Achieving Health Equity What Will it Take?

Transcription

1 Q1 These presenters have nothing to disclose Achieving Health Equity What Will it Take? Donald Berwick, MD, MPP, President Emeritus and Senior Fellow, IHI Ronald Wyatt MD, MHA, DMS(HON), Chief Quality Officer, Hamad Laura K. Botwinick, MS, Director, Graduate Program in Health Administration & Policy, University of Chicago Judy Fleishman, PhD, Director of Leadership and Improvement, Tufts Family Medicine Residency, Cambridge Health Alliance Amy Reid, MPH, Director, Co-chair, Diversity & Inclusion Council, IHI December 11, :30 am 4:00 pm #IHIFORUM

2 Session Description P2 Martin Luther King Jr. said, Of all the forms of inequality, injustice in health care is the most shocking and inhumane. The time is past due to address the moral imperative and practical necessity of achieving health equity. In its third year at the IHI National Forum, this session has been updated to include new content and new case examples. The session will help you build will for equity work and design an approach tailored to your setting. #IHIFORUM

3 Session Objectives P3 Identify strategies for Building Will to achieve health equity. Apply lessons from case studies and concepts from the IHI white paper on health equity. Develop an action plan for next steps. #IHIFORUM

4 Framework for Health Care Organizations to Achieve Health Equity Source:

5 Design of this Session P5 IHI Framework for Health Care Organizations to Achieve Health Equity Feature Case Studies for each component of the Framework Focus on how they did it, and tools used.

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7 Schedule for the Day P7 Introductions Overview: Don Berwick & Ron Wyatt 5 Pillars for Achieving Health Equity Case Studies Kaiser Contra Costa Cambridge Health Alliance Take-Home Messages

8 What is Health Equity? 8 Health Equity When all people have the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance. Health Inequity A difference or disparity in health outcomes that is systematic, avoidable, and unjust that is tied to social, economic, or environmental disadvantage. Braveman, P.A., Monitoring equity in health and healthcare: a conceptual framework. Journal of health, population, and nutrition, (3): p Kawachi, I., A glossary for health inequalities. Journal of Epidemiology and Community Health, (9): p. 647 Whitehead, M. and Whitehead, The concepts and principles of equity and health. Health Promotion International, (3): p. 217.

9 Inequitable Care & Health Outcomes 9 Communities of color (except Asians) more likely to report health as fair or poor. Infant mortality for blacks 2.5 times higher than for whites. Low-income and uninsured adults are less likely to rate the quality of their care as excellent or very good Blacks are 3 times as likely to die from asthma than whites. American Indian/Alaska Natives twice as likely to have diabetes. Homeless populations experience unsafe discharges. Black women have lower rates of breast cancer but are more likely to die from the disease. Women with disabilities are less likely to receive screenings for breast and cervical cancer. Blacks are 10 times more likely to have AIDS; Hispanics are 3 times as likely. American Indian/Alaska Natives twice as likely as whites to have frequent mental distress. 2.5 times more Hispanics as whites report having no doctor. Adolescents and adults with disabilities are more likely to be excluded from sex education. LGBT inequities related to oppression and discrimination - youth more likely to be homeless, 2-3 times as likely to attempt suicide, lack health insurance and lack knowledgeable health care providers 2014 National Healthcare Quality & Disparities Report. June Agency for Healthcare Research and Quality, Rockville, MD. CDC Health Disparities and Inequalities Report, HealthyPeople WHO disability and health fact sheet. Commonwealthfund, Racial and Ethnic Disparities in US Health Care: A Chartbook, Commonwealthfund, Achieving Better Quality of Care for Low-Income Populations: The Role of Health Insurance and the Medical Home for Reducing Health Inequities. May 2012.

10 Presenters and Panelists P10 Donald Berwick, MD, MPP, President Emeritus and Senior Fellow, IHI Ronald M. Wyatt MD MHA, Chief Quality Officer, Director, Hamad Healthcare Quality Institute, Hamad Medical Corporation Laura K. Botwinick, MS, Director, Graduate Program in Health Administration & Policy, University of Chicago, Chicago, Illinois Judy Fleishman, PhD, Director of Leadership and Improvement, Tufts Family Medicine Residency, Cambridge Health Alliance, Malden, Massachusetts Amy Reid, MPH, Director, IHI, Cambridge, Massachusetts Erika Jenssen, MPH, Assistant to the Health Services Director, Design Director, Blue Zone, Contra Costa Regional Medical Center, Health Centers and Detention Health, Martinez, California Winston F. Wong, MD, MS, FAAFP, Medical Director, Community Benefit Director, Disparities Improvement and Quality Initiatives, Kaiser Permanente, California

11 Equity vs Equality P11 #IHIFORUM Source: and Angus Maguire for the Interaction Institute for Social Change

12 December 11, 2017 This presenter has nothing to disclose Achieving Health Equity: What Will It Take? Ronald Wyatt MD, MHA, DMS(HON)

13 The Invisible

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16 Accessed via internet

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20 The Reasons

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23 Felon Label= Second Class Citizenship Once released from incarceration Often denied the right to vote Excluded from juries Denied food stamps Barred from public housing Denied financial aid Denied access to the mainstream economy Studies have shown 95% of employers immediately disregard an application if the box is checked indicating a felony conviction Sociologists have frequently observed that governments use punishment primarily as a tool of social control, and thus the extent or severity of punishment is often unrelated to actual crime patterns.

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27 Not just license plates: 54 products Alabama prisoners get 25 to 75 cents an hour to make Posted April 02, 2017 at 07:37 AM Updated April 02, 2017 at 07:37 AM

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33 ison-factory html

34 St. Clair s therapeutic community, which houses inmates with problems like substance abuse and mental illness. Credit: William Widmer for The New York Times

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38 Girl Interrupted accessed via internet 11/24/2017

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41 Potential Solutions Telehealth; The use of electronic information and telecommunications to improve longdistance health care; Medicaid financing for eligible prisoners; Medical parole. Accessed via internet 11/24/2017

42 Potential Solutions Integrating mental health care and substance use services Creating gender-specific programs that address the specific needs of and protect the human rights of women, lesbian, gay, bisexual, and transgender people, and men; Coordinating or integrating key services such as health care, mental health care, infectious disease care, access to essential medicines, substance use services, access to benefits, and family preservation across all levels of involvements at both the individual and organizational levels; Consider both health and criminal justice outcome A Review of Opportunities to Improve Health

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44 Thank-you

45 December 11, 2017 This presenter has nothing to disclose Achieving Health Equity: What Will It Take? The Framework for Achieving Health Equity Donald Berwick, MD, MPP

46 Just Mercy and The New Jim Crow Of al the forms of inequality, injustice in health care is the most shocking and inhumane.

47 Framework for Health Care Organizations to Achieve Health Equity Source:

48 December 11, 2017 This presenter has nothing to disclose Achieving Health Equity: What Will It Take? Making Equity a Strategic Priority Amy Reid, MPH

49 Make Equity a Strategic Priority The What Equity is articulated explicitly in your organization s strategic plan documents Leadership communicates the importance of equity as standard practice Staff are aware of the organization s equity priority and buy in to it The board is engaged with your health equity agenda Departments and teams are funded to be able to impact equity

50 Make Equity a Strategic Priority The How Understand your organization s process and timeline for updating your strategic plan Whose buy-in and championing support do you need? Map your key players Begin one on one meetings to align interests Discuss how equity fits with your current culture to understand and prepare for what may help and hinder advancement of this priority in your context Add equity to an upcoming board meeting agenda and get their support to hold you accountable Integrate equity in to upcoming leadership messaging opportunities Trainings to develop a shared language and understanding of history

51 Table Discussion Exercise Is health equity as strategic priority for your organization? How do you know?

52 What Will It Take? Erika Jenssen, MPH Assistant to the Health Services Director Design Director, Blue Zone

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54 Contra Costa at a Glance

55 Contra Costa Health Services

56 CCRMC Equity Infrastructure

57 CCRMC Equity Efforts

58 CCRMC Strategic Plan

59 AIM

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62 Contra Costa Health Services Equity Team

63 Personal Health Equity Team