Health Equity

Ed Prewitt:

Thank you, Fred. We are here today for a discussion about a key aspect of Anchor Institution's health equity. I'd like to welcome our special guest, Catherine Anderson, who is Senior Vice President for Health Equity Strategy at UnitedHealth Group.

Catherine Anderson:

Thank you, Ed. It's a privilege to be here today.

Ed Prewitt:

All right, well, let's jump in. So while the need for health equity is obviously not new, there's an intentional focus on it by many healthcare organizations today. We've been publishing quite a bit about this in NEJM Catalyst. In your role as United Health Group's Leader of Health Equity Strategy, what are you focused on?

Catherine Anderson:

We're focused on several things, and I would say just fundamentally making sure that health equity is core and embedded in all of the work that we do across the entire organization. And being really intentional about having health equity as part of who we are and how we work is really key to moving the needle, quite frankly, and improving outcomes aligned to our goals. 

Last year, our board, as part of their work in supporting the health equity initiatives across the organization, agreed to a list of six key areas where our efforts would really be focused. And those areas are mortality and life expectancy, socioeconomic challenges, care experience, and the workforce care, access and affordability, behavioral health and mental health, and chronic condition management. And by organizing our efforts around those six key pillars, has allowed us to really focus all of the efforts of the organization to make sure that we're driving the best in them.

As an example, we launched our Communities of Health program to convene community partners, to provide underserved communities with the infrastructure they need to be able to increase access to care and create equity in health outcomes. For example, in St. Paul, Minnesota, we partnered with Fairview Health System and three other organizations to provide services that increase access to primary behavioral healthcare and nutrition support.

Similarly aligned to the six pillars in '22, we committed to expanding the pipeline of diverse healthcare professionals and addressing the projected healthcare shortage, excuse me, health workforce shortage. And by doing this, we're able to build reflective workforce that is like the populations that we serve and the communities that we serve.

Ed Prewitt:

I think a really important part of this is that your board has adopted and stated these key pillars, and so the organization knows this is a strategy. When other organization leaders are considering what they should work on to develop their own health equity strategy, what are the building blocks that they should begin with?

Catherine Anderson:

Well, and I'm glad you mentioned the commitment of the board and that we've made these things public because I do think that's part of the building blocks for any organization that's looking to really make an impact in health equity because the organization needs to anchor itself against shared goals.

Beyond that, those organizing pillars as we've done our work and what I think others need to think about is how do you build the infrastructure to be successful? And within that infrastructure, we need to create rigor so that there's an opportunity to understand first the disparities that are happening within specific communities or populations. And then how are the efforts and the interventions that we're designing really driving impact?

And by building that rigor and how we use data, how we design interventions and how we measure impact allows us to be able to check ourselves and see are we really improving the lives of individuals that we serve? 

Beyond that rigor and those core organizing principles or pillars, I think the other thing that we've learned is really the importance of engaging with communities and really building that community engagement as core competency for the organization. We know through our work, and frankly it started many years ago when we were awarded an accountable health community by CMMI, that genuinely engaging with communities is really important to actually driving impact. And through our work, both in Hawaii and now nationally, we know that there's a huge opportunity for the private sector to really take an outside in approach to population health design by learning from the community.

We can have all of the best intentions and data, but at the end of the day, we know that communities know best what will be needed to really improve outcomes for the people that live or are served in those communities. And our role is really around bringing the analytics and the data, helping to build meaningful interventions, and then how to measure the impact of those interventions.

Ed Prewitt:

I'd like to go deeper into what you were just saying about working with community-based organizations. And these are partnerships that many organizations find important. They may not have the resources to support patients and communities at scale. And as you say, you want to work with communities, you need to work with communities. So what role can these partnerships play?

Catherine Anderson:

Well, I think first and foremost, we have to know that no one organization can do everything on its own. And that has been a realization for us and really why we have stated that building meaningful relationships with communities is and should be a core competency of ours. And so addressing and coming into the conversation knowing, regardless of where you're coming from or what your organization's mission is, you can't do it alone. 

And so we look very intentionally about how to bring a broad set of partners to the table to engage in a meaningful way. And this could be faith-based organizations, community-based organizations, employers, other payers, and it really depends on the individual community and what the real need is and what the community wants to lean into. 

NA couple examples that I'd love to provide of how this work has come to life for us is first is a model that we call UnitedHealthcare Catalyst, that was launched in Maui, and was really around an understanding of the challenges faced by Native Hawaiians and Pacific Islanders. Specifically, we know that they're two and a half times more likely to be diagnosed with diabetes. With that as the data platform and our understanding of the population being served, we also then had to learn where were there opportunities to actually improve the outcomes for those populations. 

And we learned that food insecurity is a huge issue on the islands, and a lot of that is, I think, around the cost of food and the availability of food in Maui, but also about food that is appropriate to the specific cultures of the people who live on the islands. And with that as some of the foundation in building relationships with key partners, including the University of Hawaii and Waipono Aquaponic Greenhouse, and the FQHC locally, we were able to design an intervention that maximized the capacity of local farmers to grow food that is culturally aligned to the needs of the population. And then working with the FQHC to expand the delivery of that food along with education about how to use specific ingredients, how to eat healthy. And that combined effort with a lot of different partners really is what's core to the work that we're doing in communities.

Another example would be the work that we're doing in St. Paul, Minnesota in a partnership with Fairview Community Health and Wellness Hub. And as I mentioned before, some of the biggest challenges in that specific community were around being able to meet the health and wellness needs of a very diverse community. And so our work with Fairview is really to build a hub that serves community members to help them access care to primary and behavioral health services. And the partnership has been both with Fairview but then other partners, again, specific to the needs of the community of St. Paul. And in this instance, similar to Hawaii, we've been working with primarily BIPOC-owned farms to purchase fresh produce to bring to the hub to make available to the community around Fairview.

Ed Prewitt:

So you work in an organization, very large, has a lot of social and economic capital, and this presents opportunities. How do you think about leveraging this for maximum impact for patients, communities, and other stakeholders?

Catherine Anderson:

We began very much from day one of looking about how do we partner and who do we partner with, and how do we make sure that long-term, whatever the intervention is, will be sustainable. The other thing that we think about is how do you get to the root cause of the highest priority needs? It's really easy for us to look at data and say, we know specific disease states exist in a specific community or disparities exist. 

But the challenge with just looking at the data is we often don't understand the root cause, and to be able to pinpoint what the specific solution would be for each community. This is not something that you scale and you do the same thing everywhere. It has to be very customized based on the listening to the community of what's really driving the challenges that community faces.

And then I would say the other thing that's really important is making sure that you build and maintain collaborative partnerships, and they need to be broad. The examples I shared had providers involved, had community-based organizations, had farmers. We've got some educational institutions involved in some of our work. And so it's really important to be intentional about building those partnerships and collaborating with the organizations who care most about the population that we're trying to collectively improve.

And then I would say that the other thing to be really mindful of, and this has been a lesson for us as we've embarked on this work, is making sure that the communities have sufficient infrastructure and resources. One of the things that I think is a huge risk for all of us as we think about this work is assuming that a bunch of money or a bunch of other resources could really drive impact, when in fact there wasn't enough infrastructure to begin with to really move the needle.

An example of this has been our work in Memphis. We knew based on the data that neighborhoods in Memphis have some of the highest rates of cardiac disease, diabetes, hypertension, and emergency room visits in the area. And when we looked at the data and we started to engage with the community, we knew that there was a gap, by candidly, in access to services, which was driving some of the lowest rates of primary care that we see in the Memphis area.

And so in partnership with the University of Tennessee Health Science Center, West Clinic Community Partners, we brought this data to the convening and spent time understanding what really was driving the challenges that were resulting in the data that we were seeing. And based on that partnership and collaboration, University of Tennessee established a health hub with partnership from United in the Uptown community to holistically provide care to people who live there at no cost.

Ed Prewitt:

These are great examples of really substantial programs, and as you emphasize, they're sustained. They're sustainable. Just to wrap up, how would you describe the goal, the overall goal of all of these programs?

Catherine Anderson:

Our goal is to help communities work together to improve health and social outcomes in a sustainable way. Certainly focusing on advancing health equity and at the same time looking at community vitality and doing it really at a systemic level, so that we know that the efforts that we collectively put in will drive the greatest impact.

Ed Prewitt:

Terrific. Well, thank you Catherine for sharing your insights.

Catherine Anderson:

This has been a great conversation. Thank you.

Ed Prewitt:

And I'd now like to welcome Dr. Namita Seth Mohta, who's the Executive Editor of NEJM Catalyst Innovations and Care Delivery.