Olu Jegede, M.D., serves as the vice president of clinical care and health equity at Cone Health, an integrated health system in North Carolina. He recently spoke with Healthcare Innovation about his role in identifying strategies to identify and eliminate health disparities among Cone Health’s patient population.
Healthcare Innovation: Can you describe some of the health outcome disparities you see in the Cone Health’s service area in North Carolina?
Jegede: The big one now is the life expectancy disparities. We usually use our hospital, Moses Cone Hospital, as a landmark. If you were to drive five miles north from that campus, the people who live there live up to 85 years of age. And if you were to drive five miles south from the Moses Cone campus, the population there only lives up to an average of 70 years of age. So we have a 15-year gap in life expectancy between these two Zip codes that are only separated by a five-mile radius of the Moses Cone campus. That is staggering to us. I think it’s time we stopped talking about it and started doing something about it.
HCI: When you took this job a year ago, did you put a lot of focus on primary care or are there also equity issues in hospital care to be addressed?
Jegede: I usually talk about them in two ways. One is hospital-based and one is community-based. Community-based is key because we are talking about population health, and we are talking about our patients with disparities in a lot of things, including life expectancy. In the hospital we are seeing some gaps in outcomes. For instance, for patients who are admitted for pneumonia, there was a gap in the outcomes when it comes to mortality. So we work on those different areas. When we interrogate our data, and we see where those gaps are, we try to work on closing those gaps.
HCI: Is maternal health inequity one of the areas you're targeting and if so, what are some approaches you can take to that?
Jegede: Specifically, infant mortality is our focus but that also touches on maternal morbidity or mortality. We're working closely with two teams in obstetrics and gynecology and the Women's Center generally to close that gap. One of the things that we're working on is to have community health workers. and antenatal care and even pre-pregnancy education about how to avoid teenage pregnancy and smoking cessation before pregnancy. And there is a program in partnership with the Guilford County Health Department working on doulas in the community for maternal health during childbirth.
HCI: Can you give a specific example of the progress you are making?
Jegede: Last year, we actually bridged the gap in control of high blood pressure between the African American population and others.
We had about a 7 percent gap in the control between African American and especially the Caucasian population. Our aim was to bridge that gap.
We use several different tactics. We train our CMAs on how to measure correct blood pressures. We train our providers on individualized care about blood pressure. We actually came up with the protocol on how you see individual patients and the path of prescribing medication for them. And we know that some medications don't work for the African American population and some work better when it comes to the African American population. We have community-based pharmacy doing work with some of the difficult-to-control patient population. They will measure their blood pressure and change their medication as they go and also call them to remind them of taking their medications and to avoid those habits like smoking or salty diet that increases blood pressure. Then we have remote blood pressure monitoring. It allowed us to see when their blood pressure is out of range, and then we remind them of taking their medication. So a lot of those tactics began to work in the favor of our patients and their blood pressure control. We are really happy because we went above and beyond our target.
HCI: I understand that you have a program called Catch 5 in 5. Can you describe that a little bit?
Jegede: Catch 5 in 5 is our strategy around these life expectancy disparities. Catch stands for "Collaborative Actions Toward Community Health,” and five in five refers to giving five years back to the population in the next five years.
HCI: Wow. That's pretty ambitious.
Jegede: Yes, it is. And that's why we call it a bold goal. It involves a lot of things and it's collaborative because Cone Health can not do this alone, knowing that a lot of this has to do with social drivers, and also economic issues in the community.
HCI: So you partner with public health and community-based organizations who have ties in the community?
Jegede: Exactly. We partnered with a lot of people. The health department is one of them. We have a memorandum of understanding with the City of Greensboro to provide health and wellness, where people can have an opportunity to do to learn habits that will keep them healthy. We have another memorandum of understanding with the Greensboro Housing Authority and we work with many other community-based organizations like churches and schools. All of us are are coming together to really work on this very, very daunting task.
HCI: North Carolina just expanded Medicaid recently. Will that have an impact on health equity in the state?
Jegede: Yes, as a result, we expect about 21,000 people to join our network as patients who will be qualified for Medicaid. We are hoping that that will give people the opportunity to have a primary care provider and be able to be screened and get wellness visits, and then we can begin to find things early and they don't come in when it is already too late.
HCI: In many markets around the country, there's a shortage of primary care physicians. So if you have an expansion of the number of people who might have access to primary care finally, is it a challenge to find enough providers to offer that service?
Jegede: It is a big challenge. One of the things we think is going to help us is to expand our provider network and also to leverage technology. For example, we're going to have digital primary care access in the community to help bridge that gap so people can be screened at the community level and be connected to the primary care provider digitally.
HCI: Are there some challenges with gathering data about the disparities and sharing that data with clinicians?
Jegede: We have pretty robust data analysts at Cone Health and they do a great job in getting that internally generated data. The area where we may struggle is the population-based data because we have a lot of providers in our community, especially when it comes to the ACO, who are not on Epic.
HCI: There’s a shift underway from fee for service to value-based care. Do you think that you have it set up so that your providers can be rewarded for working on these equity issues or is there more work to do to make that shift?
Jegede: I think it's a work in progress. The system is prepared to do full value-based care and we're working towards that. I know a lot of areas are still fee for service. But when we make that paradigm shift to value-based care, that is actually when we can do a lot of what we are talking about here — knowing that if we don't do that, then we have to spend a lot of money caring for people.