John Muir Health’s Tosan Boyo: ‘Equity Work Is Quality Work’

Are most health equity initiatives separate from value-based care efforts? Tosan Boyo, M.P.H., senior vice president of hospital operations at California-based John Muir Health, says the two should be intertwined. “Equity work is fundamentally quality work,” he told the Population Health Colloquium on Oct. 12.

John Muir Health is a hospital network headquartered in Walnut Creek, serving Contra Costa County, Calif. Until last October, Boyo served as chief operating officer of Zuckerberg San Francisco General Hospital and Trauma Center.

Boyo said that with value-based care, health systems need to be very intentional about how they are tailoring care to patients and the population being served.

“A question that I recommend organizations ask themselves is how are you ensuring that your organization understands the population being served — and are you reflecting the population being served? Value-based care is not just about the metrics,” Boyo said. “It's not just about the structure, it's also about intention — what are you trying to achieve and how are you trying to achieve it?

He mentioned that during the height of the pandemic, most health systems suddenly realized how important what happened outside of the hospital was. “When I was in San Francisco, we realized that we could not be successful in messaging about masking, hand-washing, and not congregating in close settings without partnerships with community-based organizations,” Boyo said. The healthcare organization needed to better understand and listen to community-based organizations in the Black, Latino and Asian-American communities to understand how to message more effectively.

“That highlighted how critical equity work is and how much value-based care needs to be focused on tailoring to the patient and the population,” Boyo said, adding that the pandemic also forced John Muir to look at how well their health system is integrated with the public health department.

“We started looking at how well the data that we have in our hospitals translates to other hospitals and clinics, and whether we could look at the impact we're having in our county with the public health data,” he said. When vaccinations first went live in Contra Costa County, one of the questions that Boyo posed to the institution is: how do we know that the people who needed vaccines the most are the ones who are getting the most attention? “If we're looking at this through an equity lens, that means that those who are likely to experience higher morbidity and higher mortality are going to need more attention,” he explained. “We stratified our entire patient hospitalization data with a COVID diagnosis by Zip code, and then instead of simply saying anyone can show up for a vaccine, we worked to deploy vaccines to those communities. That is another example of how value-based care should really be focused on the patient, and population and bringing it back to the intention of what you're trying to achieve.”

The intention is going to be key, Boyo stressed, but so is quantifying your impact. It is one thing for an organization to say it is collecting data on race, ethnicity, language, sexual orientation, and gender identities, but are they stratifying that data? He asked whether the most important quality metrics in your organization have been stratified, and what you are doing to close morbidity and mortality gaps. “Ultimately, equity is how you fundamentally validate and verify the impact of your quality work,” he said.

Panel moderator David Nash, M.D., asked Boyo for some tips on better integrating health systems with public health. “Reach out to the county health agency to better understand the impact you're having in the community,” he said. “If we assume that equity work is quality work, that means that you want to understand the quality impact you're having in a community, and you will be on the same page as the county public health department.” Looking through the lens of value-based care, it is imperative that you understand what is happening upstream, which is in the public health data, he said. Boyo described quality work as a cycle because when you discharge patients back into the community, you want to ensure that you're actually seeing the fulfillment of that cycle.

“If we assume that COVID is not going away, and that there are going to be other variants and versions of this for a while, it is in the best interest of health systems to continue to be connected with the county and with public health agencies because that is how you do surveillance together,” Boyo said. “That is how you understand incidents together; that is how you understand prevalence together and then you can be proactive so that you know who is going to come to your emergency department, which in turn is going to better help you reallocate your resources.”