A1 Diversity and Inclusion to Achieve Health Equity Marcos L. Pesquera Vice President Health Equity, Diversity & Inclusion Tiffany Capeles Director Health Equity A Culture of Diversity and Inclusion to Achieve Health Equity 1
System Health Equity Council Health Equity, Diversity & Inclusion Council Regional Vice President, Mission Integration Chief Executive Officer, Central Louisiana Region Vice President, Medical Affairs, NLa System Director, Business Intelligence Chief Medical Officer, Health Plan Vice President HR, SPOHN/Santa Rosa Region Vice President, Advocacy & Government Vice President New Mexico, Mission Executive Vice President, Corporate Chief HR Officer Director Chile, Social Responsibility Manager, Supplier Diversity Vice President, Performance Effectiveness President, CHRISTUS Home Health Vice President, Comm/Public Affairs Director Mexico, Social Responsibility Chief Financial Officer, Northern Louisiana Region Senior Vice President Chief Nursing Officer Senior Vice President, Mission Integration Officer Senior Vice President, Health Vice President, Health Equity, D & I Vice President, Strategic Marketing Vice-President, Senior Counsel Vice President, Mission & Benefit Chief Executive Officer, CHRISTUS Health System Chief Executive Officer, ArkLaTex Market Vice President HR, Louisiana Regions System Director, International Quality Vice President, Mission Integration- International Diversity and Inclusion to Achieve Health Equity Diversity & Inclusion Cultural Competence Health Health Equity is the attainment of the highest level of health for all people. Health Equity means efforts to ensure that all people have full and equal access to opportunities that enable them to lead healthy lives. Would you want to be the smallest child in this image? Equality Equity 2
Care is The Relationship! Diversity & Inclusion 3
Diversity & Inclusion; Impact on Outcomes Diversity & Inclusion Racial and ethnic disparities in care may emerge from a number of patient level attributes. For example, minority patients are more likely to refuse recommended services, adhere poorly to treatment regimens, and delay seeking care. These behaviors and attributes can develop as a result of a poor cultural match between minority patients and their providers, mistrust, misunderstanding of providers instructions, poor prior interactions with healthcare systems, or simply from a lack of knowledge of how to best use healthcare services. Institute of Medicine Report, Unequal Treatment AHA: Equity of Care Pledge Diversity & Inclusion 4
Diversity: Race/Ethnicity and Gender (All US Regions & Corporate) Diversity & Inclusion 9 Diversity Representation at CHRISTUS of Communities Served Executives by Gender 8 7 6 59 % 5 4 41 % 3 2 AHA 2020 Leadership 17% AHA 2017 Leadership 15% White Black Hispanic Asian 2+ Races AI/AN NH/PI Unknown Female Male Associates Managers Executives Executive Workforce Diversity Internal Pipeline Diversity & Inclusion Goal: Represent the Communities we serve at all levels Number of African American & Hispanic Associates Mentee s (US Markets) Number of Women Associates Mentee s (International Markets) Request and review diversity demographics data for each region, discussions occur at all regional executive teams and develop and implement a plan to address gaps in representation by end of Q1 of FY 18 2 of all executives are in a formal mentoring relationship with a minority associate by Q4 of FY2018 5
Race, Ethnicity and Language Training: The Basics Diversity & Inclusion Training Objectives Why disparities and data are important What health disparities are and their impact on patients How to collect race, ethnicity and language data Which data collection categories to use Why the data collection technique matters How to ask so patients are comfortable How to address concerns How to address patient discomfort about providing the data How to respond to concerns and questions that patients may ask Cultural Competence 6
Culturally Competent Care Cultural Competence Practitioner s Guide The delivery of health care services that acknowledge and understand cultural diversity in the clinical setting, respects patients health beliefs and practices, and values cross-cultural communication. (Kaiser Permanente) Organizational Application A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enable effective work in cross-cultural situations. (Health Resource and Services Administration) What is Cultural Competence? Evidence Linking Communication to Outcomes Cultural Competence Emotional Intelligence Daniel Goldman Mirror neurons ensure that the moment someone sees an emotion expressed on your face, they will at once sense that same feeling within themselves. And so our emotions are experienced not merely by ourselves in isolation but also by those around us-both covertly and openly. Communication Patient Satisfaction Adherence Health Outcomes IOM Report; UNEQUAL Treatment 7
The Provider and Patient Interaction Cultural Competence Past Experience Race, Culture, Education, Knowledge, Gender, Class Reality Filters Culture, Education, Knowledge, Gender, Class, Social Standing, Race, Assumptions Assumptions Perceived Reality Patient Behavior Provider Behavior Perceived Reality Dr. Judy Ann Bigby, Associate Professor, Harvard Medical School Director, Office of Women Family and Programs, Brigham and Women s Hospital, Boston, MA. Linguistic Access Strategy Cultural Competence REL Data Collection Training Census Data Internal Assessment Language Access Needs Assessment Language ProficiencyAssessment QBS Level 1 and 2 Training Qualified Bilingual Staff, Customer Service Representatives Policies & Procedures Assessment of Language Needs Delivery System Training & Competency Monitoring & Evaluation CLAS Standards Joint Commission HIPAA Section 1557 of ACA ADA Title VI Interpreter Services Standardization Request for Proposal, System Leader, Liaisons, Champions, Regional Leaders. Tracking System Interpreter Services Modalities OPI, VRI, QualifiedBilingual Staff, Contracted In-Person Interpretation, Translation & Localization Patient Satisfaction Surveys Provider & Associate Feedback of Services Utilization Tracking Preferred Language Monitoring 8
Educational Opportunities Cultural Competence Cultural Competence I Front Line Cultural Competence II Clinical Unconscious Bias Diversity & Inclusion Tool-kit Fierce Conversations Qualified Bilingual Staff & Facilitator Training For other training opportunities, please visit us on SharePoint under the Diversity & Inclusion Department U.S. Department of Health & Human Services Physician s Practical Guide to Culturally Competent Care CME/CE Credits 9
CHNA / Social Determinants Process for Involvement in CHNA for SDOHs ID key United Way organizations FQHCs Other Health Care Providers Social Service Providers State Agencies Foundations Public Safety/Law Enforcement 1 Business organizations/chambers of Commerce Elected Officials Civic Organizations Advocacy Organizations Faith-based Organizations Catholic Charities CHRISTUS Fund Recipients Data Collection 2 Prioritize of Needs 3 Communication Validation Sessions 4 Health Needs Assessment Summary 10
Care for the Poor Review of FY 2017 Goal Strategic Goal Understanding your Target Texas Facility Caring for the Poor & Underserved Snapshot, FY 16 Texas Facility Zip Codes with Most Uninsured Non-Emergent Patients FY 16 ED Visits ED Uninsured ED Uninsured Non-Emergent (25% of ED Uninsured visits) (37% of Uninsured Non-Emergent) 78254 78253 5% 6% 78250 78251 9% 14% 78253 6% 78251 78228 14% 5% 78245 2 78245 2 78227 22% 78242 2% 78237 8% 78227 22% 78207 3% 11
Texas Facility Top 6 Chronic Diagnostic Codes of Target Zip Codes, Uninsured Non-Emergent Patients Nicotine 5% 15% 2 25% 3 35% 4 45% 42% Hypertension 32% Diabetes 14% Remaining Chronic Diagnostic Codes 7% Anxiety 6% Unspecified asthma, uncomplicated Other chronic pain 3% 3% Nicotine, Hypertension, Diabetes, Anxiety 93% Targeted Diagnostic Codes Hypertension Nicotine Dependence Diabetes Anxiety 6 5 4 3 Race/Ethnicity of Texas Facility Patients with Target Diagnostic Codes within Target Zip Codes 48% 33% 10 8 6 4 2 Demographic of Texas Facility Patients with Target Diagnostic Codes within Target Zip Codes 48% 76% 81% 36% 2 8% Race: Hispanic Age: 26-54 No PCP Catholic 1% 2+ Races Black Asian Hispanic AI/AN Unknown White 12
Care for the Poor and Underserved Progress to Date Mission Driven Goal: Improving quality of life for the poor and underserved populations, by providing the right care, at the right time, in the right setting. F03. Achieve a reduction in ER visits for the economically disadvantaged by improving access to appropriate care alternatives. Grant applications for special initiative programs were submitted for 7 of 8 markets. These grants support local programs to reduce inappropriate usage of the ED among the uninsured population. Care for the Poor and Underserved and Equity of Care goals will be consolidated in FY 2018 with a focus on hypertension. Economic Impact: Stimulating Our Local Communities 2016 Earl G. Reubel Award A national award recognition for Supplier Diversity Leadership among Hospital/IDN/GPO 13
Health Equity of Care Review of FY 2017 Goal Health Compass 2020 Equity of Care Improve disproportionate Emergency Department (ED) revisit rates by race and ethnicity for index ED visits. 14
Understanding your Target Louisiana Facility Zip Codes with the Highest ED Revisits Health 70611 7% 70634 2% Louisiana Facility ED Revisits Snapshot ED Visits 70669 5% 70663 5% 70665 2% 70601 70669 4 5% 70601 4 70611 7% 70605 14% 70607 12% 70615 70615 70647 4% ED Revisits 24% 70605 14% Louisiana Facility Top 10 Chronic Diagnostic Codes of Target Zip Codes Health Hypertension Diabetes 0 500 1,000 1,500 2,000 Atherosclerosis & Coronary Artery Disease Nicotine Dependence Major Depressive Disorder Anxiety Disorder Chronic Obstructive Pulmonary Disease (COPD) Heart Failture Gastroesophageal Reflux Disease (GERD) All Other Top 10 Chronic Diagnostic Conditions 39% Hypertension + Atherosclerosis & Coronary Artery Disease + Heart Failure + Hyperlipidemia + Diabetes 61% Hyperlipidemia 15
Health 6 5 4 3 47% Targeted Diagnostic Codes Hypertension Diabetes Atherosclerosis & Coronary Artery Disease Heart Failure Hyperlipidemia Profile Black 2014 White 2014 Total 70601 21,481 8,760 30,241 70605 2,913 28,613 31,526 70615 6,803 5,680 12,483 70611 807 18,082 18,889 70669 1,178 8,646 9,824 52% Total 33,182 69,781 102,963 % of Total Populati 32% 68% on Source: Census Data, 2014 American Survey 10 9 8 7 6 5 47% 95% 8 7 6 5 4 3 2 81% 69% 57% 13% 67% Medicare Medicaid Managed Care 4% 5% Other Self Pay 2 4 3 1% 1% 2+ Races Black AI/AN Asian Hispanic White 2 Race: Black Insured PCP Gender: Female Age: 55+ Equity of Care: Compass 2020 Guidance Health Threshold Metric Threshold Identify key factors influencing disparities among the most affected minority groups. (Completed by Q1 of FY 17) Target Developa planthat addresses how the key factors will be mitigated. Description 1. At leadership meeting, analyze regional 30-day ED revisit data by race and ethnicity a. 30-Day revisit baseline b. Top 10 diagnosis c. Geographic mapping 2. Select Target. 3. Selectsocial determinantor chronicconditionto address. 4. Literaturesearchon culturallycompetentbest practicesto addressselectedissues in target population. Maximum Target (Completed within Q2 & Q3 of FY 17) Maximum Select and implement an evidenced based culturally competent program to effectively reduce ED re-visits by race/ethnicity based on current local ED utilization. (Completed within Q3 & Q4 of FY 17) 5. Identify resources needed to support implementation of best practice. 6. Identifycurrentcommunityresourcesand programs, as well as, existing hospital programs that may be leveraged to meet resource needs for desired outcomes. 7. Developa culturallycompetentinterventionthat accountsfor the following components: a. Socioeconomic challenges b. Language barriers c. Health care access 8. Implement evidence-based program. 9. Program outcomes will be reported via the Triple Aim Framework (see below). 16
2018 Next Steps Combining Goals Health 4 35% FY 2016 Emergency Department Prevalence of Hypertension & Diabetes 3 25% 2 15% 5% Market 1 Market 2 Market 3 Market 4 Market 5 Market 6 Market 7 Market 8 Diabetes (Encounters) Hypertension (Encounters) 30-Day Non-Emergent ED Revisits Prevalence of Hypertension Health Market 1 Market 2 Market 3 Market 4 Market 5 Market 6 Market 7 Market 8 1 1.1 1.2 1.3 1.4 1.5 Rate of Revisits per Patient 17
Equity of Care: 3-year Goal Health Extending the healing ministry by improving the care coordination of our minority and most vulnerable populations resulting in improved blood pressure control. Health Acute Care/ Uninsured ACO & Health Plans Racial/Ethnic Minorities Sharing Our Commitment Goal: To establish a communication strategy that will share our commitment to health equity, diversity and inclusion, to not only internal stakeholders, but also to external stakeholders as well. External Website & Intranet External website Public Net Internal website/ Intranet Associates Net Content Mission Resources Initiatives Recognitions Evidence-based results Contact YouTube Channel Network Content Diversity Poster Health Equity Video MovieClip Mashup The Office Facebook People network Content Laws & Guidelines Real Stories Testimonials Spotlight Initiatives Events I commit to Health Equity Campaign Diversity/Color IQ Diversity Engagement Survey Twitter On the Go Network Content Short & Clear Updates Did You Know Diversity Facts A Thousand Words Picture Hashtags: #BlackFathers #DayInALifeOf #HealthEquity Highlights Country Shout out LinkedIn Niche network Content Top # Tips Impact Legislation Thoughts as Q&A CHRISTUS Calling CHRISTUS blog Heartfelt Real Life Stories 18
COLOMBIA Thank you! 19