The upheaval of the COVID-19 pandemic set against the backdrop of centuries of racial injustice, continues to weigh heavily on our communities as we move into the winter months. Perhaps some of the most challenging and disheartening things to witness as a family physician who spent 25 years practicing in our diverse community and now as Chief Health Plan Medical Officer at HealthPartners, are the broad and long-standing health and care disparities that have come into sharper focus during this time. Every one of the negative impacts of the pandemic has affected communities of color and other underserved populations with greater force and depth. The pandemic, landing atop baseline inequities, became a one-two punch that has taken so much away from so many.

More and more individuals and families faced barriers to accessing the health care services they needed. Beyond the issue of access, we saw how mistrust, rooted in painful history, added to the challenge of meeting the needs of our communities slowing progress and compounding the harm many experienced.

Meaningful change that removes barriers to care

As an organization that provides health care and insurance coverage, our leadership saw that we needed to take additional action and ramp up our efforts to improve health equity – a problem we've been committed to solving for decades. So, the question became: How can we create meaningful change for both our members and patients that builds trust, removes complex barriers to better health and makes health care services accessible to all?

We believe it requires a more deliberate focus on systemic causes of inequity, such as social drivers of health, and policies that aggravate the problem. We must make sure we actively change ourselves, continually strive to eliminate the impact of implicit bias, and advocate externally to address the factors that result in these inequities. We know there must be accountability, too. That means listening to our community members, setting new goals, launching new initiatives and strengthening partnerships. These actions are part of an ongoing active effort, and we're encouraged to see many other health care systems doing similar work.

HealthPartners’ four fundamental cornerstones of health equity work include:

1. Organizational commitment: Explore implicit bias and racism within our organization and improve how we operate internally to increase diversity and inclusion in the workplace.
2. Programs and services: Close the gap on mental health and chronic condition disparities through care and coverage.
3. Community connection: Strengthen partnerships throughout our community that advocate for change.
4. Local economic development: Identify ways we can make a difference as an important keystone institution to improve our communities’ health and economic equity.

Organizational commitment to advancing health equity creates accountability

To help accelerate our progress and strengthen accountability, we formed the HealthPartners Equity, Inclusion and Anti-Racism Cabinet in 2020, a diverse group of our organization's leaders.

Under the cabinet's leadership, we set ambitious goals for our organization to achieve by 2025:

• Increase the racial diversity of our leadership team by 100%
• Build an anti-racist culture and deepen our cultural humility
• Eliminate disparities in maternal and infant care
• Eliminate disparities in childhood immunizations
• Eliminate disparities in chronic conditions and preventive screenings

One of the first steps to achieving these goals was to look internally, examining ourselves. We assessed how we are working together to provide quality care and health equity for every patient and member – making sure they feel welcome, included and valued. Ultimately, when we truly embrace our differences and diversity as an organization, we're better positioned to serve our members and patients. And having a diverse staff and leadership team that mirrors those we serve can only help advance this journey toward greater inclusion. By approaching the effort with humility and curiosity, we open ourselves up to the amazing benefits that diversity in a welcoming culture brings.

A large body of this work in 2021 focused on building an anti-racist culture and fostering cultural humility as an organization.

We implemented the following tactics to tackle this area and drive greater inclusion among our teams:

• Bias trainings for every member of our team to examine unconscious bias and develop better ways to respond to each other, our patients and our members
• Forums on topics such as race, identity, gender identity, disability and poverty

Part of this process has also involved engaging with our members, patients and communities to hear from them what we can do to build trust and address bias. By listening first, we gain new perspectives we must include if we hope to improve health outcomes. Armed with what we learn, we're creating new initiatives, like our Community Health Worker program. This program prioritizes connecting members and patients to share culture-specific knowledge, skills and values to help people feel represented, comfortable and empowered in their health care decision-making. It serves as an example of humility, plus curiosity, which helps drive change.

Care and coverage that closes disparity gaps

Thinking about closing health care disparities means taking a hard look at our insurance coverage, care delivery and associated policies to ensure we're operating with health equity in mind in every interaction we have with a patient or member. Using this “equity lens,” we can see things differently and change what could be aggravating or sustaining inequity.

We know that people of color and other underserved populations face additional barriers to accessing the care they need. Often these barriers are tied to societal, economic, community and environmental factors.

Moving toward an increasingly equitable system of both care and coverage requires understanding how these social drivers impact health equity. More importantly, we can support and measure efforts to address these drivers, so we can invest in and grow the array of effective approaches available in our communities.

Examples of social drivers include:

• Safe housing, transportation and neighborhoods
• Racism, discrimination and violence
• Education, job opportunities and income
• Access to nutritious foods and physical activity opportunities
• Unhealthy air, soils and water
• Language and literacy skills

We can and should act on these social barriers and provide solutions that give all members and patients the same access to care, prioritizing those that have the greatest impact on health, well-being and cost.

Some of our efforts across our clinics, hospitals and health plan include:

• Providing language services
• Providing transportation services
• Offering a mix of different options for appointments, including telehealth, drive-up sites and other accessible care sites
• Eliminating gaps in preventive screenings and childhood immunizations by making them more accessible, whether it be by offering walk-in appointments or mobile care options

Also, closing disparity gaps involves having that conversation about health equity with members and patients to connect them to the right resources and customize communications to better meet their needs. For example, the conversation may start in a care management relationship with someone who has diabetes. We can be the bridge to keeping their care plan on track by helping them find affordable, healthy food. Or it could be in an interaction between member services and a plan member where we learn that they are experiencing transportation barriers that we help them resolve. A health assessment is a significant first step toward documenting and understanding social drivers affecting those covered by our health plan.

One example of the impact of these critical conversations and perspectives is our work to ensure equitable access to the COVID-19 vaccine across the Twin Cities. Through translated campaigns and one-to-one outreach, we were able to help 20% more individuals hardest hit by COVID-19 schedule their vaccination. This campaign also included ensuring vaccination sites are accessible via public transportation and dispersing our vaccine supply to clinic locations serving our most diverse communities.

We will continue to build out our capacity to collect and analyze social needs data, which will help us adapt and evolve our programming to better support our members and patients.

Community connection creates change

Because we know most of what contributes to an individual's health and well-being happens outside of the health care system, we're only stronger if we can work together. By partnering with trusted institutions and members of the community, we can effectively advocate for healthier communities, not just more health care.

As part of the HealthPartners 2025 Partners for Better Health Goals, one of our primary areas of focus is building partnerships in the community through our Make It OK, Little Moments Count and PowerUp initiatives.

We continue to work with diverse community partners to help guide these initiatives:

• Make It OK provides a toolkit of resources and information to help organizations, employers and the communities address disparities in mental and behavioral health treatment, helping end the stigma around mental illness.
• Little Moments Count promotes family-friendly workplaces by providing organizations with educational resources on simple ways to improve children's health and well-being outcomes.
• PowerUp works with schools, employers and communities to connect families and children with resources and tools to help them lead healthier lives through eating better and exercising more.

Through our partnerships, we can assist our members and patients even more by connecting and referring them to community resources that directly address their needs.

Strengthening our local economies

Ultimately, improving health equity means everyone must take accountability for supporting the cities, communities and regions they serve. It's vital to know what's happening in the business community to identify the best ways to give back and strengthen our local economies.

One example is in our position as an anchor employer in St. Paul. We are an active business leader, at the table, serving on boards and advocating for policy changes that improve social conditions to help the community thrive.

As part of our Central Corridor Anchor Partnership in Minneapolis and St. Paul, we're one of 10 organizations investing in educational opportunities to hire more area residents, spending more procurement dollars with local businesses as we work to improve Green Line transit use and assure growing prosperity.

In addition, we have several initiatives and partnerships to address social drivers of health in St. Paul, including building homes with Habitat for Humanity, providing respite care with Catholic Charities and improving access to healthy food with local food shelves.

Health equity is a journey

It is critical to understand that achieving health equity is a journey. Ultimately, it is about listening to and learning from our members, patients, staff and community, pursuing positive change and removing barriers to better health.

It takes the courage to try new things, to acknowledge when actions are not working, and pressing on when other issues could distract us. These actions build the foundation needed to improve health outcomes and earn trust among those we serve.

And it also involves continued effort and dedication, plus the humility to realize that we can't do it alone. We need other health care systems, employers, organizations, cities, individuals and communities to collaborate if we’re truly going to move the needle on health equity. We’ll all be stronger and healthier if we do this work together.

“For more about childhood vaccine disparities and how building trust and relationships with both patients and parents can help close the gap, listen to the discussion Dr. Andrea Singh had with Dr. Kari Haley and Dr. Steven Jackson on our Off the Charts podcast.”