Healthcare providers have long worked to improve the wellbeing of their patients, but recent months have driven home the understanding that health organizations can do much more for those whose challenges extend beyond a physical illness.
It’s a call that’s been at the front of CommonSpirit Health CEO Lloyd Dean’s mind for decades. Often a public advocate for greater health equity, he said he’s been driven by childhood memories of an African American community in rural Michigan where health services were sparse and many died early to what the industry would now describe as unmanaged chronic diseases.
“With nine kids, I never had access to healthcare. I was bussed, fortunately, to an upper-middle-class school miles away—and I only tell you that because I got to see the contrast between that community and the community that I grew up in,” Dean told Fierce Healthcare. “The only time I really had access to a health provider was a high school football physical and when my mother would be going to the hospital to have one of my brothers or sisters."
“Because I saw my parents suffer, saw people in my community suffer, I always said to myself ‘If I’m ever given a chance, I’d like to change that and make sure people of color, in my economic situation—we were on welfare—could have access to healthcare,'" Dean said.
Suffice it to say that Dean now has that chance. He leads a health system that spreads across 21 states with more than 1,000 care sites and 140 hospitals. CommonSpirit Health is the country’s largest nonprofit health system and the largest provider of Medicaid services.
The system participates in “almost every major federal program that is geared toward poor, people of color and vulnerable communities,” Dean said. It’s also invested more than $200 million in community programs outside of its portfolio and headlined industry-wide calls to action on issues like racism in care and gun violence.
However, Dean said that his organization and others have a “moral imperative” to push those social efforts beyond rhetoric and into meaningful action. Here’s more of what he had to say about the industry’s unmet responsibilities surrounding health equity, social determinants and other issues.
Fierce Healthcare: Over the pandemic, we’ve seen a growing focus on integrating community services and social determinants into care. Why is this an important strategy for provider organizations?
Lloyd Dean: If there’s anything that we’ve learned and continue to learn from the pandemic, it’s that no single system can do it alone. It’s going to take every health, health-related and social agency within a community to really meet their needs.
We’ve done things like partnerships with roving clinics. We’ve partnered with sports parks in metropolitan areas and rural community-based organizations to get people vaccinated. It’s all this concept of not just being in a community but being part of a community. It’s knowing that the handoffs from one agency to another and being a part of the fabric of an infrastructure of a community is the wave of the future.
That’s important, particularly as you look at communities of color, vulnerable communities. And when I talk about the health of a community, it’s more than just healthcare. It’s violence, it’s access to healthy foods, it’s transportation, housing, making sure that we have the services that are all essential for one to live in a healthy environment.
FH: Does that recent swell of support for social determinants and health equity have teeth? Does it seem like the various new programs being announced by organizations will stick around for the long run?
LD: These initiatives are making a difference in measurable, both quantitative and qualitative, ways. It’s a journey and we’re in the midst of it, but I think, again, the pandemic just kind of unveiled a lot of the things we know about health inequities and chronic conditions. In a lot of ways we were just tinkering around the surface, and now are going deep and addressing the root causes of some of the issues.
People over the last year and a half have stood up and said, “We’re not only making financial commitments, we’re readdressing how we look at communities, how we look at ethnic diversity, how we make sure that all corners of our community get equal access.”
People have not only focused a lot of resources but now understand that if we’re going to address these in a comprehensive way, we’ve got to work together but be transparent and acknowledge that some of these inequities are driven by institutional racism, some of them are driven by access, some of them are driven by legislation and red lines being drawn. Those are the problems, and the good news is that while we have a long distance to go, social service agencies, community-based organizations and organizations are all being called to a higher standard.
One thing I’ll say is that it’s all about knowing how we access the data and get to information. One of the things that was a problem with vaccines and vaccinations, for example, is that we thought we knew where people were and who was where. But we didn’t, so we joined an entity called Truveta that’s now 17 of the largest health entities in the country coming together to share data so we can better serve communities. Together we can use these data to target our resources and target our capabilities.
FH: Inequity is also a factor within the workforce. As a health system and an employer, how can organizations like CommonSpirit and others tackle these issues and why is doing so important?
LD: We’ve got to be an integral part of the solution—and the problem that I’m talking about is the deficit in diverse clinical providers and leadership in this country.
We entered into a partnership with the Morehouse School of Medicine. It’s a 10-year partnership and we’ve committed as an organization to providing $100 million to help develop and train culturally competent physicians and new graduates. We’re starting new graduate medical programs. The prediction is that we’ll add 300 diverse, majority African American providers. We’re starting five new regional graduate medical programs on medical campuses throughout our footprint. We’re going to be opening up in 10 markets new GME programs
That all gets at something that there’s been a lot of discussion about—that in our country only 5% of physicians are Black. Studies have shown people of color are much more likely to not only access care, to access the health system, but to also be confident if they can see and communicate with clinicians of color. We’ve seen that particularly in underserved and vulnerable communities, so we’re trying to do things like that to help get at the root causes because we think it’s going to take those kinds of collaborations and those kinds of targeted initiatives in order to address what we’ve talked about for decades.
FH: How can an individual or their organization get the ball rolling on health equity and social responsibility?
LD: My advice would be that wishing for change is not going to bring a lot of change. We’ve got to be purposeful, we’ve got to be specific, we’ve got to be transparent about what is the problem. Then, we’ve got to be bold and courageous to bring that change.
For organizations like ours, for companies both public and private, not-for-profit and for-profit, that the game has changed. What equals a good organization is not just how much money you made but how much you’re doing for society, for communities. It’s not just about your products and your services.
It’s about “Do you have a social consciousness?” Beyond your fiscal goals, what are you doing to leave this earth, this community in a better place? What are you doing to help not just health but the lived experience that we all hope and dream about?
We have a huge responsibility and I think it’s fair that accountability is being set forth for how we judge a “good” company, how we judge a value-based organization. My call is not just to be a part of an initiative like “We’re going to put money in this health equity fund,” but to do substantive things, hard things. Use our voice and look inward to our own organizations and make sure that we’re hearing our employees and the communities we’re blessed to serve.
It’s going to take that kind of leadership. We want to be an example, and not because diversity is an economical benefit. It’s a moral imperative we are called to step up to, and I think we can do more.
FH: What role does the public sector have in achieving these equity goals?
LD: It’s going to take us all to create change and address the systemic and chronic issues. We’ve seen that there has to be coordination and integration between federal policy and state policy—for sure, we’ve seen what that looks like when it doesn’t go smoothly through the pandemic and getting resources.
How do we legislate and adjudicate equity, how do we hold accountable where we see injustices? That’s not something where a single entity can bring about the necessary change. That takes starting at the local community, grassroots level, up to the highest levels of this country.
Communities and citizens are demanding more, rightfully, from their government structure, from a programmatic legislation perspective. And I think that’s fair. That same demand and accountability on public companies and private companies is fair and just for government. If we accept those new accountabilities and expectations, and if we understand that each of us play a role but we all have to be at the table and working together, I think it’s the only way we’re going to address some of these very, very complex problems.
FH: Where does tech and digital factor into the push for health equity?
LD: I am a true believer that technology can play a significant role in helping us address some of the key challenges that we face as a nation, particularly as it relates to healthcare and behavioral health.
One of the things that I really am passionate about with technology is that it gives the patient, the citizen access to their own health data, their own understanding of what’s going on with them and helping them kind of own their health status. It helps them track what they’re doing, communicate what they’re feeling, the issues they’re dealing with. From an education standpoint, technology is a very powerful medium.
I haven’t even mentioned AI, the power it allows. AI went from being a mystery thing that happens in a corporate facility or warehouse to being accessed by you and me at our fingertips, which helps us understand things quicker.
I live and breathe the power of technology used effectively, but we have to keep it accessible, we have to keep it affordable and it has to be in a language that regardless of who you are, where you are, you can interpret and use it.
FH: Technology also has a capacity to exacerbate health equity when implemented poorly. From a leadership or organizational level, how can that type of damage be avoided?
LD: Again, I think it gets back to corporate consciousness, social responsibility and the bar in terms of what equals a desirable, good company.
As I look at younger generations, it’s not just about what we do but how we do it and how we utilize the gifts and innovations that we have not just to make money. Return to shareholders in a public company, that’s critically important, but I think the metric on how consumers want to relate to your company is what we’re seeing played out.
That’s a long way of saying that the essence of technology will be measured by the standard metrics that we know, but as we go forward it will also be about what greater good for which the technology is utilized. Having capabilities that will solve some of the most prevalent problems that we as citizens and community members and human beings are dealing with, but to be hoarding that and not using that for a greater good as a short-term strategy? The moral compass light will continue to shine brighter on entities that don’t understand that.