FEATURE · SOCIAL DETERMINANTS OF HEALTH
really focused on. We launched our Health Equity Accreditation Program this year, for health plans, healthcare delivery, FQHCs; and our Health Equity Accreditation Plus Program looks at interoperability what data exchange with community-based organizations looks like, and how to make information actionable. We’ve also been doing a lot of research around community health workers, and how we might still leveraging them.” “I’m so glad that NCQA is helping
to push everything forward,” Hagland replied. “Plans, providers, all want that clarity” in terms of reward systems for work on the social determinants of health.” And the challenges are many, includ-
ing transportation, Hagland noted. “Tell us about transportation-related issues in your geographic area, Tina?” he asked Simmons. “We function across a tri- county area, with a lot of our partners and health systems,” Simmons replied. “Atlantic Hospital is at the southern end of Worcester County, which is very rural. It can take over an hour for someone to get to a hospital facil- ity; that’s where a lot of transporta-
Tina Simmons, R.N.
tion issues arise. From a health equity standpoint, that’s also where a lot of issues arise; a lot of vulnerable popula- tions live there. We very much partner with our community organizations and with other local hospital systems. And we are trying to take care to patients; we recognize that a lot of patients aren’t going to be able to come to us; we need to come
“Atlantic Hospital as at the southern end of Worcester County, which is very rural. It can take over an hour for someone to get to a hospital facility; that’s where a lot of transportation issues arise. From a health equity standpoint, that’s also where a lot of issues arise.” —Tina Simmons,
Atlantic General Hospital
Andrea Boudreaux, Psy.D.
to them. That’s where we’re leveraging telehealth as much as possible; though you also have device- and WiFi-related issues there that you have to work through. But we’re trying to take as many services as possible into communities. And we’re working with our school; we devel- oped a telehealth program with our school, but put it on hold because there were able to find local providers and create wellness centers. But we’re using technology
that allows for a complete visual assess- ment if you connect providers to nurses. So we’re looking to deploy those teams to areas of the county where people can’t easily reach services; that’s a big area of focus. And also leveraging telehealth and behavioral health. We opened two crisis centers last year, with a group of almost 20 partners, grant-funded, but really embed- ding telehealth in behavioral health.” “Andrea, how does this landscape
look to you in Washington, D.C.?” Hagland asked Boudreaux, who said, “it’s amazing how we have such similar strategies in Washington, D.C. We, too, have been focusing on telemedicine; we, too, have been struggling with transportation issues. “The District is broken up into eight wards, and wards seven and eight are east of the [Potomac] River; and the life expec- tancy in Ward seven is 54 years, and in eight is 84 years. And at the crux of health equity is identifying the means to provide patients equal access to care. So what things do I need to put in place? That’s where health equity comes in. We work with the Foundation to get Uber rides; the District has added transportation to and from school into its budget. We, too, use telemedicine, and give children access to healthcare through school nurses. And we’ve already started our weekend mobile units going out into the community every weekend. We’re identifying how we bring care to people when and how they need it, to meet their needs, while addressing all the issues—food, trans- portation, and so on.” “And Lauren and Brian, what are the
biggest challenges in data, and what are we finding out? Bryan, why don’t you start on that topic?
“At the crux of health equity is identifying the means to provide patients equal access to care. So what things do I need to put in place? That’s where health equity comes in… We’re identifying how we bring care to people when and how they need it, to meet their needs, while addressing all the issues— food, transportation, and so on.” —Andrea Boudreaux, Psy.D., Children’s National Hospital
“We actually came out with a paper
last year that was supported by the Commonwealth Foundation. And we found that inputted versus self-reported data made a difference. We looked at all the data sources involved, and looked at accuracy,” Buckley said. “People want to understand how the data is collected, and whether they can trust it. So we believe that you really have to create a gover- nance structure; governance is a key piece in all of this. But also, there’s this belief that patients don’t trust us. So we want to make sure that we’re seen as trustworthy. I teach at Georgetown University, and people tell me, go take a walk and see what people’s experiences actually are. And when you start doing more of that demo-walking, you realize how difficult it can be to collect that data.” “I can imagine you have two faces to
this,” Hagland said. “You want to protect patients and protect their data, but at the same time, we have to share data in order to improve the healthcare system.” “That’s it exactly,” Riplinger said.
“The question is, what are the challenges involved in the collection, sharing, and use of this data? In doing a nationwide survey of health information profession- als, we found three top challenges around collection: training, organizational policy within their organizations, and patient mis- trust. Lack of a trained workforce is a huge challenge. But also, a medical coder might not have access to the appropriate part of the record that would provide that kind of information. And where do I draw the line
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