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How Mass. hospitals move forward with intention on health equity

Hospitals in Mass. are moving forward with health equity through an 1115 waiver, but the state’s Hospital Association is looking long-term.

If there’s anything that sticks out to Massachusetts Hospital Association’s (MHA’s) Izzy Lopes about healthcare’s heightened emphasis on health equity in the last four years, it’s intentionality.

Health equity work has been around for decades, the MHA vice president of Health Equity work said during a recent interview, but it’s the intentionality that’s made all the difference.

“COVID-19 was one of the main things that happened that compelled people to really pay attention to what was happening with regards to healthcare and healthcare access,” according to Lopes.

Indeed, COVID-19 made evident many of the racial health disparities that have plagued the nation for centuries. Black, Hispanic, and American Indian/Alaska Native (AI/AN) people were all more likely to contract the virus and get sicker from it compared to their White counterparts. Meanwhile, access to care and even the vaccine intended the prevent COVID were unequal for racial/ethnic minorities.

These disparities were reflective of the disparities seen across other disease states, like heart disease and maternal mortality, that healthcare has been fielding for centuries. But it took the pandemic, plus the larger racial reckoning happening across the nation, to put health equity into mainstream conversation, Lopes explained.

“It's been an ideological change,” she said. “It was a shift that happened to compel people to see the importance of health equity.”

Despite decades of promoting health equity—Lopes said hospitals are community-based organizations, too, and as part of their decades-long population health efforts, hospitals have naturally embraced equity—it’s time for a status check.

In the state of Massachusetts, where Lopes works as an expert on health equity, things are moving forward.

Just recently, MHA announced that Massachusetts is the first US state to achieve The Joint Commission’s healthcare equity accreditation standard. This came with a proposed action plan of achieving The Joint Commission’s Health Care Equity Certification by 2025, MHA said.

Achieving the accreditation standard is part of the 1115 Medicaid waiver Massachusetts received to work on health equity across the commonwealth. The Joint Commission said it intends the accreditation standard requirements to indicate a hospital’s commitment to health equity. The six standard requirements include:

  • Identifying an individual to lead activities to improve healthcare equity
  • Assessing patients’ health-related social needs
  • Analyzing quality and safety data to identify disparities
  • Developing an action plan to improve healthcare equity
  • Taking action when the organization does not meet the goals in its action plan
  • Informing key stakeholders about progress to improve healthcare equity

Achieving the accreditation standard, which MHA hospitals did within the first year of the five-year 1115 waiver, was a grueling process, Lopes said. MHA’s role in the process is to support, convene, and guide member hospitals during the process and ensure they are on track.

But it’s the will and intentionality of member hospitals that has helped them move the needle on health equity in this tangible way, Lopes noted.

“There's been an ideological shift, which is so critically important, that basically speaks to this will and this desire and this idea that we have to band together as a system to really address these issues that we're seeing with regards to just access issues and quality of care issues and making sure that patients ultimately can be seen and heard as they are seeking to get their care,” she said.

“We have our hospitals and our members thinking intentionally about how to address the needs of the patients that they serve and the communities that serve,” Lopes continued. “It's such a ripe and opportune time, especially with the 1115 waiver, for us to have these conversations and to truly be innovative and to push the envelope with regards to advancing health equity and eliminating these disparities.”

MHA’s member hospitals have been successful in this work because they have recognized the key role that the community must play. Most medical and population health experts know that health and well-being are mostly achieved outside the four walls of the hospital. It’s that notion that has inspired so much of the social determinants of health (SDOH) innovation that’s happened in the past decade.

That SDOH work needs to keep happening in order to most tangibly move the needle on health equity, Lopes advised. To get there, hospitals and health systems need to lean on their community-based organization (CBO) partners.

“Yes, patients get their needs addressed at the hospitals or in that hospital setting, but hospitals really thinking about their partnerships in a different way and how can they form these alliances and collaborations will essentially support the patient throughout their care journey,” she explained.

“That has been such a stark evolution as we talk about healthcare,” Lopes continued. “There's been a lot more conversation and importance put on these partnerships and forging these meaningful relationships in order to make sure that the patient can get what they need.”

In fact, not coordinating with CBOs and making other overtures to incorporate the patient and community voice is one of the biggest mistakes a hospital can make, Lopes added.

To be sure, most healthcare organizations are well-intentioned when building out new programming to serve patients. Health equity is not an area ripe for genuine malintent. But it’s an easy trap to fall into where the hospital makes a patient-facing decision without consulting patients and community representatives.

“One of the pitfalls is essentially not having that participatory, inclusive decision-making that involves patients and that involves the community in a meaningful way,” Lopes said.

Take, for example, a new care access modality.

A hospital system may plan a mobile health unit to meet patients where they are. Without the input of patients and community leaders, the hospital may completely miss one neighborhood in need for a different one that is less centrally located to the intended patient population.

“It goes to that notion of, ‘if you build it, they will come,’ but it's thinking about that in a different way,” Lopes advised. “It's asking, ‘What do we need to build in order to empower folks and empower patients and to activate them in a way where they are involved in the process?’”

Community involvement gets to the point of intentionality that Lopes said has helped propel Massachusetts hospitals to such quick success with The Joint Commission accreditation standard.

“There needs to be this organizational will and commitment to do this work, which I think is so impressive to have a collection of members who are so committed to this work,” she stated. “That's the first step of establishing a structure where leaders are really investing in health equity, and that is something that we have definitely seen be the case across the board on a systems level.”

Massachusetts has only completed the first year in the five-year 1115 waiver, but Lopes already has her sights set on what comes next. After all, “the work of health equity transcends five years,” she said.

“As we're making these changes, how are we making sure that we're taking into account sustainability and that this work can continue?” she posited.

Part of that longevity plan is fortified by the requirements set out by The Joint Commission, both the accreditation standard and the Health Care Equity Certification MHA sees its hospitals achieving by next year.

The certification process is extremely rigorous, Lopes pointed out, and by undergoing that rigor, hospitals can build intentional health equity work into their DNA. The 1115 waiver, plus the accreditation standards and certifications the waiver entails, is just the first step.

“As a collective, we need to do better,” Lopes concluded. “There's an opportunity for the system to be better. And so, it's this notion of a collective will to do this work, and let's essentially show our willingness to do this work by investing because essentially the hospitals are investing, making this investment in the 1115 waiver.”

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