DIVERSITY, EQUITY AND INCLUSION

Advancing health care equity

How Minnesota’s health plans are leading the way

BY LUCAS NESSE, JD

Health equity–it’s giving all people and their communities the opportunity to achieve their highest level of health by eliminating gaps in care. It’s at the core of how we make health care work better for everyone.

Achieving equitable health outcomes is multilayered. It requires those of us in the health care industry to not only be culturally competent and antiracist in our policies and approaches, but that we are looking at all the factors that lead to successful outcomes in life–also known as the social drivers of health. This includes ensuring that people have ample access to good jobs, quality education, safe and stable housing, reliable transportation and many other life assets.

The disproportionate impact of the COVID-19 pandemic on people of color is just one example of how health disparities have weighed heavily on our diverse communities. It reveals that there is much more work to do to improve access and deliver equitable care to everyone, but also that we must listen more to communities of color to better understand what their needs are.

With this, Minnesota’s nonprofit health plans have a renewed focus on equity, creating a number of initiatives that will support Minnesotans–particularly those from vulnerable communities – in their health care journey. I am grateful to highlight a few of those equity programs, along with the people who helped bring those initiatives to life.

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HealthPartners has mobilized a grassroots movement to help close gaps in outcomes and educate colleagues on ways to reduce bias and promote cultural humility and anti-racism. Some 350 employees have stepped up to become Health Equity Champions, serving as a resource to advance equitable care throughout the enterprise. “Being welcome, included and valued is a basic human need and essential to health and well-being,” said HealthPartners Chief People Officer

DeLinda Washington. “Our Health Equity Champions are a great resource as we work to educate our colleagues.”

In addition to being ambassadors, the Health Equity Champions also help research, write and share the HealthPartners Culture Roots newsletter.

Recent issues have focused on addressing disparities in depression screening and treatment, microaggressions and advancing LGBTQ health. In an issue on maternal and infant health disparities, the newsletter shared how HealthPartners is addressing bias to provide the best care and service to patients and members. HealthPartners team members collect data on births and prenatal and postpartum care and partner with community organizations to ensure patient DeLinda Washington, Chief needs are met. People Officer, HealthPartners The United States has some of the highest maternal and infant mortality rates among developed countries, especially among people of color. Black infants, for instance, are nearly four times as likely to die from complications related to low birthweight compared with white infants.

In an effort to eliminate these disparities, HealthPartners has implemented structured, consistent practices for how clinician teams address the complications that can occur during pregnancy and childbirth. This includes things like managing hypertension during pregnancy, addressing abnormal fetal heart beats during labor and preventing and managing hemorrhaging that can happen after pregnancy. These structured approaches are called

“safety bundles,” and include steps to: • Be ready. • Recognize and prevent. • Respond. • Report and learn.

Medica recommends new guideline to support more equitable renal care for Black Americans

Medica is calling on its network of providers to adopt a new clinical guideline to diagnose and assess kidney disease that will lead to more equitable renal care and improved outcomes among Black Americans. The change is expected to reduce delays in referrals for specialist care and kidney transplants. Medica is asking doctors to stop using the most common method to diagnose and assess the severity of kidney disease, which is estimated glomerular filtration rate (eGFR). Most providers calculate eGFR by assuming Black people generally have higher baseline levels of serum creatinine and therefore adjust their scores upward. This method can overestimate kidney function in people with African ancestry and lead to worse outcomes. “Using race as a factor when estimating kidney health is imprecise and disproportionately puts Black Americans at risk for severe health complications that could otherwise be treated,” said Senior Medical Director Charlotte G. Hovet, MD, who has been in charge of this effort for Medica.

Black people are about three times more likely to develop kidney failure than white people, according to the National Kidney Foundation. Black people are also less likely to receive a transplant evaluation, have less access to the waitlist, spend longer time on the waitlist are less likely to survive on the waitlist and have lower rates of transplant success.

Medica’s Medical Policy Committee, comprised of credentialed Medicanetwork physicians in a variety of disciplines, voted to adopt a new guideline that recommends providers use either a direct measure of GFR or another method of estimating GFR using serum cystatin C which does not involve consideration of the patient’s race. The new guideline aligns with leading advocates for the advancement of equity in kidney care.

Charlotte G. Hovet, M.D.,

Sr. Medical Director for Quality, Care and Utilization Management at Medica

Blue Cross looks at how police interactions impact community health

Blue Cross and Blue Shield of Minnesota is partnering with three local entrepreneurs to look at police interactions as a social driver of health.

After Daunte Wright was fatally shot during a traffic stop by Brooklyn Center police in 2021, Twin Cities entrepreneurs Jazz Hampton, Esq., Andre Creighton and Mychal Frelix developed TurnSignl, an app connecting users to an attorney in real time if they are stopped by law enforcement or have a car accident. The attorney provides legal advice to the user.

“The three of us sat down and decided that with our professional and community backgrounds, we were uniquely placed to create a solution to help keep people’s rights protected, reduce stress, trauma and anxiety – and get everyone home safely,” said Hampton, co-founder and CEO of TurnSignl.

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Blue Cross and Blue Shield of Minnesota, under the leadership of Bukata Hayes, its vice president of Racial and Health Equity, is funding TurnSignl as part of a five-year strategy with the city of Brooklyn Center that aims to improve racial and health equity. The pilot program will provide up to 3,000 residents free access to the TurnSignl app. The technology is designed to protect Bukata Hayes, Vice President driver’s rights, de-escalate roadside police of Racial and Health Equity, interactions and help ensure both drivers Blue Cross and Blue Shield and police officers return home safely. of Minnesota Experts say police-involved shootings of Black people are having a negative effect on the wellbeing of communities, regardless of whether the residents had a personal connection to those incidents. “We know that 80% of health is determined by environment, neighborhoods, income and other stressors that exist outside of interactions with doctors and the health care system,” Hayes from Blue Cross said. “The impact of historical and contemporary trauma and systemic racism felt within BIPOC communities have long added increased mental health burdens to the already large overarching health inequities that exist throughout Minnesota. Our partnership with TurnSignl is an innovative, relevant and responsive way to address those priorities and create a healthier future for all.

UCare Community Response Team focuses on COVID, medical screenings in diverse areas

Among UCare’s 630,000+ members are new Americans, BIPOC and

LGBTQIA+ individuals and people with disabilities. The organization is proactively working to provide more inclusivity to them and anyone else facing greater social and economic burdens due to structural oppression. The organization formed a Community Response Team in early 2021, allowing team members to flex as necessary to members’ needs. The 15-plus member team is focusing on COVID-19 response, but it also screens for medical issues, mental health and substance use disorders or other social needs that may be adversely affected by the COVID-19 pandemic. Jennifer Garber, Vice The Community Response Team includes President of Mental Health a manager, a team lead, case managers, and Substance Use Disorder Services for UCare community health workers and engagement specialists. Team members speak multiple languages, come from diverse cultural backgrounds and bring diverse skill sets to their role.

“The pandemic accelerated our concerns about health equity for the members we serve,” said Jennifer Garber, UCare’s vice president of Mental

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Health and Substance Use Disorder Services, who’s been leading the response team. “We wanted to remove barriers to vaccinations such as transportation and language, and also to de-complicate all the conflicting information about COVID-19 for our members.”

UCare Foundation team members and community relations staff also connect with trusted community leaders and organizations to reduce health inequities. For example, UCare recently operated 80 COVID-19 vaccine clinics in partnership with Hennepin Healthcare, The Stairstep Foundation and the MN Department of Health, providing 8,300 vaccines and 95,000 KN95 masks to individuals in underserved communities across the state.

Sanford Health Plan Navigators and Guides join members in their health care journey

Sanford Health Plan is helping its members overcome barriers with an assist from dedicated staffers who join members in their health care journey.

The organization uses health guides and health navigators to identify member challenges and develop solutions to connect them to the resources they need. Health guides are available to all members, while health navigators are a resource for members of Medicare Advantage from Align, powered by Sanford Health Plan.

Sanford Health Guides, a no-cost benefit to plan members, help connect members to their providers, follow care plans and build relationships with them to better understand their barriers to care. Other services include:

• Helping members with financial and prescription assistance. • Identifying barriers and creating solutions to address them.

• Building relationships with members’ care teams.

• Attending appointments and advocating on members’ behalf. • Connecting members to resources in their communities.

Leading these programs is Julie Smith, the plan’s executive director of Value Strategy and Clinical Operations, who added: “The guides and navigators form personal relationships with members to get to know their priorities and challenges and ensure they’re able to access appropriate care.” Sanford Health Plan serves patients and plan members across 250,000 square miles, which include Minnesota communities such as Thief River Falls, Bemidji, East Grand Forks, Canby and Worthington.

These are just a few examples of how Minnesota’s nonprofit health plans are reaching BIPOC communities and vulnerable members. We know our work around health equity will never be done, but greatly reducing disparities must always be at the forefront of everything we do.

Julie Smith, Sanford Health Plan’s Executive Director of Value Strategy and Clinical Operations

Lucas Nesse, JD, is President and CEO of the Minnesota Council of Health Plans.

Health care equity – leading the way to better outcomes

Health care equity is increasingly recognized as an important element in improving patient outcomes and lowering medical costs. Recognizing the wide range of issues that go into improving health care equity is the first step in removing barriers to care that should not exist. This article looks at some current initiatives to address these issues is brought to you by the Minnesota Council of Health Plans.