Catholic Health World - March 1, 2021

Pandemic exacerbates dementia 2 Executive changes 7 PERIODICAL RATE PUBLICATION

MARCH 1, 2021 VOLUME 37, NUMBER 4

Catholic health care works to reverse worrisome dip in children’s health insurance coverage

By LISA EISENHAUER

Statistics show a troubling trend for children nationwide: more of them have no health insurance.

After falling to 4.7% in 2016, the percentage of children without health coverage ticked up to 5.7% by 2019, according to an annual analysis of census data done by the Center for Children and Families at the Health Policy Institute at Georgetown University. The change means that the number of children on public or private insurance rolls shrunk by about 726,000 children over three years.

Experts like those who do the analysis for Georgetown fear that the number for 2020, which won’t be known before this fall, could show a sharp spike because of the loss of jobs and employer-provided

insurance due to the coronavirus pandemic.

“It’s extremely troubling. We knew the number was going in the wrong direction,” said Joan Alker, who co-authored the analysis. “We’ve known that for a couple of years, and of course the pandemic has so many negative consequences for children and everybody in our society.”

Dr. Heidi Sallee, a pediatrician at SSM Health Cardinal Glennon Children’s Hospital in St. Louis, talks with a young family. The family is featured in a video that is part of CHA’s Medicaid Makes It Possible campaign.

Impact beyond families As executive director and a co-founder of the Center for Children and Families, Alker has spent years documenting how factors like access to health care improve the lives of children and families. Children without insurance, for example, are more likely to suffer from chronic but treatable conditions like asthma.

Continued on 4

In-house entrepreneurs CHA leads, members drive effort to end racism, health disparities ready Providence’s A membership-driven initiative being third incubated led by CHA is addressing systemic racism and its effects, both within Catholic health company for spin-off care and throughout the communities that

By LISA EISENHAUER

By JULIE MINDA

This quarter, Providence St. Joseph Health’s digital innovation unit is launching DexCare, the third company that it has incubated for spin-off. Under its Entrepreneurs-In-Residence program, the notfor-profit Catholic health system employs businesspeople who shepherd some Providence start-ups to independence and continue to lead those companies as they find their legs in the marketplace.

Aaron Martin, Providence executive vice president and chief digiMartin tal officer, says employing entrepreneurs in this way is part of the health system’s nearly decade-long acceleration of its digital technology strategy. The Providence Digital Innovation Group Martin heads buys or develops from scratch, nascent technologies with the potential to significantly enhance health care delivery.

It refines the products and field tests them at Providence health care sites.

If a technology platform shows broad commercial promise, the digital group creates a start-up company to move the product along to a wider market. It may hire entrepreneurs with a proven track record to position the start-up to eventually leave the incubator and secure first-round financing from private venture capitalists.

Providence will receive founder’s shares in DexCare by virtue of its role as creator of the company. Separately, Providence’s venture capital arm, Providence Ventures, will evaluate DexCare as a potential investment.

Proof of concept Created and then scaled by the Providence Digital Innovation Group since about 2016, DexCare is a technology platform that the health system uses to make it easier for people who are searching for an ambulatory care provider to find a clinician Continued on 6

Catholic health ministries serve by taking steps to end health and social disparities.

The effort includes ensuring that testing and treatments for COVID-19 are available and accessible in minority communities and advocating for better schools, safe housing, economic opportunity and criminal justice reform.

The initiative, Confronting Racism by Achieving Health Equity, was rolled out to the public on Feb. 4 with the pledged support of 23 of the nation’s largest Catholic health care systems. The systems together employ nearly a half million people across 46 states and the District of Columbia and care for almost 4 million patients annually.

Sr. Mary Haddad, RSM, Sr. Mary CHA president and chief executive officer, said during a press briefing announcing the initiative that Catholic

Saint Agnes Health Institute staff set off to knock on doors in Baltimore in August to promote participation in the census, which determines how much federal assistance communities receive. Saint Agnes Hospital, part of Ascension, started the institute in 2018 to partner with the community to promote wellness and disease prevention.

health ministries’ efforts to end racism go back to their founding by congregations of women religious who cared for the poor and vulnerable. Those congregations led efforts

to integrate care for patients of color in the last century and lent their voices on behalf of justice during the civil rights movement.

Continued on 3

In ministry affinity groups, women build up their careers, capabilities

By JULIE MINDA

Debra Rockey, right, Trinity Health senior consultant for human resources and organization effectiveness, chats with a participant at the Women's Empowerment Fall Event in October 2019, held at St. Mary Mercy Livonia Hospital in Livonia, Michigan.

When employees are more engaged in their workplace, they are more productive, deliver better outcomes and are more likely to stay with an organization.

One way that some Catholic health systems are deepening employees’ engagement is by hosting affinity groups for employees who share common interests, and multiple ministry systems have established such groups for women. The groups aim to help women build connections with their colleagues, establish mentor relationships, advance their careers, build their skills and nurture their souls. Representatives from a sampling of systems say the groups’ work has a direct impact on the mission.

“When people are more engaged there is less turnover and greater employee Continued on 8

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CATHOLIC HEALTH WORLD March 1, 2021

Pandemic adds to stress of patients with dementia and their caregivers

By LISA EISENHAUER

As if the illness and deaths caused by COVID-19 weren’t bad enough, research shows the pandemic and precautions put in place in response have caused stress that has exacerbated the conditions of many nursing home residents with dementia and made caring for them more challenging for workers.

Sr. M. Peter Lillian Di Maria, O CARM, director of Avila Institute of GerSr. Di Maria ontology, and her Avila colleague Alfred Norwood shared what their review of the latest studies of long-term care center residents found during a CHA webinar in late January titled “Dementia Care during a Time of Norwood COVID.” They also offered suggestions to help keep residents’ mental function from declining and to address the heavier burden that has been placed on care centers’ staff.

Studies done since the start of the pandemic clearly show what experts in nursing home care like her and Norwood have long known, Sr. Di Maria said. “Stressed residents with dementia are more dependent and behavioral,” she said. “These increase both caregiver time and caregiver stress, which ultimately results in caregiver fatigue, compassion burnout, care staff turnover, and higher labor costs.”

The research also has pointed to new findings such as that COVID can cause or worsen dementia, Sr. Di Maria and Norwood said. Among the studies that the pair referenced were: A survey done in April by medical staff of 139 patients in Italy with dementia and cognitive disturbances that found that 54.7% of patients in the study group “experienced the worsening or the onset of behavioral disturbances, with agita-

COVID worsens behavioral issues in patients with dementia Over 50% of nursing home residents have dementia After COVID, residents with dementia declined • 56% had increased behavioral issues • 34% had worsening cognition • 18% had functional decline COVID mortality increased with • Number of aided activities of daily living • Severity of dementia Sources: “Facing Dementia During the COVID-19 Outbreak,” Journal of the American Geriatrics Society, June 9, 2020, and “Risk Factors Associated With All-Cause Mortality in Nursing Home Residents With COVID-19,” JAMA Internal Medicine, Jan. 4, 2021.

tion/aggression, apathy, and depression representing the most commonly observed manifestations.”

A survey of 4,913 caregivers of patients with dementia in Italy that found increased behavioral and psychological symptoms such as irritability and apathy in 60% of the patients after a month in quarantine due to the pandemic. It also found stress-related symptoms in twothirds of caregivers. “Health services need to plan a post-pandemic strategy in order to address these emerging needs,” the authors concluded.

A look at best practices done by Canadian researchers that concluded that efforts should be made to address the psychological health of frontline health care workers and informal caregivers “as they are paramount to success” in dementia care amid the pandemic.

Less control, more dependence Norwood discussed how changes in activities and surroundings and loss of control over those things can lead to adverse reactions from patients with dementia. He identified new sources of stress related to COVID safety protocols, such as being confined to their rooms, cut off from in-person visits with relatives and cared for by people wearing masks.

“Stress triggers survival, fight-or-flight reactions in residents, making them either more dependent or more behavioral,”

he said.

He and Sr. Di Maria said the behavioral disturbances can take many forms, including hallucinations, delusions, agitation and aggression. Meanwhile, overwhelmed residents sometimes give up on or forget how to perform basic activities of daily living — such as brushing their teeth or feeding themselves — making them more dependent on care providers.

Norwood noted that while there are medications available that have been shown to slow the progression of some forms of dementia, there is no known medical treatment or pharmacological cure for the condition. He said most patients with dementia, nevertheless, are on some form of psychological medication, usually for depression, anxiety or sleep disorders.

Those types of drugs can introduce additional concerns. Norwood said research has found psychotropic medications “often escalate rather than reduce adverse reactions or behaviors.”

Overlooking pain Norwood said unmanaged pain is another cause of behavioral disturbances.

Researchers say pain often goes unnoticed in patients with dementia and can be masked by symptoms of COVID. Identifying and effectively treating pain could go a long way in addressing behavioral issues, Norwood said.

Norwood said there are nonpharmacological means to keep patients with dementia calm and less likely to act out.

Among those are creating a predictable, low-stress environment by keeping to strict schedules and routines, adjusting activity and lighting to those schedules and improving sleep management.

Sr. Di Maria offered additional “lowlabor interventions” that have been shown to put patients with dementia at ease, such as video visits with loved ones, regular exercise and aromatherapy.

“These are all activities that create cues to trigger retained behaviors, such as dancing, walking or singing along with very familiar songs,” she said. “So, the many things that we already know and do in our programs are also helpful now as we’re coming out of COVID.”

Overwhelmed staff For the long term, Sr. Di Maria recommended that to meet the physical and emotional needs of residents nursing homes adopt a “relationship-centered” care model. In that model, staff works to build stronger bonds with residents, reach more definitive diagnoses of residents’ conditions and craft specific plans for dealing with chronic issues for each resident.

Meanwhile, facilities should address the extra toll the pandemic has taken on staff, Sr. Di Maria and Norwood said.

Workers should be given more training in how to use the interventions, how to problem solve so patients’ conditions don’t escalate and how to reduce their own stress through breathing and meditation techniques.

Research says such investments in staff will pay back in lowered expenses in the future; in less troubled staff, residents and families; and by aligning everyone “with the mission that each of us wants and that is giving the best possible care that each of us can based on what we know today,” Sr. Di Maria said.

A recording of the webinar is available to CHA members at chausa.org/ online-learning. leisenhauer@chausa.org

Upcoming Events from The Catholic Health Association Virtual Meeting: Sponsor Formation Program for Catholic Health Care – Session Three March 4 – 5 (Invitation only)

Virtual Meeting: Theology and Ethics Colloquium

March 10 | 11 a.m. – 6 p.m. ET (Invitation only)

Webinar: Advanced Issues in Sponsorship – Session One: Sponsors and the Board Relationship

Formation Leader Community Networking Call March 11 | 1 – 2 p.m. ET

Webinar: Advanced Issues in Sponsorship – Session Two: Prophetic Action and Advocacy April 14 | 2 - 3:30 p.m. ET

Webinar: Advanced Issues in Sponsorship – Session Three: Sponsor and Mission Leadership Relationship May 12 | 2 - 3:30 p.m. ET

Webinar: Advanced Issues in Sponsorship – Session Four: Recruitment and Selection of Sponsors June 9 | 2 - 3:30 p.m. ET

Webinar: Advanced Issues in Sponsorship – Session Five: Initial and Ongoing Formation of Sponsors July 14 | 2 - 3:30 p.m. ET

Webinar: Advanced Issues in Sponsorship – Session Six: Ministry Identity and Sponsor Assessment Aug. 11 | 2 - 3:30 p.m. ET

March 10 | 2 - 3:30 p.m. ET

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© Catholic Health Association of the United States, March 1, 2021

March 1, 2021 CATHOLIC HEALTH WORLD

Ending health disparities

Confronting racism as a ministry

From page 1

The 23 Catholic health care organizations that have signed the Confronting Racism by Achieving Health Equity pledge are:

“But over the past year, we have been confronted with the fact that any strides that have been made against racism have simply not been enough,” Sr. Mary said. “COVID19 and the police killings of George Floyd and others impel the Catholic health ministry to address the devastating impact that racism has on the health and well-being of individuals and communities.”

‘Seize this moment’ Lloyd H. Dean, chief executive officer of CommonSpirit Health, said at the briefing that Catholic health care providers see systemic racism as a threat that impacts their ability to Dean improve the health of the communities they serve. He pointed to statistics that show Black, Hispanic and Native Americans are almost four times more likely to be hospitalized for COVID and almost three times more likely to die of the virus than white Americans.

He said that while efforts have been made in the past to address racial disparities in health outcomes, they have failed because they have been episodic. Catholic health care systems comprise the largest nonprofit sector in health care in the U.S. and collectively they can make strides and join with others who share their vision for strong equitable health and mental health care.

Now is the time, Dean said emphatically.

“Shame on us if we do not seize this moment as a nation and as a society to make measurable, demonstrable and systemic changes,” Dean said.

The initiative has four focus areas for Catholic health systems. The first is to com-

Staff of Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, take a knee in support of racial equality in June. The hospital is part of the Franciscan Missionaries of Our Lady Health System.

mit to ensure that testing for COVID is available and accessible in minority communities and that new treatments are distributed and used equitably as they become available. Signatories to the pledge also commit to prioritize vaccinations for those at higher risk — seniors and communities of color, including Native American communities.

Change from within The second focus area is enacting change across health systems. Dean said one way that CommonSpirit Health is working to address root causes of health inequities is by partnering with the Morehouse School of Medicine in a 10-year, $100 million initiative to develop and train more culturally competent providers and doctors of color.

Receiving care from a physician of the same culture builds the trust of patients and can lead to better health management and health outcomes, he said. Morehouse is one of only four medical schools at historically Black colleges.

Catholic health systems are examin-

ing how their organizations recruit, hire, promote and retain employees; how they conduct business operations, including visible diversity and inclusivity at the decision, leadership and governance levels; and how they incentivize and hold leaders accountable.

Ernie Sadau, president and chief executive officer of CHRISTUS Health, said in his remarks at the briefing, “visible diversity and inclusion” are critiSadau cal. He noted that the system’s board makeup is 45% minority and 40% women. In Mexico, a CHRISTUS Health leadership program increased the percentage of female executives to 45% from 10% in just a few years.

“We have evidence that our work is changing things for our associates, for our patients, for our communities that we serve,” Sadau said. “CHRISTUS is changing from the inside out and we’re proof that change is possible.”

Time is right to take the lead, say those behind CHA’s equity pledge F

or Dr. Rhonda Medows, it was a “trifecta of harm and tragedy” that prompted her to urge CHA and its members to take the lead in confronting racism and health disparities.

That trifecta was the coronavirus pandemic, the economic downturn caused by a nationwide Medows lockdown, and the racial injustice and hate crimes that gave rise to a national outcry.

“Altogether it made it clear in my mind that this was not something that we could sit by the wayside on, that we had to be a powerful voice to advocate on behalf of people in general and in particular people of color who were being so enormously harmed,” says Medows, the president of population health management for Providence St. Joseph Health. She is chair-elect of CHA and leader of its advocacy and public policy committee.

Medows and fellow board member Darryl Robinson, senior executive vice president and Robinson chief human resources officer at CommonSpirit Health, were among the leading early proponents behind CHA’s Confronting Racism by Achieving Health Equity pledge. The CHA Board of Trustees approved the pledge in July. Providence St. Joseph Health, CommonSpirit and 21 other large Catholic health systems have signed on.

Time to double down

Robinson sees the vow to work to end racism, health inequities and social injustice as an expansion of the diversity, sustainability and philanthropy efforts already underway at CHA member organizations as well as at CommonSpirit. “I just think that our collective legacies underscore that we have actively been involved in this work in so many ways, it was really

more of an extension of what we are already doing,” he says. “The other thing I think is that we are part of the broader society and we’re all major employers, and if not us, then who will do that work?”

While many systems have long embraced diversity and community outreach as part of their mission, Robinson says he hopes that joining the CHA-led effort will prompt them to redouble that work. “It encourages people to, if you’re in a community that is having difficulties, extend your reach further into them,” he says. “If you are focused on people of color, which is great, but there are other individuals who are within your communities who are also struggling, extend yourself into those parts of your population as well.”

Medows says she wants the pledge to move health systems to act. “What I’m hoping it accomplishes is that we move beyond stating that we are not racist and stating we are in support of loving our brother and being inclusive and valuing diversity, to actual action, action that has a measurable impact,” she says.

‘Woke’ nation

The time is right for this type of commitment not only because of the disproportionate toll of COVID-19 on communities of color and the rage sparked by the police killings of George Floyd and others, Medows says, but also because the national discussion around those tragedies has made the broader public aware that minority and vulnerable communities do not get equal treatment. She noted, for example, the fact that Black, Hispanic and Native Americans have had much higher hospitalization and death rates from COVID than white Americans has been spotlighted in the media and decried by civic leaders.

“I think, as my son would say, people got woke and stayed that way and actually learned and listened,” she says. “It’s really hard to know something and just simply ignore it after that.”

To change the nation’s course and end its inequities, Medows says three things need to be addressed: the social determinants of health, those elements such as housing and good nutrition that impact a person’s life and

well-being; the racism and implicit bias that affects the quality of care for patients; and the access to and quality and type of health care people are given. All of those are focuses of the pledge.

Her request of care providers who want to personalize the effort would be to do a self-assessment and ask themselves what do they know and what do they need to learn about the communities they are caring for, to ask the people in those communities what they are concerned about and to listen closely to the answers, and to be patient and willing to go back again and again to hear what patients and communities want and need.

“People deserve the dignity and respect of a conversation, of information sharing and the ability for people to listen to what they have concerns about and what questions they may have,” Medows says.

‘We have to do better’

Robinson views the equity pledge as part of a much wider movement needed to improve the prospects of the next generations. He says the effort must go beyond health care to address the broader needs of distressed communities. When there are limited employment opportunities, affordable housing and health care access, people are forced to make difficult choices, he says. “Members of challenged communities must have the capability to fully compete in an equal and equitable manner. That does not exist today.”

For individual care providers, he hopes that committing to equity will prompt them to search for deeper meaning in their careers. For health systems, he hopes the pledge prompts them to open opportunities to a wider cross section of workers from within their communities.

“We have to do better, as a nation, as member organizations, as individuals,” he says. “We have to do better, and we can.”

3

Ascension Avera Health Benedictine Bon Secours Mercy Health CHRISTUS Health CommonSpirit Health Covenant Health Elizabeth Seton Children’s Franciscan Missionaries of Our Lady Health System Franciscan Sisters of Christian Charity Sponsored Ministries Holy Redeemer Health System Hospital Sisters Health System Mercy Mercy Health Services MercyOne Peace Care St. Ann’s PeaceHealth Providence St. Joseph Health SCL Health Sisters of Charity Health System SMP Health System SSM Health Trinity Health

The third focus area is advocating for improved health outcomes for minority communities and populations. Members will promote and improve the delivery of culturally competent care and oppose policies that worsen or perpetuate economic and social inequities, including when it comes to such issues as education, housing and criminal justice reform.

Building trust The fourth leg of the pledge is to strengthen trust with minority communities. Signatories vow to foster, strengthen and sustain authentic relationships based on mutually agreed goals to better understand the unique needs of their communities.

Dr. Tamarah DupervalBrownlee, senior vice president and chief community impact officer with DupervalAscension, said her system Brownlee is keenly aware that trust, honesty and transparency are keys to giving communities the best possible care.

“Our Catholic ministry is called to take an active and intentional role to improve care and address what matters most to those we serve in many ways,” Duperval-Brownlee said.

She said Ascension is building trust within the communities it serves in several ways, including by tracking health disparities, addressing and removing socioeconomic barriers to better health, ensuring representation of those communities in health care teams, investing in sustainable structures and resources to ensure that health care advances are available equitably and don’t compound disparities, and by applying “cultural humility” so as to listen better and understand issues affecting the health and well-being of people who’ve been marginalized.

Accountability and commitment Sr. Mary said the initiative will produce measurable outcomes. “We will be putting measures in place that will be able to track the progress, not only to hold ourselves accountable but also to look at ways that we can continue to improve.”

In offering inspiration for the effort, Sr. Mary cites a quote from Pope Francis: “We cannot tolerate or turn a blind eye to racism and exclusion in any form and yet claim to defend the sacredness of every human life.”

More information about this initiative can be found at WeAreCalled.org.

— LISA EISENHAUER leisenhauer@chausa.org

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CATHOLIC HEALTH WORLD March 1, 2021

Children’s insurance

public safety net programs by immigrants, and red tape barriers that make enrolling and The effects of that illness can spiral staying enrolled challenging. beyond just the children’s health, Alker Confusion and red tape said. It can affect their education by causwere the reasons cited for a ing them to miss class time and lose ground drop in about 100,000 children in their studies. It can from the Medicaid rolls in Misaffect their parents’ finansouri from mid-2018 through cial stability if the family’s 2019. As the state changed its only option for medical verification requirements, it treatment is emergency removed ineligible adults from care, which can carry its public health insurance rolls steep charges. as well as their children, many The strain eventually of whom remained eligible for Alker extends to the rest of sociMedicaid or CHIP programs. ety as children and their families struggle, “I think it may have been a Alker said. “That’s why we need to make combination of factors. Some sure all children are covparents moved out of state, ered and they are covered and some probably didn’t realcontinuously.” ize that they had to reapply for CHA has made chilchildren who still qualified,” dren’s health care covsaid Deidre Griffith, regional erage one of its advo- A staff member at Community Health Initiative Napa County in California discusses insurance options with a family. The director of community health cacy focuses. Paulo nonprofit works with Providence St. Joseph Health and many other partners to help clients access health care and health for SSM Health.

Pontemayor, a CHA direc- insurance.

Griffith said the situation Pontemayor tor of federal government has been rectified in part by relations, said the organization is working under the Trump administration. “We just provide health coverage to more than oneoutreach to families from with others, including the Children’s Hos- need a kind of renewed national commit- third of the children in the United States. community-based assis­ pital Association and the American Acad- ment to how important this is,” Alker said. Government figures show that as of Septers and in part because emy of Pediatrics, through the Partnership “I’m heartened that the new administra- tember Medicaid enrolled about 30.8 milof federal financial incenfor Medicaid to raise awareness of how tion has made health insurance a critical lion children and CHIP about 6.6 million. tives and policy changes many people the program serves and to piece of what they ran on.”

The analysis Alker co-authored found to Medicaid put in place lobby for easier access. that from 2017 to 2019, Medicaid and during the pandemic. The “We know that healthy mothers, healthy Range of causes CHIP coverage of U.S. children dropped Griffith number of Missouri chilbabies, healthy children and healthy famiFunded jointly by the federal govern- by almost 1 percentage point. The analysis dren enrolled in pub­ lic lies equal healthy communities,” Pon- ment and states, the Children’s Health blames that decrease on a range of causes, health insurance had climbed to a record temayor said.

Insurance Program is administered by including cuts in outreach and enroll- of 633,000 by the end of last year, according He and Alker pointed out that for states in accordance with federal rules. ment assistance, efforts to undermine the to state figures. decades providing access to health care for CHIP provides insurance through Medic- Affordable Care Act, a chilling effect from children had been a bipartisan priority, but aid and through separate CHIP programs. the Trump administration’s public charge Reaching out to families it seemed to have become less of a concern These government programs combined regulation that discourages the use of Elba Gonzalez-Mares sees firsthand the hurdles that families in need of health care coverage face.

She is the executive director of the Community Health Initiative Napa he caseworkers at the Community ance. Interpreting the rule was so fraught Mares, executive director of the nonprofit County in California, a Gonzalez-Mares Health Initiative Napa County in Califorthat many staffers at social service agencies Community Health Initiative. “It’s such a nonprofit organization that nia weren’t alone in seeing how the Trump didn’t even know what advice to offer. delicate topic.” was established in 2005 to help children and administration’s enforcement of the public “They were afraid that they were going That’s why her agency joined others their families get coverage and services. charge rule was discouraging undocuto tell somebody something incorrectly that and, with the help of immigration lawyers, Her agency works with several partners, mented residents from seeking needed could potentially harm their legal status and crafted and distributed a flier with a clear including Providence St. Joseph Health, to services like health care and health insurchange their life forever,” said Elba Gonzalezset of talking points to use when counselsee that children and families have access ing undocumented residents. The flier is in English and Spanish. to health care. It currently has a caseload of The flier explains that when immigrants 14,000; of those, 60% are children.

Does "public charge" apply to me? or visitors apply to enter the United States, “After 15 years of doing this, we have become a legal permanent resident, families that have gone through four difKnow Your Rights + understand "public charge" change their immigration status or extend ferent changes in their coverage,” GonzaThe new public charge rule is set to go into effect of February 24, 2020, and it is important to be their nonimmigrant visa, immigration lez-Mares said. “Helping them transition informed about potential changes. When a person applies to enter the U.S., get a green card (Legal officials will consider whether they are Permanent Resident status) or change the status or length of a non-immigrant visa, immigration from one to the other was not an easy task, likely to become a “public charge” and officials will consider whether that person is likely to become a "public charge” in the future by but avoiding that break in coverage is just looking at all of the person’s circumstances, including previous public benefit usage, income, receive tax-funded safety net services and employment, health, education, skills, family situation and whether a sponsor signed a contract (an so important. Families can get lost in that health insurance in the future. The review “affidavit of support”) promising to support the person. The changes to the public charge rule do not transition very easily because it does get will include public benefit usage, income, apply to everyone, and do not apply to all benefits. overwhelming.” employment, health, education, skills, use of benefits will not automatically make family situation and whether a sponsor California offers health insurance prosigned a contract promising to support the grams for all state residents up to the age of you a "public charge" person.

26, even those who because of their immi“The changes to the public charge rule gration status don’t qualify for Medicaid Programs not Affected exceptions do not apply to everyone, and do not apply Medi-Cal used by children under 21, pregnant T & U Visa applicants + VAWA selfcoverage. Gonzalez-Mares said language to all benefits,” the flier says. The benefits women or for emergency services petitioner and cultural issues leave many families that it does not apply to include school WIC | School Lunch | Breakfast Programs Benefits used by family members, unaware that they can get coverage and of Emergency Disaster Relief DACA, special immigrant juveniles lunches, emergency disaster relief or MediGreen-card holders applying for how to enroll.

Cal, California’s Medicaid program — but citizenship (only when green-card programs affected - Most Common Some immigrants who are eligible for that exemption is only for children and holder DID NOT leave the U.S. for Medi-Cal (over the age of 21) public health care coverage in the state fear young adults under 21, pregnant women or more than 180 consecutive days and CalFresh | Food Stamps | EBT re-enter the U.S.) that applying will have a negative impact for emergency services.

Cash assistance (i.e., SSI, TANF, General Assistance) Certain parolees and other nonFederal public housing and Section 8 assistance The flier includes several phone numon their quest for a green card, which citizens Institutionalization for long-term care at bers undocumented residents and those bestows permanent legal residence staRefugees/asylees government expense who work with them can call to get more tus, or citizenship aspirations. Her agency specific assistance. helped create clear talking points about Connect with a trusted messenger Gonzalez-Mares said her agency has the public charge rule so that counselors Get help making the right choice for you and your family. used the talking points in combination can confidently and correctly advise immiwith other training, such as simulations Community Health Initiative Napa County 707-227-0830 OLE Health 707-254-1770 grants on their rights. (See sidebar.) involving confused clients. “We even had COPE Family Center 707-252-1123 On the Move 707-251-9432 Since the onset of the pandemic, GonImmigration Institute of the Bay Area 707-266-1568 a mental health provider give us some Puertas Abiertas 707-224-1786 zalez-Mares said the Community Health County of Napa 707-253-4511 UpValley Family Centers-St.Helena/Calistoga 707-965-5010 talking points on how you defuse that fear Initiative Napa County hasn’t had a sharp This provides general information, but is not legal advice. Immigration law can be complex, and generally can have exceptions, so you when the client’s calling you, because it’s a should consult with a licensed attorney or a Department of Justice accredited representative to discuss your individual circumstances. increase in its caseload. It has, however, lot of fear,” she said.

Gonzalez-Mares said the goal of agenseen its casework increase as more clients cies like hers is to let clients know staff is who were laid off or otherwise lost income there to listen to, support and help them. need assistance revising their enrollment “But we also want to make sure they’re information and figuring out how to retain making the right choice by having the right www.upvalleyfamilycenters.org/public-charge health insurance.

From page 1

Talking points clarify public charge rule for visa holders

T

learn

Know

IMMIGRATION

A flier used by the Community Health Initiative Napa County and other agencies in California that work with immigrants offers talking points on how to handle questions surrounding the public charge rule.

The flier is available in English and Spanish.

information in front of them,” she said.

— LISA EISENHAUER

Bucking the trend Even with California’s broad public health care programs, the number of

March 1, 2021 CATHOLIC HEALTH WORLD

children in that state who have insurance coverage has dipped as it has in almost every state. The Georgetown analysis shows that the only state that has consistently bucked the national trend in the last three years is New York.

Melissa Zapotocki is director of Community Zapotocki Health & Well-Being with St. Peter’s Health Partners in Albany, New York, part of Trinity Health. “I know in New York and within St. Peter’s that we do a pretty good job in trying to ensure that all children are signed up and enrolled in some sort of health insurance coverage,” she said.

She is one of about six certified applications assisters at St. Peter’s who are trained to help people enroll in New York’s health care marketplace, NY State of Health. The state takes a proactive approach to health insurance, Zapotocki said, promoting its exchange and providing support for community-based organizations that can help residents enroll in insurance as well as other social safety net programs such as supplemental nutrition assistance.

Zapotocki said St. Peter’s sees helping provide access to health insurance as part of its Catholic mission. “We strive to be a compassionate, transforming healing presence in our community and we’re committed to providing health care services to all patients and especially the poor and vulnerable and the most in need,” she said.

Texas-sized coverage gap No state has more uninsured children than Texas. Data compiled by the Texas Medical Association put the figure at 11%, or 1 million children. At least 350,000 of those children are eligible but not enrolled

5

Mercy Health to sell children’s hospital in Toledo

Dr. Heidi Sallee talks with a patient at SSM Health Cardinal Glennon Children’s Hospital earlier this year in a photo captured by the boy’s mother. SSM Health hospitals have staff and programs that help families secure health insurance and access care.

in Medicaid or CHIP, according to the nonprofit public policy institute Every Texan.

Christopher M. Born, president of Dell Children’s Medical Center in Austin, Texas, said his Born hospital spent $11.5 million on the care of uninsured children last year. Dell Children’s is part of the Ascension Seton regional system.

Over the next two months, Born said Ascension hospitals across Texas are launching a financial counseling effort

to provide patients or their parents with immediate assistance and information about the insurance options and financial aid they qualify to pursue. Financial counselors will be available on-site and by phone and will contact patients as needed to complete follow up.

Insuring all children will give every single child access to health care regardless of their zip code, ethnicity, or their parents’ income, Born said. “More importantly, it will improve the overall health of our community.”

Mercy Health Toledo is selling Mercy Health – Children’s Hospital to Nationwide Children’s Hospital, a nonprofit system that became a partner in operating the children’s hospital this year. The sale is expected to be complete by Jan. 1.

The 72-bed children’s hospital is on the campus of Mercy Health – St. Vincent Medical Center. Both hospitals are part of Mercy Health Toledo, a subsidiary of Cincinnatibased Bon Secours Mercy Health.

The Children’s Hospital has a staff of 136. The hospital’s pediatric physicians and specialists will have the option of joining Nationwide Children’s staff, said Erica Blake, a Mercy Health communications manager.

“There will be no change for our nursing staff and other Mercy Health – Children’s Hospital team members,” she added.

Nationwide Children’s main campus in Columbus, Ohio, is home to the Department of Pediatrics of The Ohio State University College of Medicine. It has affiliations with several other hospitals across Ohio.

After the sale of Mercy Health – Children’s Hospital is complete, Nationwide Children’s will lease the space where it is housed from Mercy Health Toledo.

The two health systems will continue to collaborate during and after the sale on research and population health initiatives, they said in a joint press release.

leisenhauer@chausa.org

Number of Uninsured Children in the United States (in millions), 2008– 2019

PAUSE. BREATHE . HEAL.

God’s Eye on the Sparrow For just this moment, bring your attention to your breath.

INHALE deeply and settle yourself into your body.

EXHALE the stress and tension you feel.

On your next inhale pray, God’s Eye On The Sparrow.

And as you exhale, God’s Eye On Me God’s Eye On The Sparrow God’s Eye On Me KEEP BREATHING this prayer for a few moments.

(Repeat the prayer several times.)

CONCLUDE, REMEMBERING: Even now, God is with you, as near to you as your breath. Continue giving yourself the gift to pause, breathe, and heal knowing you are not alone.

Sources of Children’s Coverage, 2017 –2019

“Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes? Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they?”

MATTHEW 6:25-26

Visit chausa.org/well-being for more well-being resources.

© Catholic Health Association of the United States

6

CATHOLIC HEALTH WORLD March 1, 2021

Entrepreneurs From page 1

at Providence who suits them and has open appointments.

It employs artificial intelligence to pull information from the Providence electronic medical records system and its workflow system. DexCare identifies which providers or facilities have capacity to receive new patients and it gives patients and prospective patients a choice of locations and appointment times, guiding individuals to the appropriate care setting.

Innovation group employees built DexCare from the ground up. Providence says that with DexCare it has created a new product category it calls an access and capacity optimization platform.

Serial startups The innovation group is made up of nearly 200 strategists, software engineers, marketing specialists and investors. Entrepreneurs in residence have had a hand in guiding two of the three technology companies the group has incubated to date: DexCare and Xealth.

After identifying DexCare as a spin-off candidate, Providence hired as entrepreneurs in resiStreat dence Derek Streat and Sean O’Connor. The duo, who had worked together on another start-up, have been preparing the company for its launch since April 2020. Counting DexCare, Streat co-founded or has been involved in O’Connor the earliest stages of six venture-backed technology companies.

Just prior to joining Providence, he was vice president of digital solutions at Johnson & Johnson, which acquired C-SATS, one of the start-ups Streat led on. O’Connor partnered with Streat in C-SATS. Prior to that, he’d held several senior posts at Intuitive Surgical, a medical device company.

O’Connor says, “There is a lot of value to ideas growing from and developing within large, complex health systems” such as Providence. Streat says this is because the business concepts are put through the ringer of real-life use before they are exposed to what he calls the wild world of courting venture capital funding.

As clinicians, prospective patients and current patients use the DexCare system, the business plan concepts are tested. The providers and patients won’t adopt the technology if it’s not useful, and that fact drives the entrepreneurs and the digital innovation team to keep refining and polishing the product, says Streat.

Providence uses DexCare technology to increase the number of patients seeking care at its ambulatory care sites including primary care offices and urgent care facilities. DexCare has helped the health system to respond nimbly as patient volume has shifted from in-person venues to telehealth venues during the pandemic, according to information from Providence.

In addition to Providence, five other health systems are using DexCare. Streat said they are not disclosing the names of those systems at this time.

First up The innovation group began creating Xealth around 2016, and it was the first spin-off to employ the Entrepreneurs-inResidence development model. It was spun off as a private, for-profit company in 2017. Providence Ventures has invested in Xealth’s series A and subsequent financing rounds.

Clinicians use Xealth to “e-prescribe” educational videos and other resources to patients to improve health outcomes.

Before turning their attention to Xealth, the four entrepreneurs who shepherded that company, Mike McSherry, Aaron Sheedy,

Sara Vaezy, Providence St. Joseph Health chief digital strategy and business development officer, takes part in a virtual meeting with colleagues. Vaezy plays a central role in ensuring Providence St. Joseph Health’s incubated companies and the entrepreneurs who run them have the resources and staffing they need to grow and succeed.

Eric Fu and Sundar Balasubramanian, had worked together at Swype, a virtual keyboard company.

McSherry was Swype’s chief executive, Sheedy was chief operating officer, Fu was vice president of platform engineering and Balasubramanian worked in business development. McSherry and Sheedy now hold those same jobs at Xealth.

Fu is Xealth’s chief technology officer.

Balasubramanian is no longer with the company.

Xealth made Fast Company’s list of “Most Innovative Companies” for several years. Last summer, Cerner and LRVHealth announced a partnership with — and $6 million investment in — Xealth.

Providence’s Martin serves on the boards of Xealth and Wildflower Health, another company that has a product with roots in the Providence Digital Innovation Group.

Wildflower Health bought Circle in 2018. Circle, a company with a women’s health app that gives patients access to health information on pregnancy, breastfeeding and other topics, was incubated within the Providence innovation group.

Providence became a customer of Wildflower Health when it acquired Circle.

Providence Ventures is a minority investor in the private, for-profit Wildflower Health.

(The Circle incubation did not involve entrepreneurs in residence.)

Three, two, one When DexCare launches as a private, for-profit company and closes on its series A round of funding, Streat and O’Connor will cease to be Providence employees. Other employees who have been working on DexCare will join them at their new start-up.

At that point, Providence will become an investor in and customer of DexCare. The health system has been helping DexCare to identify additional investors.

Streat says, “I am a firm believer that if you are a nonprofit and you want to scale your mission to many people, you need the access to capital that a for-profit can have. You need investment to build these technologies, and that is difficult to do as a nonprofit.”

Streat notes that Providence’s incubation approach has been successful because the system is able to identify pressing needs in the health care field and make the mission-based case for new technology to fill those gaps. It can get that technology started, and then it can spin it off when the capital is needed for large-scale commercialization and growth.

Streat encourages other ministry systems to consider incubating for-profit start-ups. “I hope more health care systems will do this because there are a lot of problems to solve in health care, and while it’s very challenging to address those challenges, if you can find a way to do it in your system, and nurture those ideas, you may be able to scale those ideas” so others can use them as well. jminda@chausa.org

“In the diversity of peoples who experience the gift of God, each in accordance with its own culture, the Church expresses her genuine catholicity and shows forth the ‘beauty of her varied face.”

POPE FRANCIS | Evangelii Gaudium (Joy of the Gospel), #116 | 2013

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Finley

Robinson

PRESIDENT/CEO Andy Barth to president and chief executive of HSHS Sacred Heart Hospital in Eau Claire, Wisconsin, effective March 29. He was president and chief executive for the northeastern Wisconsin region of Aspirus Health, with additional assignments across the system. Barth replaces Sandy Anderson, who was interim president and chief executive.

ADMINISTRATIVE CHANGES CHRISTUS Health and a subsidiary have

made these changes: Dr. Mike Finley to system medical director and designated institutional official for CHRISTUS Health and Dr. Loren Robinson to chief Barnett medical officer and vice president of medical affairs for CHRISTUS St. Michael Health System of Texarkana, Texas.

Nicole Barnett to chief nursing officer of Mercy Health – Anderson Hospital in Cincinnati.

Dennis Mahaney to executive resident of mission integration at Kenmore Mercy Hospital, part of Catholic Health of Buffalo, New York.

Becky Urbanski, senior vice president for mission integration and marketing at Benedictine of Minneapolis, announced plans to retire on July 1.

Saint Mary’s East of Erie, Pennsylvania, to be sold to Hill Valley Healthcare Saint Mary’s Home of Erie, Pennsylvania, is selling its Saint Mary’s East eldercare facility to an affiliate of Hill Valley Health-

care, a New York City-based for-profit nursing home operator. The sale is expected to close in May. The campus includes a 139-bed nursing facility, and independent living facility, rehabilitative services, adult day services, Alzheimer’s care and respite care.

The Sisters of St. Joseph of Northwestern Pennsylvania sponsor Saint Mary’s Home and its facilities. After the sale, Saint Mary’s East no longer will be Catholic. However, the buyer said it will continue to provide faith-based services to residents.

Hill Valley Healthcare is a venture formed to own and operate skilled nursing facilities. Saint Mary’s East will be Hill Valley’s 11th facility — its first in Pennsylvania.

Hill Valley said it expects to retain employees at their current pay rate. Plans call for the facility to be renamed Nightingale Nursing and Rehab Center in tribute to Florence Nightingale.

In addition to Saint Mary’s East, Saint Mary’s Home also has an eldercare campus in Western Erie, which will not be included in the sale.

CHA invites everyone to use its free resources at chausa.org/masks to promote mask wearing and protect the health of all. #LoveThyNeighbor

8

CATHOLIC HEALTH WORLD March 1, 2021

Women’s networking From page 1

satisfaction. We believe that this contributes to better care for pa– tients and families,” says LaRonda Chastang, Trinity Health vice president, diversity and inclusion.

Rapid growth Mercy of Chesterfield, Chastang Missouri; Providence St. Joseph Health of Renton, Washington; and Trinity Health of Livonia, Michigan, are among Catholic health systems that host multiple affinity groups for their employees. Providence St Joseph Health has over 20 such groups, called “caregiver resource groups” including groups for Blacks, Latinos, veterans, and people who identify as LGBTQ. All caregiver resource groups are open to everyone. No one is excluded if they have interest in participating.

Debra Canales, Providence St. Joseph Health executive vice president Canales and chief administrative officer, is the executive champion for the system’s women’s resource group. It was formed about three years ago by several women at the system’s headquarters. It’s grown to include 250 women and men; employees from multiple Providence St. Joseph Health facilities participate. Canales says the group provides “an opportunity to learn from one another and to

professional goals “that bring about fulfillment and allow women to give back to one another,” Chastang says. There is a system-level women’s group with about 80 participants and two smaller facility-level groups. Trinity Health also has a group in its mid-Atlantic market specifically for women of color. The health system is encouraging the creation of more local-level groups.

The Mercy Women in Leadership program launched in 2018. There Maureen Heary, left, Trinity Health senior manager of enterprise infraare six committees. All structure operations, and Shaista Ansari, Trinity Health applications together more than 700 technical analyst, participate in a fall 2019 Women’s Empowerment Fall people have signed on to Event cosponsored by Trinity Health. participate. Employees at director level and above learn more about the Providence family of can join the Women in Leadership group. organizations.”

Mercy encourages female physicians to At Trinity Health affinity groups called take part in the affinity groups and about “business resource groups” are led by one in five are doing so. Mercy Vice Presiemployees and sponsored by execu- dent of Talent Experience Barb Grayson tive leaders. Participation is open to any says participation can be beneficial for docemployee at any level. The groups are tors considering a move into administraintended to “build an engaged system of tion leadership. colleagues throughout Trinity Health who are actively seeking personal and profes- Let’s do lunch sional development,” says Chastang. In The women’s networking groups at 2018, Trinity Health had two business Mercy, Providence St. Joseph Health and resource groups. Today, the system has Trinity Health host educational series, more than 16. lunch and learns, webinars and the like The Women Inclusion Networks pro- on such topics as resume building, career vide women with opportunities to pursue networking, goal setting, leadership skill-

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building, self-care and work-life balance.

Prior to the pandemic, Mercy and Providence St. Joseph Health each had in-person events that drew several hundred attendees. Trinity Health hosted “morning mingles” between resource group members and executives.

Under pandemic restrictions, group activities have migrated to virtual communications platforms including videoconferencing and social media. At Mercy, group members can join a Facebook site or a Microsoft Teams forum.

Executive rank gap At Mercy, Providence St. Joseph Health and Trinity Health, one of the purposes of the women’s groups is to encourage more women on career tracks that rise to executive roles, since women are not as well represented in executive suites as men are.

Chastang explained that “women are not always afforded opportunities for exposure to executive leaders and there is a lack of sponsorship and coaching for women to assume leadership roles.”

The affinity groups may help women to overcome these barriers by giving them a forum to meet with, collaborate with and share ideas with one another and with Trinity Health leadership.

BUILD the BRG is a Trinity Health resource group that was formed for and by Black women. The acronym stands for Black women United In Leadership and Development the Business Resource Group.

Chastang says the group aims “to address the unique experiences of Black women in the workplace. Black women have different lived experiences, and experience the work environment differently based upon many factors including systemic racism and unconscious bias.”

Cynthia Bentzen-Mercer is executive vice president and chief administrative officer of Mercy and executive sponsor of Women in Leadership. She says that Mercy has less gender diversity at the senior Bentzen-Mercer leadership level than at lower levels. While the gap was not created intentionally, she says Mercy believes it must be intentional in addressing it, by creating new job pathways and opportunities for women.

Grayson says that by providing a structured way for women to connect with and mentor one another, and grow their skills, Mercy is encouraging women to aim high in the pursuit of career goals.

Chastang and Canales note the affinity groups also provide valuable visibility for women. Trinity Health taps its resource groups as focus groups for important system decisions. Providence St. Joseph participants in caregiver resource groups have visibility to executives.

Belonging Bentzen-Mercer says the level of enthusiasm for Mercy Women in Leadership has been evident since the group’s launch, when an email sent out to gauge interest garnered a rare 90 percent response rate. More than 80 percent of respondents expressed interest in serving on one of the six committees.

Chastang at Trinity Health says she finds it inspiring to see the involvement of extremely busy women who are working long hours during the pandemic. “In spite of competing demands, making time for BRG involvement is extremely rewarding and fulfilling” for Trinity Health employees.

Canales says while it is too early to gauge the impact of Providence’s women’s resource group, it is clear from anecdotal evidence that participants are benefiting.

She says, “One woman said to me, ‘Now, after three years working here, I feel like part of a team.’ We all want to have a sense of belonging. These groups create a sacred space, a place to have a conversation.

“It’s the emotional elements that keep people here,” Canales says.