As the nonprofit Institute for Healthcare Innovation (IHI) begins accepting applications for the next cohort in its Pursuing Equity Learning Network and Action Community, executives with Minnesota-based HealthPartners discussed with Healthcare Innovation their experience in the first cohort, which was launched in 2017 to remediate healthcare disparities using a framework developed by IHI and its partners.
In 2020, the second iteration of Pursuing Equity involved teams from 22 healthcare organizations working to advance equity and racial justice in two project areas: one clinically focused and one strategically focused. The aim now is to build on those lessons and expand Pursuing Equity to more health systems.
Biotech company Genentech has fully funded the next iteration of Pursuing Equity, which will run from January 2023-June 2024. That will allow dozens of health systems around the country to have an opportunity to join an IHI Learning Network at no cost to gain skills, tools, and knowledge to confront unjust disparities in medical outcomes and advance a culture of health equity in their organizations. In addition, 10 health system teams will engage in an Action Community where they’ll come together to make measurable improvements in clinical practice areas where disparities by race, ethnicity, ancestry, language, sexual orientation, or sexual identity have been uncovered.
Based in Bloomington, Minnesota, integrated health system HealthPartners includes a multispecialty group practice of more than 1,700 physicians serving patients at more than 90 clinic locations and seven hospitals throughout the Twin Cities and Western Wisconsin.
HealthPartners has been working on equity issues longer than most health systems. It was in the early 2000s that the health system explicitly articulated equitable care as an element of quality, said Nance McClure, chief operating officer. “We had the capability of being able to get our own data from our electronic health record. I think we were probably the first group in Minnesota that started asking patients preferred language, self-identified race and country of origin.”
McClure added that there is value in participating in Pursuing Equity to hear what other systems are doing in the spirit of sharing what works and what doesn't. “Certainly, we've gotten some good ideas from other groups of things that we could try,” she said.
In the Pursuing Equity cohort, she added, there were some chief equity officers complaining that they couldn’t get their leadership and counterparts engaged in the effort. “At HealthPartners, we have had absolute 100 percent board engagement from the beginning,” McClure said. “We also don't have an issue of getting this included in operations because we've structured it that way. The other thing is we've been very practical about measurement. We have robust quality measurement in Minnesota. We've got standard quality measures that are reported by all care groups for many of the chronic and preventive conditions and now for infant and maternal health, where we're able to then look at those results by race, for example, and identify where there are gaps.”
HealthPartners releases these reports at the department and clinician level so people have the data. “We can look behind the scenes across a number of measures and identify where we see the biggest gaps in things like preventive screening for colorectal and breast cancer,” McClure added.
Beth Averbeck, M.D., senior medical director for primary care, said they have seen some of these screening gaps start to close. She also gave an example of how thinking about disparities is starting to be baked into everything they do.
“Yesterday we had a physician who is helping us with monkeypox present to 700 clinicians on monkeypox, and he happened to put up a disparity slide just to say here's who's getting monkeypox across the United States,” Averbeck said. “And he did it by race and I was just really glad he did it. I think it just goes to show that that's kind of part of what we're trying to do is to say when we're looking at things, we need to look at any potential disparities, and the fact that we have practicing clinician pull up that data was good to see.”
She said involving clinicians in equity work is about believing it needs to be done and then putting the supports in place so that it can be done. “We've done some maintenance of certification modules around our disparity work. I would say it's really not that hard to engage clinicians because they know how important it is.”
“We have learned that measurement is tricky,” McClure said. “You can get mired in data. You can look at data by all races and by 187 languages preferred for care, and so forth. And when you do you just get nothing significant. The numbers get too small and suddenly you have no significance and then that then you lose all your credibility with the doctors," she explained. "People build these dashboards, and you just stare at them. We've gone the other way and we pull our data by patients who are white and patients of color, grouping them all together. And then commercially insured and patients with Medicaid and then sometimes patients who speak English and patients who prefer other languages. You see the data more vividly; you actually see the gaps and you see the significance.”
