Providence Reflects One Year After Health Equity Pledge

A year after making its health equity pledge, Providence is excited about the work it’s done to reduce racial health disparities. Although far from complete, the organization is celebrating its progress in leveraging insights from community health workers to address the biggest pain points in health inequities.

Like many other healthcare organizations, Providence made a pledge backed by a $50 million, five-year investment to address the racial health disparities plaguing the nation. Emphasized by the unequal disease burden carried by communities of color during the COVID-19 pandemic and elevated to national conversation by the murder of George Floyd, health equity quickly became a key priority for the nation’s leading healthcare organizations.

And so came Providence’s pledge, which entailed both a focus on ameliorating the immediate threats to health equity COVID-19 posed, as well as looking to community health partners to address existing disparities and doing the work at the organization level to instill cultural competence.

Providence is only a year into this mission, which organization leaders have acknowledged will be a long road, and which gets a full five years of funding. But according to a recent progress report looking at the year’s work, the organization said it’s on the right track.

“We recognized that this is a long journey and that we were getting started as a large and complex organization that cares for very different populations across our entire footprint, and so we were really intentional about setting this work up strategically for success in the long haul,” Karen Boudreau, MD, senior vice president of Enterprise Care Management and Coordination at Providence, said to PatientEngagementHIT.

“When we had our recent one-year anniversary of starting the work, we were really thrilled with how far we have come already. Again, recognizing that this is work that can take a long time and needs to be set up carefully and we need to establish and re-establish relationships with the community in a new way.”

In fact, it’s those very community relationships that have been at the heart of the organization’s success so far, Boudreau said. Providence’s work has been underscored by its wealth of internal data about population health needs and community experiences. That information, coupled with its community health needs assessments, helped chart a path forward in health equity work and gave employees something tangible to act upon.

Equally as instrumental was the qualitative data Providence gathered at the outset of its health equity mission, Boudreau added, crediting work by her colleagues Whitney Haggerson, vice president of Health Equity and Medicaid, and Haley Maier, director of Strategic Projects and Initiatives.

The pair convened a group of more than 40 caregivers and health equity advisors to discuss their experiences with health disparities, giving deeper insights into future endeavors for Providence.

“We talked with them and really tried to listen deeply to their perspective about their experience with healthcare as a caregiver, as a person either getting their own care or getting care for their family, and then as a member of a particular community, whether it be the LGBTQ community or the Latino community or the Black population,” Boudreau explained. “The courageous insights that were shared in those conversations, which were confidential conversations, were incredibly moving and really grounded us.”

For Haggerson, a leader in Providence’s health equity work, those conversations were a touchstone throughout the organization’s first year of the health equity pledge.

“We have a ton of quantitative data, but there's so much that you don't hear through that,” Haggerson said in the same call. “Having those conversations and grounding ourselves in the experience of our caregivers and our neighbors and our community members is so pertinent and that's been something that our regional teams have emulated as well.”

Perhaps most saliently, Haggerson said this information helped Providence determine how it would build out community health partnerships to fulfill its three health equity priorities: COVID-19 disparities, latent health disparities, and internal or organizational health equity.

For example, the organization’s earliest health equity work last July included COVID care packages providing masks and hand sanitizers to the community. Providence checked in on its community partners that serve key social determinants of health, like food banks and homeless shelters, and funneled key resources like PPE and cleaning supplies so those groups could continue offering social services.

“That transitioned into making sure folks had equitable access to testing and then equitable access to vaccines and now, as we're thinking both continued access to testing and vaccines, but also looking at post-COVID clinics,” Haggerson said, alluding to the clinics needed to address long-COVID symptoms.

When working on health disparities outside of COVID, Providence has been able to build on those community health partnerships.

“As we're identifying the health disparities that exist in our regions, we’re not creating a solution in a vacuum, but doing that in collaboration with these community organizations,” Haggerson explained.  “I'm seeing some really promising relationships being built.”

In Southern California, for example, the healthcare organization parlayed partnerships with predominantly Black church congregations issuing COVID-19 tests and vaccines and are rolling out new projects to address other disparities.

“Now, we're partnering with them to address hypertension rates, which we know disproportionately impact the black community as well,” Haggerson continued. “We’re really starting from, ‘Gosh, we didn't have a relationship in the beginning, we reached out to see how we could help.’ And then from there, we've just listened and said, ‘What else can we do? How else can we partner?’ Now, these congregations really do see us as their partner in addressing the needs of their community.”

Making progress toward stronger community-based healthcare and more health equity isn’t necessarily simple, Boudreau acknowledged. Health equity is an enormous problem, and discussion about it only became earnest and commonplace in the past few years. Healthcare organizations aren’t entirely used to operating in this way, so there have been some areas where Providence has had to make careful considerations.

“Anytime you're working on something as large and as complex as eliminating health inequities, you have to be prepared to adapt and pivot when you need to, without losing sight of your big goal,” Boudreau pointed out.

Take, for example, the allocation of resources, Haggerson offered.

“As in healthcare anywhere, there's a lot that we could be focusing on, so we had to really figure out, how do we prioritize this?” she said. “If we try and do a hundred things, we won't do a hundred things well.”

Much of Providence’s earliest work was figuring out the one or two things that it could start with that would make the biggest impact, Haggerson said.

And as healthcare needs have evolved, health equity strategies have had to change, too. Back in March and April, Providence joined numerous healthcare organizations across the country in supporting patient navigation in vaccine access. Through a text message campaign, Providence focused on populations that are high-risk for COVID-19 infection and explained the best way to get an appointment for the shots.

But soon enough, the organization started hearing from patients that they’d already gotten the jab or that they had a plan for doing so. Providence didn’t need that outreach tool anymore.

“We put that on hold and said, ‘Alright, now how can we take what we learned from this personalized text messaging, connection to care, connection to community health workers and put it on the shelf so when we're ready to engage in it again, it's there and ready to go?’” Haggerson considered.

That strategic decision-making will be key as Providence continues to embed health equity into all of its work, the pair agreed.

“This really is the north star for our organization, making sure that we are doing everything we can to achieve equity for all that we serve,” Haggerson said. “We put out our health equity statement and one of the really key components in it that speaks most loudly is our fifth pillar that we're committing to which is, humbly welcoming discussion and feedback.”

“We need to have those conversations about what's working and what isn't and own the pieces that we have had in perpetuating these inequities or disparities and doing the personal and institutional work to change that,” Haggerson concluded.