As the movement towards health equity and addressing the social determinants of health (SDOH) evolves forward, the leaders of some patient care organizations have made their commitment to their communities more explicit over time. One such organization is Nemours Children’s Health, anchored by children’s hospitals in Wilmington, Delaware, and Orlando, Florida, and which serves families across four states—Delaware, New Jersey, Pennsylvania, and Florida.
The December 15 press release announcing the news began thus: “Nemours Children’s Health announced today that it is joining the Healthcare Anchor Network in a major step to advance its vision of creating the healthiest generations of children. The Healthcare Anchor Network is a nationwide collaboration of more than 65 health systems, including only 5 pediatric health systems, that helps its members leverage business decisions to invest locally and inclusively to address social determinants of health and promote equity in surrounding communities.”
As its website explains, the Healthcare Anchor Network “exists to incubate and scale strategies that establish the anchor mission as a healthcare sector priority and to lead innovation in anchor mission implementation, both internally and in partnership with community. We aim to define the healthcare leadership standard and promote industry collaboration for proactively addressing economic and racial inequities in community conditions that create poor health (or what is sometimes referred to as structural determinants of health). The long-term goal is to reach a critical mass of health systems adopting as an institutional priority to improve community health and well-being by leveraging all their assets, including hiring, purchasing, and investment for equitable, local economic impact.”
Further, the Healthcare Anchor Network’s website explains, “We seek to address root causes: economic and racial inequities that create barriers to health and thriving for people and communities. We value equity, community well-being, and sustainability as core principles of healthy communities. Founding members of the Healthcare Anchor Network include Advocate Aurora Health, CommonSpirit Health, Henry Ford Health System, Kaiser Permanente, ProMedica, Providence St. Joseph Health, Rush University Medical Center, RWJBarnabas Health, Trinity Health, and UMass Memorial Health Care. Today, over 65 hospitals and health systems are Network members. The Healthcare Anchor Network convenes health systems in order to share best practices for advancing an anchor mission approach within their health institutions, address common challenges, co-develop new tools, and identify areas where collaborative efforts may be possible.”
"Investing in children’s health is the single most powerful means to ensure a healthy generation of Americans and a robust economy,” R. Lawrence Moss, MD, FACS, FAAP, president and CEO of Nemours Children’s Health, said in a statement carried in the Dec. 15 press release. “Our health anchor strategy will double down on our commitment to improving children’s nutrition, housing, education, and the economic opportunities for families in our communities.”
The press release went on to note that, “Earlier this year, Nemours Children’s announced its bold strategy to redefine children’s health, which includes eliminating health disparities and helping communities thrive economically. This approach to promoting whole child health, “Well Beyond Medicine,” recognizes that most determinants of children’s health actually occur outside hospital walls--at home, school, and the neighborhoods in which children live, learn, and play. Partnering with the Healthcare Anchor Network will enable Nemours Children’s to tap into best practices from health systems across the nation to better address root cause of poor health such as economic, racial, and environmental inequities.”
And the press release quoted Kara Odom Walker, M.D., M.P.H., MSHS, Nemours Children’s Health’s executive vice president and chief population health officer, as stating that “We are also eager to use this partnership to further the progress of our diversity, anti-racism, inclusion, value, and health equity (D.R.I.V.E.) initiative across our organization and to advance racial equity in the communities we serve by creating a pipeline to hire more diverse employees, purchase more goods and services from diverse suppliers, and strategically invest in our local communities.”
The press release went on to state that “The long-term goal of the Healthcare Anchor Network is to reach a critical mass of health systems adopting as an institutional priority to improve community health and well-being. By leveraging all their assets, health systems can make strategic decisions in hiring, purchasing, and investment designed for equitable, local economic impact.
“We are very excited to have Nemours Children’s Health, one of the country’s distinguished children’s health systems, join our network. Our goal is to scale adoption of the anchor mission approach and we are eager to work with the health system to ensure that children and their communities can be healthy and thrive,” stated David Zuckerman, executive director of the Healthcare Anchor Network.
And, the press release noted, “Implementing strategies learned through the Healthcare Anchor Network will also build on Nemours Children’s work to align the financial incentives of the U.S. healthcare system to support a pay-for-health model that will lead to health equity. Healthy kids become healthier adults, making children’s health an engine for personal and national economic vitality.”
Shortly after the announcement, Dr. Walker spoke with Healthcare Innovation Editor-in-Chief Mark Hagland regarding Nemours Children’s Health’s participation in the Healthcare Anchor Network, and the connection of that participation to Nemours’ overall strategic goals. Below are excerpts from that interview.
What was your and your colleagues’ overall sentiment about being involved in the Health Anchor Network?
We’re really thrilled to be part of this. And this represents our ongoing commitment to learn from others in the field, and to infuse our own views on how we can address community health and well-being. As Dr. Moss has said, we need to focus on these upstream determinants of health, and to build sustainable initiatives around this. The Health Anchor Network brings together organizations working in this area. And so we’re just thrilled to be a part of this. To be fully engaged allows us the chance to learn best practices, and figure out how to address these challenges nationwide.
In your view, what needs to be done at a high level to advance this movement?
First, we know that many health systems and communities are experimenting everyday. And COVID-19 has underscored the importance of communities in need, and those that are experiencing greatest inequities in our nation, around food insecurity, housing insecurity, transportation needs, and the support needed to address poverty, and intergenerational issues in poverty and opportunities. So we’re focusing on those intersections: how we measure and deploy resources.
In that regard, part of our work involves deploying social screeners. What’s more, it’s becoming clear that some families need to be provided Internet access just to access resources. What’s more, food insecurity bubbles up in many cases, as do issues around housing and health, per our kids with asthma or those exposed to lead. So those intersections help us prioritize. It often means we need to focus on what happens at schools, so we have initiatives focused on school-based involvement, and on where children live, learn and play in their neighborhood environments. Do they have access to testing and immunization, for example? Through the Health Anchor Network, we can make sure we’re connecting to policy efforts, and can scale effective practices.
We haven’t yet figured out how to organize this work, across the healthcare industry; there remain no standardized templates for how to approach this kind of work. Your thoughts?
Probably, there should never be templates, because every community is unique. And the other reality is that health systems have some of the solutions, but not all of them, so no matter where you are, you need local stakeholder groups to partner with you. The Healthcare Anchor Network has been around since 2016, and every single health system involved has a different story, and solutions will be unique. But there are some common threads: thinking about economic and housing supports seems to be a common thread; and how to use and leverage the data, to create a start, is important; and that’s a big part of why the Healthcare Anchor Network is bringing people together, sharing thematic groupings, working on areas like housing, economic development, etc., to work together and problem-solve.
Let’s talk about data: the challenges of data, the opportunities involved, and how we move forward. Health systems have a ton of data, but so often, it’s poor organized. How do we move forward in that area?
Data is only as good as the question it’s aiming to serve. So we have to make sure we have a defined purpose for collecting the data. And you’re right, health systems have tons of data, but if you don’t know what you’re looking for, it’s like looking for a lost piece of jewelry on the beach, you’ll never find it. So what does our workforce look like? Does it match and mirror the community we’re serving? We can do the same around disparities. For example, if we want to ask, have we provided equitable access to flu vaccines? That’s a great place to start. Maybe there are zip codes being left behind. So how accurately are we collecting this data? Are we looking at race and ethnicity in the right way, and how do we best collect the data?
When it comes to collecting and analyzing socioeconomically marginalized communities of color, how do you even know that what you’re seeing is correct?
You have to collect the right data from the communities; we have to ask about race and ethnicity, and then look at the data and not just store it somewhere in a file, and then be able to ask questions. So we’re building out our internal capacity to create dashboards, to create heat maps around issues like asthma, mental health care needs. And we’re seeing overlapping hotspots. We need to make sure we have community health workers and patient navigators. There may be multiple barriers to receiving the best services from us. So that’s part of what we have to do to address issues, when planning interventions. And often, those require a lot of partnerships with community organizations. Playspace challenges are guided by inequities, for example.
What’s the secret to figuring how where and how to intervene in specific communities?
That’s part of the journey we’re on, to create the right approach. And the reality is that these are zip codes or neighborhoods affected by poverty, but they’re not usually called out in the clinical process. We haven’t traditionally looked at zip codes, for example. So we want to create social screenings, so we can apply resources linked to specific local needs, down to the neighborhood level. That’s where there’s a lot of work we need to do, and interest. But it’s also in the context of COVID019. So we need to reorient our payment system around these needs.
What have been the biggest challenges, and the biggest lessons learned so far, related to health equity and social-determinants-of-health work?
The biggest challenge is around starting with equity in mind. We have not created a system set up for that; we’re often just working with the person sitting in front of us, without that connection to the whole. So building out an approach focused on health inequities, is both a challenge and a huge opportunity. We’re fortunate to be involved in a health system that’s focused on this, and the health equity commitment that Dr. Moss recently signed onto, that’s incredibly exciting. Once we can do the health equity and healthcare payment reform, we can (move forward).
What advice would you like to share with your peers in other organizations who want to get further involved in social-determinants-of-health work and health equity work?
All health systems have the opportunity to focus on inequities; COVID has shown us how important it is to focus on inequity today; so, start with what’s in front of you, whether it’s COVID testing rates or vaccination or flu vaccination. So start with what’s in front of you; that will bring people together, leaders at all levels of the organization. And this work requires partnership from front-line individuals to top-level senior executives.
On a scale of 1 to 10, how hopeful are you that things will move forward with alacrity in this area?
I understand that many people have been trying to reduce health disparities for many decades, and it won’t happen overnight. But with the right leadership, capacity, and resources, we will make significant progress, and we will be able to demonstrate that a commitment now can pay off in the long run. Dr. Moss has spoken so eloquently of Wendell’s situation.
Yes, Wendell, the child who experienced a severe injury playing around a trash can because he had no access to a safe, easily accessible playground, and as a result, he and his family and the healthcare system ended up being involved in very intensive patient care delivery as a result. Per Wendell’s story, where do we go in the next few years?
Dr. Moss shares that story so eloquently. But Wendell’s story also demonstrates how we need to move upstream; and that we need to fulfill basic needs for every child to build the most productive life possible. Childcare, afterschool programs, education access. And what we’re also learning is that these interventions are low-cost; we just have to figure out how to move those interventions from very expensive later in life to inexpensive early in life.
In other words, we need to intervene much further upstream, correct?
Yes, that’s exactly right.
