Keeping health equity at the center of connected healthcare

Transcript - Keeping health equity at the center of connected healthcare

Arianne D. Dowdell: I think it's hard for people to talk about what they're not doing well sometimes. If we see our patients leaving, we think that that's a win, but if we don't know what happens when they leave, is it?

Anuja Vaidya: Hello and welcome to Healthcare Strategies. I'm Anuja Vaidya, senior editor and special events lead at Xtelligent Virtual Healthcare. Connecting patients with the healthcare system remains among the most challenging hurdles to enhancing health outcomes nationwide. While novel approaches to fostering this connectedness are emerging, some groups risk being left behind. True advancement is only possible when health equity is at the center of connected healthcare efforts.

Today, Arianne D. Dowdell, vice president and chief diversity, equity and inclusion officer at Houston Methodist is with us to discuss the disparities plaguing healthcare access and outcomes, the urgent need for equitable advancements in healthcare delivery, and what the conversation around health equity is currently missing. Arianne is a speaker at our upcoming Connected Health 2024 Virtual Summit, which will be on Oct. 15 and 16. She will be speaking on a panel about boosting equitable connected healthcare access and adoption. Do join us for the panel, and until then, here is a snippet of the broader conversation around health equity within the connected healthcare sphere.

Arianne, thank you for speaking with Healthcare Strategies today.

Dowdell: Thanks so much for having me. I really do appreciate it.

Vaidya: So, first a level set. Could you just define health equity for us?

Dowdell: Absolutely. Health equity, it's really thinking about the state where everyone has a fair opportunity to reach their highest level of health, which actually differs for every single individual. So, when we think about health equity, we have to think about those other societal factors that exist aside from just going to the doctor for treatment. We have to think things about social and other obstacles that they may have, like their education, access to transportation, food insecurities, et cetera, that they may have. So, really thinking about the entire person to help them get to their best health possible.

Vaidya: Absolutely. And I'm curious, what role does health equity really play in Houston Methodist's mission and strategic goals, especially given what a vast health system it is?

Dowdell: At Houston Methodist, we believe that every patient that walks through our doors is someone that is of sacred worth. That's something that we always say. And we believe everybody that comes through the door really should have a chance to reach their best health possible. But in addition to having that, it's really when we think about health equity, part of the work that everyone in the hospital is responsible for, but we do make sure it's part of our mission and our strategic goals, for example. It's not just a standalone initiative. We have things like our community benefits program and our DEI grant program where we really work to promote health equity. And so, for the DEI program, for example, we have funds that go out to the community to help our underserved populations access different things.

So, we've given out, goodness, over $15 million so far in the past four years, but our community benefits department has been around for 31 years, even though we don't necessarily call it health equity, right? Community benefits has been around for 31 years. They've given over $180 million throughout the Houston area to address some of these core issues, which really are health equity. In order for us to be successful and think about what health equity means in getting there, we have to make sure it's really part of our strategic plan and the goals that happen all throughout our hospital, not just in one department, not just one person, but really core to the values of who we are as an organization.

Vaidya: I really think everything that you just said sort of points to how far we've come in discussing health equity. The terms have changed, the focus has changed, and I do think the pandemic played a very unique role in bringing a concept that wasn't foreign, like you mentioned, this has been around for decades, this idea that a person's health doesn't end the minute they leave the hospital, but it very much is influenced by their surroundings and their socioeconomic conditions. I thought we could discuss how the pandemic really changed the conversation around health equity. How were we talking about it pre-pandemic, and then if you could chart some of the challenges that the pandemic really brought to the forefront that really helped to change how we talk and think about health equity?

Dowdell: So when we think about health equity and how we looked at it prior to COVID, we focused a lot, and we still do, it is very important for us to look at quality and patient safety. That is a key part of what health equity is in a lot of ways. But then came COVID, then came the pandemic, which in a lot of ways was like the great equalizer. All of us were susceptible to it. But then we realized that despite the fact that any person had a chance of getting COVID, we saw the disparities that existed. There was no doubt if you looked at the data that we saw a disproportionate number of minorities dying and being hospitalized from COVID. And so, at that time, everybody's goal was to save lives, to save lives, to treat those that came in the hospital, and to prevent people from getting the disease through vaccination.

So really, health equity had to be the conversation that took place during COVID. We had to talk about access to vaccinations. We started talking about rural healthcare and the role that having access to vaccinations played. We looked at family dynamics based on cultures, families that lived with several generations in one household, preexisting conditions. All these things that made up health equity really became part of the conversation. We had town halls that took place, it became education. And so, these are all those things that are those pieces to health equity, which I would say even during COVID, really, right at the height of the pandemic, we weren't calling it health equity. We were just trying to solve for it. And so it was really different. And as terrible as the pandemic has been for so many of us, it opened up this opportunity for us to look at our philosophies, to look at how we're treating our patients, to make sure we're having those difficult conversations, but what are we doing to solve them?

So, it became a rush to the finish, and it opened up doors and allowed people to see things when they, too, could be impacted in a different way than maybe when it was just happening to one set or population of folks at a time. So, the conversation definitely has changed from pre-pandemic to pandemic, and, now after, I think there's been a lot of changes that have taken place and, quite honestly, a lot of much-needed growth in this area.

Vaidya: And I'm curious if the changes in the way we talk about health equity and moving from this idea of even just saying, 'Oh, it's important and we need to talk about it,' even just beginning the conversation, how has the approach to solving for it evolved in the last four years? What are you seeing in terms of models, innovations, ideas that are really trying to solve for this issue?

Dowdell: One thing that I think anybody that does this work on a daily basis has come to realize is that there's no one answer to how to address this, right? And so, depending on where you are within the nation, what you need to solve for may be different. How diverse your patient population is and how you go about that may be different. I think what's changed is we have a lot more data that we're focusing on in a different way. Data is huge. We have things like telehealth that we didn't have before, technologies that were around but we didn't talk about a lot. We talk about those things now. I think that there still is a bit of a confusion for some about the difference between health equity and health equality. And so, there's still education that needs to be done around that. But overall, I think there's a broader difference between the two and a broader understanding of where we [were] then and where we are now.

I think before it was hypothetical in some ways, but now we have things like CMS mandates, right? We talk about social drivers of health differently, and we look at things different. So, it's allowing us to track our data and really forcing people that if they want to work and solve these problems, it takes more than the hospital. You have to work with the community. It's not a one-size-fits-all and one organization to solve this. And so, it has changed a lot as far as the concept and getting to how do we work to solve these issues for everyone. But it is very multifaceted, it is not easy, and it takes large teams of people working together to try to figure out how do we work to solve these issues and eradicate things that happened in the past and change how we move forward in the future.

Vaidya: Absolutely. Absolutely. And I do want to drill down really quickly into something you just said because I had not heard that distinction between health equity and health equality as much, and I'd love for you to walk us through what the difference is there.

Dowdell: We talk about it as far as from the health equity perspective and also like the DEI perspective when we think about just equity in general, what it is and what it's not. And so, when we think about equality, and I say if we think about health equality, that is the doors at Houston Methodist, anyone can walk through our doors of Houston Methodist, right? There's equal rights to walk through the doors of Houston Methodist. When we think about health equity, that means are we doing what we need to do to get you as an individual to your best health? That differs from the door just being open to walk into because what you may need is different than what I may need, even though we have the exact same condition. And so there is a big difference, and it is something that we have to talk about. Just because a patient comes in with something like diabetes, doesn't mean they have to be on the same medication. Doesn't mean the treatment plan is the same, but anybody can walk through the doors that has diabetes. So, there's a difference there.

Vaidya: To me, it really brings to mind the push we are seeing in the industry towards personalized medicine and towards a more personalized form of treatment. And to me, this sounds like what we need to be doing in the health equity space of making the solution personalized, not just to communities, but to each person that walks through that door. So yeah, absolutely. And you mentioned telehealth and the rise of some of these digital health tools that have really revolutionized the way we can solve for this issue, which, on the one hand, is amazing. But now that we're about four years into the pandemic, we've seen the excitement around a lot of these tools ebb and flow. Do you feel that these tools are really capable of achieving the progress that we need to achieve in the equity arena?

Dowdell: First, I think it depends on what tool you're talking about, right? When you think about, let's take nursing, for example. Nurses are in the business because they care about people. So, if there are tools that we can create that are technologically sound that allow our nurses to be by the bedside alleviating some of the other work that they have to do, that potentially is getting someone to a more equitable outcome and getting them what they need. We have a great innovation team here at Houston Methodist. The work they do is pretty incredible. They test out these things, and they look to see, is this the right technology for us to bring into our hospital to advance health equity? But it can't just be those things alone, right?

Because you think about, again, let's go back to rural healthcare or people that don't have access to Wi-Fi, but we have to make sure that, say, on the patient access, are we making scheduling easier? Are we making sure that in addition to those technologies, we have people that are culturally competent in what they're doing, making sure we have closed-loop referrals? So the technology is just one small piece in a big issue of problems that we try to solve for, but it's also a really important piece.

We can look at the web, we can say it's great that we have access to the internet, but it also can be a bad thing at times. It's how your organization uses it. It's making sure there's a team-based approach and making sure you're thinking about who is this helping and who might we be leaving out? And if we're leaving them out, what are we doing to supplement that in the work that we're doing every day? I think it's a blessing and a curse depending on how we look at it, but our team here does a great job at paying attention to all of that through our innovation.

Vaidya: I definitely want to hear more about that because we really need to talk about what this means for the healthcare provider. We have these digital tools, but like you mentioned, they are just a tool, and it needs to be part of a larger strategy. So what would you say are really some of the key considerations for healthcare providers investing in these tools, implementing these tools, and how does Houston Methodist ensure that health equity really remains at the center of connected healthcare initiatives?

Dowdell: So when we think about the tools for our providers, a lot of that's going to come down to educating the patients and making sure that we have equitable communication and breaking down those silos. So, our providers can do a great job, but what are they doing? Again, working with patient access, working with our social work teams, all these pieces of that puzzle that come together when they think about what technologies are best in the practice that they're doing, coming to our innovation team and saying, 'Here's some of the things that we see,' and we vet them to see if it makes sense for our patient population and continuing to lead in that area.

What's also important, it's hard to say in this day and age that we don't need to have DEI, but we have to have health equity. You can't really have one without the other in a lot of ways because you have to understand that we're still treating people. And so what does that mean? We may have AI and great technologies that don't require people, but at the end of the day, we have to be able to connect with people. There has to be that connectedness to bridge that gap. So I think healthcare providers are trying to find how do we treat our patients better? But we have to make sure there is, again, that team-based approach, breaking down those silos and working together.

Vaidya: As you continue down this path of innovation but keeping health equity at the heart of all these initiatives, what would you say are some of the biggest challenges to really being able to move the needle in ways that are long past due at this point?

Dowdell: Yeah, I think this isn't necessarily a Houston Methodist issue at all. I think this is a healthcare issue that I'll talk about. I think as we're putting the pieces of the puzzle together and trying to solve for health disparities and looking what health equity is, there's a lot of new regulations that are coming out. Not everybody has funding and access to some of this technology that we're talking about. And so what happens to those organizations that don't have this? What happens to organizations as we're trying to solve for these that don't have community partners that they can work with to be able to send patients out to make sure we have closed-loop referral systems? And so, I think that as we try to solve for these, if people don't have a strong plan for how they're going to do that and don't have access to the resources, all the regulations in the world aren't going to solve for making someone healthier.

And so, I think there's lots of great conferences and conversations like the ones we're having today on how do you do that and how do you do it effectively? I think you have to understand what you're working with depending on where you sit within your state, your town, the country, and even the world really, with your population. Because not everybody has the same challenges and not everybody understands all those pieces of the puzzle that you have to put together to solve for this. But if you don't have community resources, you don't have technology, you don't have some of these other things, it will continue to be very hard. And if you don't want to educate your patients. Because patients have to want to be educated on this and everyone learns differently. And so, that piece alone is something that has to be taken into account along with the type of research that we do. All these things we need to solve for right now, but we also need to solve for the future now too. I think that's going to continue to be one of the bigger challenges.

Vaidya: Absolutely. Absolutely. And on that note, I have one final question for you, which is what would you say is one or two really critical aspects of the conversation around health equity that are missing currently? What are we not talking about in this vital arena that really needs to be talked about if we want to see the kind of progress that is needed to make healthcare more equitable?

Dowdell: I think it's hard. You could equate this to sports, you could equate this to anything. I think it's hard for people to talk about what they're not doing well sometimes. If we see our patients leaving, we think that that's a win. But if we don't know what happens when they leave, is it? So, I think we have to start to acknowledge more what can we do better? We don't even have to call it what are we doing wrong, but what can we do better? And then what do we need to do it better, and start to work really again with our community and with each other in the hospital?

We are so busy day to day taking care of patients, but I think if we don't take a step back and start bringing teams together to solve, that individual care that you and I just talked about a few minutes ago, that's never going to happen if we can't truly identify what is it we need to do better. Because at the end of the day, when we think about health equity, that's not based on your race, that's not based on your gender or your economic status, that's something that we all desire just as human beings. So, it's not unique to one set or group of people. That's something that we would all desire. So, we have to think of what do we need to do so that when and if it becomes us, we get that treatment that we want as well.

Vaidya: Absolutely. Absolutely. Arianne, thank you so much for joining us for this conversation today. I think there's so many interesting pieces that we hit upon, and I'm excited to continue this conversation with you. But thank you again for your time.

Dowdell: Thanks so much for having me. I really do appreciate it.

Kelsey Waddill: And thank you, listener, for tuning in. If you liked what you heard, head over to Spotify or Apple and drop us a review. We'll be choosing some of our reviews to be read on the show in appreciation. So keep listening through to the end because you might get name-dropped. And don't forget to reserve your spot at the Connected Health 2024 Virtual Summit from Oct. 15 through 16. Visit xtelligentvirtualsummits.brighttalk.com to register. See you there. Music by vice president of editorial, Kyle Murphy, and production by me, Kelsey Waddill.