2022 Civitas Recap: Day One, We are #BetterTogether2022!

2022 Civitas Recap: Day One, We are #BetterTogether2022!

2022 Civitas Recap: Day One, We are #BetterTogether2022!Posted by Nathan Elliott on August 29, 2022Summaries by Nathan Elliott. Formatting and editing by Madeline RizzoOn DemandDay OneDay TwoDay ThreeCivitas Networks for Health is a national collaborative comprised of member organizations working to use health information exchange, health data, and multi-stakeholder, cross-sector approaches to improve health.Were in San Antonio this year for the Civitas Networks for Health 2022 Annual Conference. Join us over the upcoming days as we recap selected sessions from this years events! In this installment, we recap some of our favorite Day One sessions.WelcomeDate: Monday, August 22, 2022Presenters:Lisa Bari, MBA, MPH, CEO, Civitas Networks for HealthScott Stuewe, President and CEO, DirectTrustOverview: Civitas Networks for Health CEO, Lisa Bari, and DirectTrust President and CEO, Scott Stuewe, open the first full day of the conference, delivering two key announcements and a call to action for attendees to start finding more common ground.Civitas Lisa Bari and DirectTrusts Scott Stuewe welcomed this years attendees to the conference (600 in person and 200 virtually) and announced the following:Civitas has signed a letter of intent with Health Level Seven International (HL7) and the Gravity Project (HL7 FHIR Accelerator focused on Social Determinants of Health data) to collaborate on implementation and dissemination efforts.The Patient Centered Data Home Governance Council and Civitas have named Velatura Public Benefit Corporation as the national Solution Partner for PCDH.In Civitas inaugural year, Bari called attention to some important changes in how the organizations membership is evolving. Most notably, what has been commonly referred to as health information exchanges (HIEs), regional health improvement collaboratives (RHICs), quality improvement organizations (QIOs), and all-payer claims databases (APCDs) are expanding their roles and blurring lines distinguishing one from another by traditional definitions. This role expansion is perhaps a demonstration of the shift from filling specific niche needs to functioning more as what Bari considers public-private health data utilities (HDUs). Look for more references to members functioning as HDUs going forward.Bari talked about the focus of this years conference in partnership with DirectTrust: Health Equity. Trust, social determinants of health (SDOH) data, interoperability, and community are key concepts in advancing health equity, and we expect to hear much more about these in this weeks conference sessions.Stuewe talked about DirectTrusts evolution over the past ten years and increasing use among major vendors and solution providers (sessions this week will highlight examples of Direct secure messaging solutions). Conferences like this are where important conversations happen that spawn new collaborations and meaningful advancements in this sector. As one example, Stuewes hallway conversations with Lisa Bari at the last SHIEC conference led to this years combined Civitas/DirectTrust conference.According to Stuewe, it is now time for organizations to reach beyond their normal networks and talk about creative partnerships. HIEs, for example, should consider talking to their HISPs to discuss mutual needs and opportunities. There are many more places to start conversations too, as will be featured this week. A key theme in this years conference is to bring more people to the table to explore how to leverage the technology that we already have to do more good for more peopleespecially those struggling to enjoy equitable experiences.As Bari put it, We are critical infrastructure for health equity. Its time to build.Moving Upstream: How to seize this momentum to transform the social and structural drivers of health equity in our communitiesDate: Monday, August 22, 2022Presenter: Rishi Manchanda, M.D., M.P.H., CEO, HealthBeginsOverview: Rishi Manchanda, MD, MPH, explains the core tenets of what health equity means, as well as discusses threats to equitable treatment and steps we can all take to build health equity into our careers and lives.Dr. Rishi Manchanda, a primary care physician and public health expert, walked audience members through a brief history of his familys experience with the Partition as India became a new nation a generation ago. It was a time of tragedy and mass disruption mixed with excitement about freedom for a new future.Manchandas family faced discrimination consistently in subsequent decades, even after coming to the United States, often from what he described as structural violence. Structural violence entails embedded practices or policies in political and economic organizations worldwide that cause injury to people (usually not those responsible for perpetuating them).We often hear about the Triple Aim, sometimes the Quadruple Aim, but Manchanda and his organization, HealthBegins, focus on the Quintuple Aim:CostsPatient ExperienceProvider ExperienceOutcomesEquityFrom a cost perspective alone (according to Kaiser Family Foundation), health disparities amount to an estimated $93 billion in excess medical care costs and $42 billion in lost productivity per year. Of course, the financial costs are less important than the human costs of failing our community members.The concept of structural violence means persistent barriers to achieving equity, which is really about treating everyone fairly. The exploitation of those with less power and fewer resources, marginalization/exclusion of people and entire communities from access to even basic services and opportunities, and the fragmentation of communities and disruption of resource sharing can all result from structural violence.Manchanda told the story of a fictional woman to help illustrate what all of this means at an individual level. Mrs. M, a single mother of two young children in her mid-forties who self-identifies as biracial (Black and Latina) cares for her frail mother in her home. She has also been dealing with Type II diabetes and mild atherosclerotic heart disease. She has a low-wage job and typically spends at least $2,000 per year on premiums and out-of-pocket expenses.At the end of last month, Mrs. M was admitted to the hospital after nearly passing out at work (diagnosis: low blood sugar). If we look at other factors in Mrs. Ms life, Manchanda explained, we can find that she and her family experience food insecurity. This insecurity is compounded by the fact that they live in a food desert (an urban area where it is often difficult to find and purchase fresh, healthy food). The food desert exists because of supermarket redlining, a form of structural discrimination or even racism, which is a form of structural violence. To provide context here, Manchanda presented a slide that depicted the layers of racism:Structural The totality of ways in which multiple systems and institutions interact to assert racist policies, practices, and beliefs about people in a racialized group.Institutionalized Discriminatory treatment, unfair policies and practices, and inequitable opportunities and impacts within organizations and institutions based on race.Interpersonal The expression of racism between individuals, through discrimination, bias, harassment, or slurs.Internalized Exists within individuals; the acceptance by members of stigmatized races of negative messages about their own abilities and intrinsic worth.There is more to know about Mrs. M. Recently, her home was foreclosed. She moved her family to a rental unit and has been unable to pay her medical bill from the hospital stay. The hospital sued, her wages were garnished, and she eventually lost her job. Now, she cannot find affordable healthy food and still has to take care of her children and frail mother. In order to care for her family and still take her diabetes medications, she decides to skip meals. These circumstances are a lot of weight and stress to bear, but people feel these kinds of pressures daily.If we look at a broader level, laws and policies can directly influence lifestyles like that of Mrs. M and her family. Between 2010 and 2013, researchers identified more than 843 state laws that disproportionately discriminated against marginalized racial and ethnic groups. We should consider the effect of these policies in our health equity response plans. Similarly, health disparities are often linked to location. The southern states of the U.S. tend to show the greatest unmet needs. There are certainly individual communities across the country where needs are highest.Manchanda offered a few takeaways from a report from the Brookings Institution:Place affects an individuals ability to access almost every dimension of opportunity, including education, health, the internet, jobs, and quality housing.Regardless of which specific measures are used to define [high-need] communities, poor people of color are far more likely to live in them than poor whites are.There are poor people of every race. But only poor people of color are systematically confined in poor places.Public policy created this pattern of residential segregation. It will take policy reform and a proactive, place-based approach to mitigate the harm caused by these policies.Why is this so? Manchanda cited an article in the New England Journal of Medicine titled, Lack of equity in policy design perpetuates structural inequities & harm. A few excerpts:By more frequently penalizing institutions caring for high proportions of Black adults, many of these programs have also unintentionally perpetuated structural racism.Value-based payment initiatives have failed to advance health equity in large part because equity wasnt prioritized during their design and implementation.The point here is that until we start making health equity explicit in our policy language at every level, were going to continue to miss groups of people and perpetuate inequities in one form or another. To make meaningful change, we need to address issues at multiple levels:Social needs at an individual level.Example: Food insecuritySocial Determinants of Health at a community level.Example: Food desertsStructural Determinants of Health Equity at a societal level.Example: Supermarket redliningDuring this weeks conference, attendees will hear more about how data will be essential to supporting change at each of these levels. We will hear about how a lack of useful data leads to effectively erasing people from existence, the kinds of data that payers are still struggling to capture, how social services organizations have been deprioritized, and about how biases continue to skew both data and paths forward.Manchanda sees a great opportunity for HIEs and other organizations in this space to make and facilitate important strides forward. These organizations can inform communities/policymakers about not only surfacing where needs are and what those needs are but also where interventions, programs, and policies are making a difference.Developed and led by Civitas Networks for Health, policymakers are now hearing about Health Data Utilities (HDUs) and their potential for helping to address unmet and unidentified needs (inequities). HIEs and related organizations are increasingly viewed by the government as critical infrastructure for health equity.As one example, the CDCs Social Determinants of Health (SDOH) Public Health Use Case Workgroup recently identified use cases that focus on the functionality and interoperability required to allow an end-user to send and exchange coded SDOH-related data.However, theres more that can be done outside of government to help lead us in the right direction. From a healthcare industry perspective, Manchanda cited At Toolkit for Centering Racial Equity Throughout Data Integration from Actionable Intelligence for Social Policy at the University of Pennsylvania. We should prioritize explicit adjustments for, and embed health equity considerations into, our use of data. With these adjustments, we can tell the stories that need to be told to help make change. Consider health equity during:PlanningData collectionData accessIn algorithms and use of statistical toolsIn data analysisIn reporting and disseminationManchanda also offered his own list of health equity considerations for HIEs, RHICs, and other data-led organizations:Organizations also have, or have had, structured programs through which to help lead change. Manchanda listed the following such programs and opportunities for involvement and encouraged attendees to consider similar future opportunities:Accountable Communities for HealthPurpose Built CommunitiesCommunities of OpportunityStrong, Prosperous, and Resilient Communities Challenge (SPARCC)Modernized Anit-Racist Data Ecosystems (MADE) for Health Justice (deadlines due August 31, 2022)NASEM Committee on the Review of Federal Policies that Contribute to Racial and Ethnical Inequities (tasked by Office of Minority Health) (oral comment on September 9, 2022; written comments due by September 30, 2022)In terms of steps forward, Manchanda advises putting race, ethnicity, language, and other demographic data to use to demonstrate gaps in services and outcomes by comparing groups in your community. Tell those stories. In addition, start to structure your plans in ways that explicitly call attention to health equity. Manchanda provided the following example:For a QI project focused on improving childhood immunizations among families by addressing unmet social needs, a team would first collect and review REL (race, ethnicity, language) data to identify differences in outcomes among two or more groups.Then, the team could set appropriate QI goals:Achieve a 20% increase from baseline in childhood immunizations among all families, ANDEliminate inequities in childhood immunizations between the racial group with the lowest rates and a comparator groupIf equity is not called out as a specific goal, we will most likely continue perpetuating the problem.Manchanda took questions from the audience, including the following examples:Q: Providers are already pretty burned out. These are great concepts, but its yet another concept to try to implement. How can we do this successfully?Manchanda responded by addressing some common responses to adding health or health data equity to the conversation with providers. For example, we might hear, I treat everyone the same. This response shows a defensive perspective at an interpersonal level, not an attempt or willingness to address the problem at one of the other layers, such as structural. Similarly, how does the provider know that they treat everyone the same without seeing the data? Does their choice of words affect their patients differently?Sometimes, the answer for providers is recognizing the moral injury that occurs when they are unaware of specific resources that might benefit their patients or recognizing when those resources are not available in their community. In these cases, it is important to understand these pain points, talk openly about them, and begin to work on community-based solutions.Q: This audience is mostly implementers, not activists. What can we do?Regardless of the specific nature of your professional work in this space, we are all leaders. We need leadership and courage to shift how we interact on a daily basis. Equity should be visible in conversations, questions, and solutions. As we do this more, we will see more effectiveness and better outcomes.Manchanda is looking forward to the Civitas membership helping to share and design the roadmap to health equity.For more information about Manchandas work and resources, visit healthbegins.orgor find him on social media.Empowering Patients with Data to Improve Health EquityDate: Monday, August 22, 2022Presenters:Deven McGraw, MPH, JD, Lead, Data Stewardship and Data Sharing, InvitaeDan Porreca, Executive Director, HEALTHeLINKCraig Behm, MBA, Executive Director, Chesapeake Regional Information System for Our Patients (CRISP)Grace Cordovano, PhD, BCPA, Board Certified Patient Advocate, Enlightening ResultsSara Abrams, MPH, VP, Data Analytics and Quality Assurance, Rochester RHIOOverview: In this presentation, the presenters discuss simplifying patient access to HIE (or HDU) data, which is framed by the urgency of Grace Cordovanos experiences on the front lines of serving patients with high-severity needs.Grace Cordovano has spent her career working with the most underserved and vulnerable populations in her community in New Jersey. She works at the crossroads of catastrophic diagnoses and end-of-life care.We are often told that we are all patients or will be, but Cordovano wanted the audience to think about the emotional/life-changing differences between being a patient at a doctors office for a wellness check or in the ED for, say, a sprained ankle, versus the experience of being a patient told that their cancer is no longer responding to treatment. There are important differences between routine care and, for example, a parent going from specialist to specialist trying to find a diagnosis and treatment for a childs rare and possibly degenerative disease. In other scenarios, some patients might be making a choice about diet and exercise, while others are choosing how to die.Cordovano thinks about patients in 5 groups:Healthy/Proactive Wellness SeekerAcute EpisodeChronic Illness(es)Life-Altering Diagnosis/Rare DiseasesEnd of Life & Death CareShe considers the first two Acts of Consumerism, while the remaining three are Acts of Survival. These levels of patient experience should also be considered when we think about SDOH. As we move through the severity levels, SDOH factors can have increasingly negative effects.This premise can all begin to sound a bit depressing, but Cordvano is excited about the future of HIEs and removing barriers. She sees improved access paying off for patients who have greater access to their information and community resources, including finding or participating in trials, being able to appeal a denial, and navigating information and tools more easily, such as scheduling appointments with less burden on patients and family caregivers.

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