty has caused and all the things around it if you're really going to affect health equity. First, you say, "Okay, well, there's not enough. They can't afford to go to the doctor, but there's also not enough good care." What are driving the doctors out? What is stopping the doctors from coming into those communities?

 

Karoom Brown:

What is is the other things? Is is it access to transportation to healthcare? Do we need to do more virtual healthcare, more videos? Is it a technology gap? Do we partner with technology companies? Do we partner with the T-Mobile's and the Verizons of the world to get communications into the homes? I mean, part of the reason why virtual school got going is because they were able to extend the computers and the internet access into certain communities that wouldn't have normally had it.

 

Karoom Brown:

But the whole theory of just, oh, well, you know what? Everybody could work virtual. One thing I think Seanelle pointed out, even COVID that we experienced this, the reach, digital divide digital. The digital divided in the minority and poverty stricken communities is real. If you don't have access to the generic things then you can't access education for healthcare, learn about better healthcare access, simple things like picking a doctor and being able to look at a website to see which doctors are the best doctors.

 

Karoom Brown:

For the first time, in a while, I got a Yellow Book delivered to my house, and it was probably about that thin. It wasn't as much information in it as it usually is because people are relying on the internet. But if you don't have that, then you don't have access to certain care. So how do we bridge the gap there? Understanding the community, partnering, as Seanelle said, with churches and community groups that understand and community healthcare systems to understand what these folks are experiencing.

 

Karoom Brown:

When folks say, "Hey, I haven't been at a doctor in two years," why? Is it because of the work hours? So is it making care more available easily at the places of employment? Is it strategically locating some type of mobile care unit that can do health checks for young children and making sure vaccines are getting to those right communities? But you have to understand, truly understand the socioeconomics and the things that are driving the communities back.

 

Karoom Brown:

I mean, just simple things like food. I mean, I grew up in places like New York that you go in a minority neighborhood, and it's nothing but convenience stores. There's not a Whole Food. It's not another bunch of healthy eating and smoothie places. You bail bondsmans and check cashing places and liquor stores and convenience stores that sell nothing but unhealthy food. Well, if that's all, you're eating day after day, you can't afford to go to the gym, you don't have anybody teaching you about wellness on a regular basis, and you can't afford the gym at that or exercise equipment.

 

Karoom Brown:

Who's teaching alternative ways of working out? Who's teaching alternative ways of living? You got to understand what's there. But I do think that what I see is communities adapting, and that's a positive change. So, we talk a lot about the negative, but I'll talk about the positive over the last year I've seen. My company when responding to COVID the first response to some folks that they didn't understand those economic challenges was like, "Oh, yeah. We just make everybody sign up on the internet."

 

Karoom Brown:

And I said, "No." I said, "You got a digital divide problem, technology. You got transportation. So how do we address that?" What we did is we opened up a call center for those that didn't have computers that can call in and schedule their appointments and figure out where to go. We set up walk-up sites and worked with our customers in estates to make sure that you could just walk up and take a test. You didn't have to go on the internet or place a phone call. Those things, we make sure we have transportation. We make sure we set up temporary testing and locations where folks would normally not be able to afford transportation but can walk to it.

 

Karoom Brown:

Then we moved those sites around the community, so it wasn't just the folks that could walk there. But then you move it 20 blocks out, and then those folks can walk to it. That type of adaptiveness is what we need anymore. Until we can truly spread out health equity, you have to understand the causes. I am big believer of it. We got here through hundreds of years. I think we're going to get to the solution quicker if we understand where we came from, and we start to adapt quickly by understanding. It's okay to be different.

 

Chris Denson:

It's easy to look at the problem, and the problem can even feel daunting to a point where it's like, "I don't even want to touch it because it feels too big." But, Seanelle, from your perspective, what have been some elements that have driven adaptation like Karoom just mentioned? I like to think of things like telehealth, the fact that we've all been forced into telehealth appointments. It breeds a bit of familiarity and comfort with technology and tools and other methods of healthcare. But what have you seen more of the upswing trends from an Urban League perspective?

 

Dr. Seanelle Hawkins:

Yeah. There are lots of upswings, trends, including partnerships. I think partnerships are critical to the success because when you collectively pool your resources, we can attack the problem. I know you wanted to talk about the positive, but we absolutely have to attack the root cause. So, when we think about, just as Karoom mentioned, the multiple traumas that manifest in our bodies from all the problems from mental health, because of COVID-19, lack of housing, and so that leads to the stresses.

 

Dr. Seanelle Hawkins:

Imagine when the moratorium is lifted on eviction, what is going to happen to our community? So, we have to really advocate together, pool our resources together, and I'm seeing that. I'm seeing that more, that there's a collective effort to attack the problem. This is reflected today in this panel here. We're talking about how we're working together to make change, and that's what's necessary. We collectively have to pull together.

 

Chris Denson:

Anjali, I want to get your take on this topic.

 

Dr. Anjali Bhagra:

I really want to lift Seanelle's idea of partnership, and partnership can look so different in different settings. In this setting, when I think of partnership, I'm really thinking of life sciences, social sciences, political sciences, and health sciences coming together. In other words, this is the health care sector. I'm really looking at the public sector, the private sector. Seanelle, I love your suggestion of, like I said earlier, this is the work we need to do with the people, not for the people. Really, that cannot be done without partnership.

 

Dr. Anjali Bhagra:

One thing that I'd love to share on the technology and the telehealth aspect, Chris, that you mentioned. With partnership with our IT team here, we were able to extend televisits to COVID-positive patients, and we were able to take care of them right in their homes. They did not need to come to Mayo Clinic for the care. We took care of them, right where they were. We actually saw more televisits in a day than we had seen in an entire year pre COVID.

 

Dr. Anjali Bhagra:

So, you're right. It is happening. There is an acceleration. The pace at which we are going to roll this change out is way faster than the number of years and centuries of inequity that have existed. Another thing I want to mention here for partnership. We recently were, the founding members Mayo Clinic, was a founding member of the Racial Justice and Business agreement, which is via the World Economic Forum. This is that partnership. I'd love to work with Urban League. We are already working with technology partners, such as K Health, Cerner, where we are trying to optimize tools such as symptom checkers. Can we reach out to individuals without them having to come to us?

 

Dr. Anjali Bhagra:

So, it's an entire frame shift of how we within healthcare want to provide care to our consumers. It's not about you finding the transportation. Certainly for complex conditions and conditions that need you to come here, we want to improve the access. But we want to be able to get to you where you are, meet you where you are to move that. That cannot happen without partnerships, so I'm personally really excited about all the collaborative collective efforts that we all are going to make over the next decade to really drive this change in a meaningful direction.

 

Chris Denson:

Well, first of all, I want to thank all of you for educating me. When you see a complex problem, it's hard to know where to start, but personally, I walk away with the idea of partnerships. You don't have to go it alone, and then just education. With complex problems there are multiple pieces of the puzzle that need to be solved almost simultaneously and not necessarily in order, and it is a continual work in progress.

 

Chris Denson:

So, I want to thank you all for joining us. Thank you to Optum for helping us put this together. Thank you again to the team here at Fast Company, and we will continue to educate you guys more. Thank you for joining us at the Most Innovative Companies Summit. We'll talk to you soon.

 

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From Fast Company's Most Innovative Companies Summit

What can health care leaders do to create lasting change? Panelists from Optum, Mayo and the Urban League weigh in.

Health inequity is a risk as great as any, but we have the tools, the partnerships and the will to address it together.

– Michael Currie, Chief Health Equity Officer of UnitedHealth Group
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Moving the needle

Making health equity real by building trust, expanding access and tailoring support to meet the unique needs of individuals and local communities.

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Optum Hemet Clinic - Whole-Person Care Under One Roof

Hemet, California, while it's growing, it's still considered pretty rural. When we started looking at Hemet and really thinking about the population that we serve there, we serve everything from pediatrics all the way up to our senior members and patients, there's a real need around the socioeconomic challenges in Hemet and there's a diverse population. We decided that instead of maybe just focusing on the seniors, this community needed something more.

We use a multidisciplinary team, integrated services, to tackle the problem from multiple corners.

It's about helping the health system work better for everyone and Hemet is no exception. It was very important to us to find a way to create that one-stop-shop so that everybody has convenient access to the care that they need in a single setting. We decided to bring in laboratory services, radiology services, and then we also partnered with our other Optum organization, Genoa Pharmacy to bring in pharmacy services.

Pharmacy is a great resource for the patients. When I prescribe something from my computer, I pick up the phone and speak to the pharmacist and find out if this is covered before the patient leaves the clinic. We have also the community center in the Hemet clinic where we provide classes, healthy lifestyle, management of diabetes, classes about preventing obesity, mental health resources, supportive groups.

We have a pretty deep connection with behavioral health services and the community of Hemet. We're also able to make those connection points for our members and our patients. We also have a pretty robust gym available to all of our patients and members as well.

Hemet is known as an underserved population and there are a lot of patients that have problems with access to care, a lot of patients that struggle with the transportation, problems with ability to afford their medications.

We know that in the depth and breadth of the Optum services that we have solutions to bring, to bear, to break down those barriers. We decided to stand up our social determinants program which we call Bridges. That's really about breaking down those barriers for our underserved population. Being in community, Care Delivery Organization, we want to treat the whole person as fast as we can and bring as many Optum assets to the table to show up for that person as possible.

We had the patient that was discharged from the hospital and this patient really need to be seen after that discharge. Immediately, the social worker was contacting many resources, arranging transportation for the patient to be brought into the clinic, pharmacists to prepare all the medications that we [inaudible] after the discharge off the hospital. The patient showed up after that for two follow-up appointments without counseling or no-showing. Actually, she wrote me a note yesterday, she said, I need you in my life. The trust that I got from my patient, it's indescribable feeling. That's what motivates me every single day that I have the ability to help someone in need.

Equitable care, access to quality care, inclusion, is something that we live and breathe every day. Every day I wake up thinking about how am I going to make a difference, and even if it's in one person's life, that's one person's life that we made easier and made sure that they could get access to the care that they needed in the time that they needed it.

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Video Component

Revolutionizing the Maternal Health Experience | Optum

00:00

[Music]

00:05

our next speaker

00:06

cali chamberlain has a bright light

00:09

that shines from within she has been a

00:12

champion for health equity throughout

00:14

her career

00:15

and today she will walk us through the

00:18

intersection

00:19

of maternal health and health equity so

00:22

please welcome

00:23

callie chamberlain

00:31

[Music]

00:35

hi everyone i'm thrilled to be with you

00:37

this afternoon

00:38

even if only virtually i'm really

00:40

looking forward to our time together

00:42

my name is callie chamberlain and i'm

00:44

the director of social responsibility at

00:46

optu

00:47

optum is one half of united health group

00:50

we are the products the services

00:52

and the technology the other side of

00:54

united health group is

00:56

the organization united healthcare which

00:57

some of you may be more familiar with

00:59

that's the insurance provider and before

01:02

i tell you a little bit more about what

01:04

i do in our maternal health strategy at

01:05

optum

01:06

i'm going to tell you a little bit about

01:08

who i am and how i come to this work

01:10

i'm a woman i'm a person of color i'm of

01:13

asian descent

01:15

i'm based in minneapolis and i have

01:17

spent so much of my summer

01:18

thinking about systems change and racism

01:20

across america

01:22

in large part due to the murder of

01:23

george floyd that happened right here in

01:24

my hometown

01:26

and as we go through this um you might

01:28

actually hear sirens or helicopters as

01:30

we prepare for the trial of derek

01:31

shelvin so

01:32

fair warning professionally i've been

01:35

fortunate to have a number of

01:36

experiences

01:37

that have profoundly shaped my path and

01:39

continued to guide me in terms of the

01:41

values that i use every day at work

01:43

i started my career in health and then i

01:45

left for a few years

01:47

um one of the things that i did during

01:48

that time was i launched a leadership

01:50

and development program called new

01:51

leaders council twin cities that

01:54

organization is committed to advancing

01:56

equity across the region

01:57

and bringing together young people who

01:59

are leading from a similar set of values

02:01

so then in 5 10 15 years as we become

02:04

more visible

02:05

we can pick up the phone and call on

02:07

each other to get things done

02:09

that organization is five years old and

02:11

has more than 70 local alumni

02:14

another thing that i did is i went to

02:16

the greek island of lesvos

02:17

with six other women to film a

02:19

documentary on the syrian refugee crisis

02:22

in greece that film debuted in times

02:24

square in 2019

02:26

it went on to win seven awards and most

02:28

importantly

02:29

it told the stories of women refugees

02:32

and entrepreneurs

02:34

and because of the relationships that we

02:35

developed on the ground

02:37

and a consistent asset we heard for

02:39

people that just wanted dignity through

02:40

work

02:41

we created a microwork application that

02:43

connects refugees to income

02:44

opportunities on their cell phones to

02:46

leverage the six hours that they spend

02:48

every day waiting in line

02:51

and as a result of that i had the

02:52

privilege to work

02:54

across the middle east and north africa

02:56

with the united nations as a peace

02:57

building fellow

02:58

to develop more comprehensive migration

03:00

policies

03:02

that time away also included running a

03:05

donut shop

03:06

and a political t-shirt shop so it was a

03:08

lot of fun

03:09

and i learned a lot and despite those

03:12

experiences or i guess maybe because of

03:14

them right i made my way back to

03:15

healthcare

03:16

um around this time the social

03:18

determinants of health were just coming

03:19

into focus which had much more expansive

03:22

definitions of health and health care

03:24

ones that i really felt like i could see

03:25

myself within

03:27

and because of my work with refugees i

03:30

really started to realize that health is

03:31

the base of

03:32

equity and without it we don't have

03:33

anything

03:35

you can have the best education in the

03:37

world you can have a safe place to live

03:40

you can have a fridge full of food you

03:42

can have a job with a paycheck that you

03:44

know is coming every two weeks

03:46

and none of that matters if you don't

03:47

have your health so as healthcare

03:49

professionals

03:50

i think the work that we do is really

03:52

unique because we have the opportunity

03:55

to positively impact the health and the

03:58

well-being

03:58

of thousands of people of millions of

04:01

people

04:02

or not the decisions that we have the

04:05

privilege to make

04:06

they really matter and i don't mean to

04:09

be dramatic about that

04:11

but oftentimes it really is life or

04:12

death and almost

04:14

always about quality of life when people

04:16

are still alive

04:17

and to me there's nothing more sacred or

04:19

profound than having the opportunity to

04:21

do something about that

04:24

and in a capitalistic society with the

04:26

for-profit health care system

04:29

i think the opportunity to be able to do

04:31

real social good

04:33

is most prevalent in the private sector

04:35

and that's why i'm at optum

04:38

but this work is also deeply personal to

04:39

me i am one of the one in five

04:42

people who have experienced

04:43

discrimination in the health system

04:45

as a result of my race or ethnicity i

04:48

have seen

04:48

up close the ways that this system

04:50

wasn't built for me or people like me

04:53

and anyone i know we say that all the

04:55

time right the health system is broken

04:57

it doesn't work for everybody

04:58

but what we don't always say is that

05:00

that's intentional

05:02

a system functions exactly as it was

05:05

designed to function

05:06

and this system this health system was

05:09

built

05:10

and created in 1798 and at that time

05:14

women were not seen as full human beings

05:16

much less women of color

05:18

so when i say that this system wasn't

05:19

built for us i i mean that that's fact

05:23

and with the coven 19 pandemic and the

05:26

increasing violence in our communities

05:28

the social uprisings that were happening

05:30

globally and right outside my front door

05:32

is ground zero

05:34

it really became clear how many public

05:36

crisis we are operating

05:38

within and how many systems are

05:40

functioning exactly

05:41

as they were designed to function we

05:44

just can't ignore it anymore

05:46

we just can't look away anymore right we

05:48

can't ignore

05:49

all the statistics that we're seeing all

05:51

the inequities that have been laid bare

05:53

that's something else i hear all the

05:54

time right

05:55

yeah we can't ignore that that's

05:58

happening we can't ignore that race is

05:59

at the foundation we have to do

06:01

something about it

06:02

and i don't know about you but i feel

06:04

that right it's not just

06:06

systems change and racism across america

06:08

out there it's right here in our work

06:10

in the health system in the medical

06:12

industry

06:13

right right across our laptops right

06:14

that's the opportunity

06:16

and that means that we have an

06:18

unbelievable moment to meet

06:20

and i think that we can lean into it and

06:22

understand our ability to impact social

06:24

issues at scale

06:26

and i think the way that we're doing

06:27

that at optimum is really unique

06:30

we're reflecting on who we are and how

06:32

we arrive at this work at this moment

06:34

and i think that what we're doing can

06:36

provide a really unique framework that i

06:38

hope is helpful to you and your

06:39

organizations

06:41

and that's what i want to share with you

06:42

today so to give you some background

06:45

my colleague and i started the social

06:47

responsibility program at optum three

06:49

years ago

06:50

we both come from very entrepreneurial

06:52

non-traditional backgrounds

06:53

so we run a very entrepreneurial

06:56

non-traditional social responsibility

06:58

program

06:59

which is to say that we're not a

07:00

philanthropic grant-making body

07:02

we are the second largest health system

07:05

in the world

07:06

so we believe that the most impactful

07:08

responsible thing that we can do is

07:10

change the way that we do business

07:12

right so that means changing our

07:14

processes our operations our culture

07:18

and in doing so we really believe that

07:19

we can shift the industry and change the

07:21

field

07:23

so about a year ago we decided to focus

07:25

on health equity

07:26

and then about eight months ago we

07:27

decided to zoom in on maternal health

07:30

we did an incredible amount of research

07:32

there are so many things we could have

07:34

selected right

07:35

we read over a thousand studies we

07:37

talked to experts we surveyed our staff

07:39

and we considered where we might be best

07:41

positioned to authentically move the

07:43

needle

07:44

and around that time i was completing my

07:46

birth doula training

07:47

so all right what's a bird zula if we

07:50

were in person i would literally make

07:51

you be like what's a bird too listen

07:53

just pretend you're doing that

07:54

and i'm gonna pretend that i can hear

07:56

you and oh my gosh i'm so happy you

07:58

asked all right so a birth doula

08:00

is somebody who supports a birthing

08:02

person throughout pregnancy delivery and

08:04

postpartum

08:05

a doula helps a birthing person have the

08:08

experience that they want to have

08:10

and prepare for an addition to their

08:11

family they help someone advocate for

08:13

themselves and navigate the health

08:15

system which are two things that have

08:17

never really sat right with me so let's

08:19

go back

08:20

the first thing that i said is that a

08:21

doula helps someone advocate for

08:22

themselves

08:24

um and what this is inherently

08:25

acknowledging right is that

08:27

oftentimes women are not heard they're

08:29

not believed in care settings and they

08:31

suffer as a result of that so the doula

08:33

is there to help amplify their voice

08:35

the second thing that i said is that the

08:37

doula helps somebody navigate the health

08:39

system

08:40

so we've already landed on this system

08:41

was not created for us

08:43

and that has real ramifications today

08:46

and

08:46

the doula is there to help navigate that

08:49

in academic and historical terms

08:51

i believe the correct term for a doula

08:54

is a village auntie

08:55

which is to say somebody who has been

08:57

through the experience of birth

08:59

and rearing children and is able to

09:01

support the birthing person throughout

09:02

that process

09:04

in spiritual terms a doula is someone

09:07

who bears witness

09:08

to someone throughout the experience of

09:09

birth a doula is someone who recognizes

09:13

birth not just as a medical event but as

09:15

a spiritual one

09:16

they are someone who facilitates a

09:18

conversation between the birthing person

09:20

and god allah buddha the great whatever

09:24

your inclination

09:26

they hold the space well a child moves

09:28

from the spiritual realm

09:29

into the physical one now i see my work

09:33

in deeply spiritual terms

09:35

and i take the tenets of dealership with

09:37

me into everything that i do especially

09:39

my work at optum

09:40

and i think it's a really beautiful

09:42

metaphor to think about how we can

09:44

transition and change because we're

09:46

always cycling through something right

09:47

that's a natural process of life

09:49

beginning and end

09:51

life and death we're constantly birthing

09:53

something creating something

09:55

whether that's a new idea or something

09:57

that we can physically see

09:58

right we do it at work we do it in our

10:01

families

10:02

we do it in our communities we're doing

10:04

it across society right now

10:06

we're birthing a new world and we're

10:07

laboring for that

10:10

so i see my role in social

10:11

responsibility in a similar way that i

10:14

see my work as a doula

10:17

my role is to clear out all the barriers

10:19

that prevent the spiritual experience

10:20

from occurring

10:22

that means addressing everything from

10:23

implicit bias to paperwork

10:25

administration all the business side of

10:27

things right and on the patient side

10:29

it's about preparation

10:31

education translating materials i'm

10:34

clearing out a way for

10:36

anything that prevents a patient and a

10:38

provider

10:39

from both showing up fully present in

10:41

their complexity and humanity

10:43

to be in deep relationship to one

10:44

another

10:46

that is the kind of experience that i

10:48

believe every person deserves to have

10:50

every single time that they interact

10:51

with the medical system and especially

10:53

when they're having a child

10:56

what i'm talking about is seeing people

10:58

as patients in care settings

11:00

instead of consumers in a marketplace

11:03

and this idea is at the very core of our

11:05

maternal health strategy at optum

11:08

that's our opportunity that's the

11:09

invitation to work at the intersection

11:12

of race and gender and change how

11:14

maternal health looks across this

11:16

country and let me give you that

11:17

landscape

11:18

right because it it's important context

11:21

and it's

11:21

kind of horrifying so in the united

11:24

states

11:25

we have the highest maternal morbidity

11:28

and mortality rate of any developed

11:30

nation

11:31

i want you to know that most of those

11:33

deaths are considered preventable

11:36

think about that most of those deaths

11:38

are considered preventable

11:40

we have an under supply of maternal care

11:44

providers

11:45

and we are the only country to guarantee

11:48

to not guarantee excuse me

11:49

access to provider home visits or paid

11:52

parental leave two things that we know

11:54

bolster maternal health

11:56

so in total what this means is that we

11:58

spend the most on our health care

12:00

we have the least amount of services and

12:02

supports

12:04

and therefore we have the worst maternal

12:06

health outcomes

12:07

now two other things i don't think we

12:10

realize that most people are one

12:11

paycheck away from being on medicaid

12:13

so that means that we need a broader

12:15

definition of who we're caring for and

12:17

how that happens

12:19

the second thing is something that a

12:20

provider said to me they said

12:23

callie sometimes i have a patient that's

12:25

pregnant they have their baby right

12:26

and then maybe i don't see them until

12:28

they get pregnant again because life is

12:30

happening

12:30

and they can't get a ride to my office

12:32

or their coverage changes

12:34

or they're working a lot of jobs

12:36

oftentimes it's all of those things

12:38

and then if there's any risk any

12:40

complication

12:41

the rate of morbidity is already so high

12:44

that by the time i see them again i'm

12:46

already working backwards

12:49

this really helped me put the work of

12:52

maternal health into a broader social

12:54

context

12:56

we can't talk about reduction in

12:57

maternal mortality and morbidity without

13:00

talking about women's health

13:01

we can't talk about reduction without

13:04

addressing the social determinants of

13:05

health

13:06

without talking about access and care

13:09

supports

13:10

and with these things in mind we got to

13:12

work we put our most vulnerable birthing

13:15

populations in the center

13:17

because i believe that when we solve for

13:18

our most vulnerable populations we

13:20

actually sell for everybody

13:21

and for us that means black indigenous

13:23

women of color

13:24

that means women who are incarcerated

13:27

birthing people who are experiencing

13:28

domestic violence

13:29

that means people who can't easily

13:31

access care and people whose experiences

13:33

never make it into any of the research

13:35

that informs clinical practice that's

13:37

who we centered

13:38

and we selected grassroots organizations

13:40

that were on the ground that were doing

13:42

the work and we said

13:43

we want to allocate dollars to you which

13:45

we don't normally do like i said but

13:46

we said look we want to partner with you

13:49

we love what you're doing we can amplify

13:50

this work together let's go

13:53

we launched pro bono projects to build

13:55

organizational capacity within our grant

13:57

partners which

13:58

you know helped them stretch their

13:59

dollars it had the secondary benefit

14:02

for us of being able to engage our staff

14:05

and helping them understand more about

14:06

the maternal health space

14:08

that also helped them interact with and

14:10

understand patient populations that

14:11

maybe

14:12

they didn't understand before they don't

14:14

look like they haven't had a chance to

14:15

interact with right

14:17

and as a third benefit that actually

14:18

started to change our organizational

14:20

culture

14:21

people started to think more expansively

14:23

about who we were providing care for

14:25

how we thought about creating our

14:26

products and services all of that right

14:29

we match our partners with internal

14:31

sponsors who could further identify

14:33

opportunities for our work to support

14:35

one another

14:36

and then because our social

14:37

responsibility program is focused on

14:39

internal systems change

14:41

um we work with our partners to see how

14:43

their strategies and insights can inform

14:44

our strategies

14:46

and then how we can continue to advance

14:48

their work on the ground

14:49

it's a virtuous cycle works really well

14:53

one of our partners ladies of hope

14:54

ministry is launching a doula training

14:56

program for incarcerated

14:58

people participants will learn to become

15:00

doulas

15:01

and then once they're released they'll

15:03

be able to obtain support to launch

15:05

their doula businesses

15:07

they'll also have the opportunity to

15:08

join a speakers bureau where they'll

15:10

help pass legislation to prevent

15:11

shackling

15:13

i don't know how many of you know this

15:14

but today in 23 states it's

15:16

common practice and totally legal to

15:18

physically restrain someone who is

15:20

incarcerated and having their child

15:21

to a bed shackle them to a bed

15:25

and from a doula perspective when you

15:27

are having sexual intercourse

15:28

and when you are physically laboring and

15:30

having a child your body's actually

15:31

running in parallels

15:33

biologically physiologically so what

15:35

that means

15:36

is that if you have experienced any

15:38

level of sexual trauma

15:39

and now you are being physically

15:41

restrained

15:42

you are likely being re-traumatized how

15:46

deeply

15:46

dehumanizing that is the furthest thing

15:48

from a spiritual experience

15:50

so we're starting to work on that one of

15:54

our partners the morehouse school of

15:55

medicine center for maternal health

15:57

equity

15:58

is conducting research on near misses to

16:00

ensure that the lived experiences of

16:02

women of color become a data point in

16:04

future research

16:05

it's the first of its kind we're working

16:08

with the wake forest baptist health

16:09

system

16:10

and the family justice center in

16:11

winston-salem to intervene at the time

16:14

of a domestic violence 9-1-1 call

16:16

if there's a pregnant person there we'll

16:18

make sure that they've got all the

16:19

supports that they need that they have a

16:20

medical pathway that they're getting

16:22

their prenatal care

16:24

we're expanding access to care by

16:26

developing financial sustainability

16:27

models with a federally qualified health

16:29

center

16:30

which is where most people who are

16:31

uninsured or underinsured are receiving

16:33

care

16:34

and like i said people are moving

16:35

between the population of being insured

16:37

or uninsured all the time

16:39

we're hoping that we can take that more

16:41

broadly across the country

16:43

we're developing a remote patient

16:45

monitoring program with our clinics in

16:47

washington state

16:48

to ensure that birthing people

16:50

understand how to advocate for

16:51

themselves and monitor for their own

16:53

um their own symptoms another is scaling

16:57

the work of cradle cincinnati

16:59

in ohio hamilton county they had the

17:02

nation's second

17:02

highest infant mortality rate and then

17:05

they started creating spaces for black

17:07

women

17:08

what they call queens village and they

17:09

were able to reduce

17:11

that rate by 24 in five years that's

17:13

pretty incredible

17:15

and as their executive director says to

17:18

make better decisions on infant

17:19

mortality

17:20

we followed black women

17:24

so all of this in total i think is great

17:27

i'm obviously biased right

17:28

but it's really not about us it's not

17:31

about how we show up

17:33

as a fortune 5 company it's not

17:36

just about how we do good it's about how

17:39

we fundamentally shift

17:40

maternal health across the health system

17:43

and bring it closer to equity

17:46

it's about how we show up as

17:48

co-conspirators in the work

17:49

and we establish trust with communities

17:51

of color

17:53

it's how we heal this part of the

17:54

medical industry's past and begin again

17:56

together i think of two things almost

17:59

every day

18:00

the first is a quote by martin luther

18:02

king jr he said

18:04

of all the forms of injustice inequality

18:07

in the health system is the most

18:09

shocking and inhumane

18:11

and the second is something that i saw

18:13

written on a sidewalk and it said

18:14

you're more powerful than you think it

18:16

was in little kid's handwriting

18:18

um so i want to pass those messages on

18:20

to you

18:22

and i want to encourage you to think

18:24

about the second quote

18:25

could to consider how you address the

18:27

first you or more are more powerful than

18:30

you think that you are

18:31

and inequality in the health system is

18:33

the most shocking and inhumane it is the

18:35

most shocking and inhumane

18:38

and if i may i'm going to ask you to

18:40

deploy your social

18:42

financial institutional capital to join

18:44

me in building a just and equitable

18:46

health system that actually works for

18:47

everyone

18:49

i'm going to encourage you to draw a

18:51

circle around your most vulnerable

18:52

populations

18:53

and to design the systems with them that

18:56

they need and that's a distinction right

18:58

you're not designing for them

18:59

you're designing with them and in doing

19:02

that what i'm also inviting you to do

19:04

is to be awed by what people are forced

19:06

to carry

19:07

instead of judgmental of how they carry

19:09

it

19:10

all of that in service of building

19:12

authentic relationships with our

19:13

communities which we're a part of right

19:15

individually as a group as an

19:18

institution

19:19

as a medical industry we're a part of

19:21

these communities

19:23

and to show up with the sole intention

19:25

of listening

19:26

learning and being in deep service and

19:28

relationship

19:30

let's model what we want to see

19:31

happening within the four walls of a

19:32

care setting

19:33

in our organizational partnerships and

19:36

ask yourself the questions that i opened

19:38

with

19:38

who are you how do you show up to this

19:41

work

19:42

and then ask yourself those questions

19:43

from an organizational perspective

19:46

we need every single person here

19:48

thinking about how we orient toward

19:50

health equity it will literally require

19:52

all of us that's what i'm birthing

19:56

i'm willing to labor for it every single

19:58

day and i hope that you'll join me

20:00

thank you

20:08

thank you so much cali for your

20:10

brilliant

20:12

opening keynote and for inspiring us

20:14

with your work

20:15

your passion and your mission

20:23

you

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