During the COVID-19 pandemic, we have seen health care organizations innovate rapidly to meet the ever-changing needs of a global crisis. As we go into our third pandemic year, we’re taking a step back to examine whether healthcare is more or less equitable now. Listen to this candid conversation with three leaders about the changes and ongoing challenges to flip existing power dynamics within healthcare institutions so that care is anchored in the needs of the underserved communities.
During the COVID-19 pandemic, we have seen health care organizations innovate rapidly to meet the ever-changing needs of a global crisis. As we go into our third pandemic year, we’re taking a step back to examine whether healthcare is more or less equitable now. Listen to this candid conversation with three leaders about the changes and ongoing challenges to flip existing power dynamics within healthcare institutions so that care is anchored in the needs of the underserved communities.
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*This is an automated transcript. Please excuse any errors or hilarious mistakes.
Episode Teaser / Eric Lam (host)
Our team was reflecting that we're in the third year of the pandemic and healthcare has obviously been at the center of it. And we've also seen a lot of healthcare organizations innovate pivot. We've seen telehealth become more prominent, seen data collection increase. And so we started asking ourselves and taking a step back and trying to see is the progress that we're making actually advancing health equity specifically for the safety net population. Have we made care more or less accessible to those that we are trying to serve?
Eric Lam (host)
I would love to start with introductions. Uh, if we can each go around, share our names, our organizations, and the roles, and I'm happy to kick it off. As you said, my name is Eric Lam. I'm with the Exygy team where we put partner with social impact organizations. Like the amazing ones that you see here today to design and build to that improves lives. Uh, I'm one of the partners and I lead our health work, which includes supporting community health centers in making their services more accessible, as well as making direct services like affordable housing, um, more accessible with our Bloomberg and so forth. So happy to dive in there, super excited for this conversation. Um, Sofi, would you like to go next and then maybe we can pass it to Sylvia and Mike afterward.
Sofi Bergkvist (guest)
Happy to, and thank you, Eric, for, for bringing us together here for the conversation today, I'm Sofi Bergkvist - I'm president at Center Care Innovations, and we have a vision that everyone has fair just and inclusive opportunities to be healthy, which is a definition of health equity. And, uh, therefore I'm very happy to have the conversation here today. And what we do is that we spark seed and spread innovations to improve health and wellbeing among historically under invested communities. Everything we do is in partnership, uh, in partnership with everyone on this call and many of the people in the audience. So we're happy to foster those partnerships further and I hand it over to Sylvia.
Sylvia Hacaj (guest)
Yes, good morning everybody. Uh, my name is Sylvia Hacaj. I am the director of development and communications at lifelong medical care. We are a federally qualified health center, uh, serving, uh, three counties in the east bay, Contra Costa, and a small part of Marin. And we basically provide, uh, high quality health, mental health, um, uh, social and dental services, uh, to folks regardless of their, uh, ability to pay their housing St or immigration status. And, uh, we were founded, um, we really grew out of the civil rights movement, um, and, uh, health equity and health access is really what our main mission is.
Michael Lok (guest)
Good morning, everyone. Um, my name is Mike Lok. I go by he and him. Um, I'm planning manager at Asian health services, um, like lifelong and great to be here with lifelong and Sylvia. Um, we're another FQHC, you know, serving Alameda county, actually Asian health services, and lifelong are two of eight FQHCs, uh, serving the great and diverse Alameda county, um, AHS. We serve over 50,000 patients a year in 14 team, different languages. And, uh, my role at AHS, uh, focuses on, you know, advocacy and empowerments of our, and the broader communities that we serve. And that sometimes involves, um, everything from, you know, healthcare reform to language access, to hyper local, you know, pedestrian safety issues and things of that nature. Um, you know, at EHS. And that gets say with a lot of FQHCs, um, you know, we, we consider, you know, advocacy, um, just as importance as patient care. So look forward to talking with you.
Eric
Thank you for that. Um, so how we actually came about this topic and creating this health equity series is our team was reflecting that we're in the third year of the pandemic and healthcare has obviously been at the center of it. And we've also seen a lot of healthcare organizations innovate pivot. We've seen telehealth become more prominent, seen data collection increase. And so we started asking ourselves and taking a step back and trying to see is the progress that we're making actually advancing health equity specifically for the safety net population. Have we made care more or less accessible to those that we are trying to serve? And so the first question that I want to kick off for this panel is what are ways in which advancement in healthcare over the past couple years, years has made care more equitable in ways. It hasn't Sofi. I love for you to start that conversation.
Sofi
Thank you, Eric. Yeah, the last two years has really been a stress test on all health systems in the world. And in many place says it's put a spotlight on the weaknesses more than anything I'm from Sweden. And there it's been a it's universal healthcare is a good healthcare system, but in that case, you see that there's been real weaknesses in care of elderly and especially immigrant elder families getting, uh, the care that they need. And here in the us, we have had deep inequities for a long time, and we are not in a better place. We have seen a much larger drop in life expectancy for black and Hispanic Americans over the last two years than for compared to white Americans. So I think it's important to recognize that we're not in a better place. Um, I don't think we should. We shouldn't frame it as if we are heading in the right direction.
Sofi
This has been two years of stress testing and really uncovering the deep, deep issues that we have. But that being said, we also have advancements in certain areas and it's important to look at those promising practices and pay attention to those and continue to invest in, to improve equity and access to care and ultimately improve equity in outcomes. And one of those indications, I think is the drop in no show rates. So people that used to schedule an appointment and then not being able to, to see their provider for different reasons are now much more likely to, to attend to the appointment that they have made and who are behind those drops in no show rates there's far more research needed, but we have heard that it relates to people that face transport patient challenges that had work, that didn't allow them to, to see their provider as timely or at all, but also people that are caring for family members being its children, being at elderly at home. So that drop in no show rates, I think is a really telling story. And where, where does that come from? It is really the increase in modalities that you now can your provider over video and also call your provider that is one step towards more patient centered care, um, that I think we should build on and do far more around.
Eric
Yeah. I love the focus on drop in no show rates and really seeing that as a telemetric and also agree that I think we do need more research and more investment in the promising practice that we have seen to see what work we be doing and where we are continue to fall short. Um, because we know that video visits were for some, they aren't always accessible for, um, everybody. Um, Sylvia, what are you seeing from your end? What has been advancing and what has, or have we been short on?
Sylvia
Well, I will just echo Sofi's, um, where we are short. I think, um, most of us know there are really severe problems in our healthcare system. Um, and, but to focus on a bright spot similarly to what's happened, if I may introduce a current event, um, you hear a lot of news analysis right now about what the, uh, war in Ukraine has done for, um, the NATO Alliance. For example, this shocking event has galvanized people in a way, you know, in a week that hadn't been able to happen in years. For me, the bright spot was around the care of the unhoused. Um, you know, we, I think in the years leading up to the pandemic folks began to realize, or not just realize, but start to implement policies that said, okay, you've gotta house people first to help them overcome addiction, to get help them get jobs and things like that, the pandemic, because it was a public health crisis.
Sylvia
And so transmissible raised the need and not just the need, I mean, raised the awareness and the, um, importance of, um, addressing healthcare for the unhoused. I mean, it's always been there. I don't wanna minimize, it's always been there, but there was a greater, um, just, uh, you know, a effort made to address this issue. And, um, what we saw was specific more money and more grants, uh, aim specifically at meeting the healthcare needs of the in housed and the, um, movement of unhoused people into, uh, into housing through, uh, in California, it was through project room key, um, which took over a lot of, uh, hotels for example, and just ensured that unhoused folks were, uh, separated by, you know, to help reduce transmission and housed. And, um, I think that was, um, a great, a positive in all of this, and I hope that that can continue here in California in particular.
Eric
Yeah. So if you think for that example, I know, uh, leading up to this, we talked about project BKI and left to dive in deeper later on in this conversation too. Learn a bit more about that and the intersection between health and a lot of other very needed, direct social services, um, before diving into that, uh, Mike, I'd love to hear from your end, uh, been seen.
Michael
Yeah. You know, and, um, I think it was mentioned before those are great points made, um, by my colleagues and Sofi was mentioning about the, you know, reduced in, you know, um, nohow rates. Um, you know, that's definitely something that we saw because, uh, with adding in, you know, telehealth in, into our services, um, but a big point I wanted to mention for the audience, um, if they weren't aware is that, you know, um, you know, um, telehealth has, was not reimbursable under Medicaid and Medicare, um, until the pandemic, it was a special, you know, um, policy put in. So that was a big sort of game changer and a big game changer when the pandemic started, um, where I think a lot of our, our clinics and other, you know, clinics were almost a hundred percent telehealth for a while in order to, uh, you know, set up the infrastructure, get the P P needed.
Michael
Um, there were supply chain issues and we were collecting donations from, um, nail salons and wherever we could in order to, you know, be able to put up infrastructure until, um, um, you know, we were able to have the testing and all the systems, um, in place. Um, but, um, I'll just mainly add as is, you know, as far as who's being left out, is there are tremendous, still language barriers that are impacting, um, you know, limited English speaking immigrant communities. Um, you know, I had mentioned before AHS, we serve, you know, 14 different languages. Um, and you know, um, not a lot of them are, are, are, are provided as far as language access when it comes to a lot of these safety net programs. Um, I believe unemployment, you know, EDD is still only in Chinese and Spanish. Um, but, um, for a lot of that cases for a lot of the other communities we serve, um, including Vietnamese, Korean, Burmese, Filipino, and a wide in a, in a, um, many more, um, you know, because tho those, whether it's been forms or, or even just flyers, you know, um, you know, we've sometimes, um, had to, uh, our staff have had to create some of those materials, those translations, just to be able to point folks in the right direction.
Michael
And oftentimes, you know, our, our patients, whether, you know, they do come to us for renewal in Medi and Cal fresh and other programs, but they're coming to us for help with how do I fill out unemployment? How I, how do I apply for the rent assistance program? And those are things that a lot of our staff aren't trained for, but, um, you know, the role that FQHCs play, we know that we play a, a wide range of roles. So, um, you know, I just say the language barrier is, is something that still definitely needs to be addressed.
Eric
Thanks for highlighting that, Mike, um, I think something that I'm hearing across, uh, with Sofi, Sylvia, you mentioned is there are some bright spots and there has been motivation and spotlight on advances. And at the same time, we still recognize huge areas for improvements, including language barriers. And I think you, the three of you, as well as a lot of the, that see a lot of that firsthand. Um, and so I wanna talk a little bit about data and how we are able to communicate what we are seeing in some ways, a quantitative way to others who may not be on the front lines as well. And we know that tracking data has been more prevalent, obviously data on, uh, COVID rate and people are able to speak a lot of statistics. Um, but how about data with respect to who is being left out of accessing care and social services and data health equity itself. And so my next question is how have data collection and analysis changed during the pandemic and where is there a clear room for improved, um, Sylvia, would you like to start with that?
Sylvia
Yeah. And it's, um, it's an interesting question that clearly even predates the pandemic. And as Mike mentioned, uh, we are, um, serving the same county and we are two of eight health centers. And so one thing that happened is that as a consortium of health centers, um, you know, we have worked together more and more to, um, to have, uh, you know, data collection systems that are in that is, that are the same, so that as patients sometimes transition between our health centers, um, we are able to keep them in the system and collect data more, more smoothly. And, um, one of the things that was fairly interesting for lifelong situation is that, um, we transitioned to the epic electronic health record system right before the pandemic hit. In fact, I believe the transition was really happening was, was kind of continuing, uh, to happen just at that moment.
Sylvia
So I joined lifelong in January of 2020, we were undergoing this, this transition. And while it was, uh, difficult because any kind of transition electronic health system health record system is difficult. It turned out to be, you know, quite fortuitous in the end because of partly because of the needs of data collection in the pandemic. So, um, investing, you know, in that, uh, in data collection at, at sort of the, um, lowest levels of the health system center level, um, you know, is the way, and it has to just kind of be that investment from the ground up so that, you know, as a, as a state, as a country, we're collecting data, I is super important. So that was, that was one of the changes we made that ultimately made, um, both communicating with our patients and also collecting data from them, uh, more smooth.
Sylvia
Um, there's always a tension between collecting data and, and serving a patient in the sense that any data collection involves questions and filling out forms and collecting information that not everybody's comfortable giving. And it can be, you know, there's a tension between having it be a barrier to care, but it's also actually, um, something that ultimately can, can help improve access to care. Um, but I just, the importance of it, I think became very clear during the pandemic, uh, in California, for example, that what is the data showing us? And when we know that the death rate for Latino, uh, folks are, is 15% higher, um, statewide than for, um, their proportion to the, to the, um, population, uh, it is 77% higher for Pacific ISS. Um, the death rate for, uh, black folks is 17% higher, uh, you know, for communities with a median income of, of less than $40,000 that the case rate is 24% higher. So we are able to cut data by, by, by ways we're used to, by ethnic group or income. We also know that housing density, where there are more folks packed into more places, also led to, you know, higher cases. So all of that was super important during COVID and remains important as we exit COVID to include, to continue to improve our own healthcare systems.
Eric
Yeah. Sylvia, something that you said that I want to underscore is you said that one of the efforts that you and lifelong medical has been part of is the consortium of health centers. And what I under that is that when we are looking at the safety net, people transition from one health center to the other. So continuation of that data collection and knowing who that person is, is critically important, which is, I, I don't wanna say unique, but it is a big factor that we cannot overlook if we really want to be caring holistic for a, a person.
Sylvia
Yeah. I mean, just from your own personal experience, imagine when you've changed a job or your job has changed their healthcare provider, it's not easy to navigate for anybody. And then you take some of the most vulnerable populations, whether it be, uh, you know, vulnerable, there's so many ways our population is vulnerable. Um, and it's just that much more of a barrier. So the more we can do to help smooth that out the better.
Eric
Yeah, absolutely. Uh, Mike with Asian health services, are you also seeing people kind of transitioning into the agent health services and your clinics and transitioning out what collaborations are you seeing from a data collection for respective, with other health centers?
Michael
Yeah. And, um, great question, Eric and I think is, um, you know, uh, what Sylvia brought up about transitioning to epic and all of the eight health centers and the Omni health consortium were able to transition. And that, that, that changed to epic was epic. Sorry, I didn't mean to make a, a pun there, but, um, among other things, you know, is, um, that being, uh, the same, the same, um, health record system that, um, a lot of the local and regional, um, hospitals use. So they're being that compatibility and that being able to help, you know, um, look at the cont sort continuum of care, like you said, if the folks went to a different health center or went to a hospital, um, and just shout out to, I'll just say shout out to, you know, my team's information systems and all our clinicians, because, um, not just the transition to epic, but in COVID it has been a lot of work, meaning, you know, their new workflow, patient workflows that are being changed weekly, if not multiple times a week, based on schedule changes, um, trying to figure out it's billing codes for telemed.
Michael
Um, whenever we have a new test site or new, um, vaccination pop up, you know, needing to have, have things set up for that. And, um, I'll just say, is, is that, um, you know, in strong consultation with other health centers and with the county public health departments, looking at, you know, the, um, looking at the neighborhoods and zip codes that had the highest case rates and highest house rates, um, something AHS has been doing is, um, trying to go out in the community and do mobile vaccination sites, um, in some of those communities and being able to not just, you know, build, and they will come come to our clinic. Our clinics are nice, but, but to have mobile teams to be out in those communities and partner with different, um, community stakeholders, whether it being churches, nonprofits, um, anybody who will listen, um, in order to try to, um, try to, um, reach the, the communities that have been hard to reach as far as both testing and vaccinations. Um, and just with the data, uh, the data's been very crucial in being able to help us find, you know, knowing that, you know, just going off of testing, um, you know, it, it doesn't show the full picture, but being able to, um, you know, use that data as well as work with, you know, trusted community providers and leaders figuring out ways to, um, really, um, you know, target do some targeted work, reach the hardest to reach.
Eric
Absolutely. So I saw you go ask me, did you ask me to add,
Sofi
Oh, that was a technical mistake, but, but I'm happy to building on, on, uh, on what Mike just said, the opportunity is during, during the IC, during the pandemic, the, the sharing of data as has been pointed out, has it was a necessity for, for being more targeted with the vaccine outreach, but how can we build on that? The, and being, allowing that sharing of data to guide resources across the board in a, in a much more proactive way. So now we have a better sense of who is facing digital barriers, where are the connected homes and which, which homes are not connected, because that starts to be almost the social determinant of health. It impacts your education, it impacts your ability to navigate other social services. And there's a lot of resources FCC and others are working to connect homes. And how can then healthcare be more of an enabler, make those homes connected.
Sofi
So this sharing of data, but also sharing of data to guide resources as a, as a real opportunity. And then we've started to see more and more of these collaborations to use data, to guide payments towards value based care. So that's another opportunity with the data and the data sharing that you can actually, what is the benefit of, of assuring healthy food? Uh, what are the health benefits? And, uh, and let that then start to build a case, um, to do invest for better access to healthy foods and housing and so forth. And then a third area is it's just much more data with remote patient monitoring. It's, it's a tsunami of data. And how can we make sure that we are being more ahead of the curve of building capabilities to analyze that data? Because if we don't, the, those systems will start to build on biases and, and drive there's there's algorithms being developed that are guided based on a population group that is not the communities we serve. So how can we make sure that we are serving, serving, uh, historically underinvested communities, making sure that we are on top of building the data analytics capabilities, um, it's given the amount of data that is coming our way. So those are three opportunities or challenges that I see.
Eric
Yeah. Thank you for highlighting those Sofi. Um, we've touched on a little bit around social deter of health, and we know when engaging communities that people don't think about healthcare alone. When they think about healthcare, when we interview people, they're talking about housing needs, food security, maybe other things. And while there's been a lot of talk and some really need initiatives to push attention on social determined to health, I'm uniquely curious about the three of your perspective on what has worked on the ground that has led to real change. So if you, each of you can give an example of a sustainable collaboration across a social safety net. Um, Sofi, did you wanna start with that?
Sofi
Can there's several. Um, so we work with federally qualified healthcare centers, but also with community based organizations and more and more so with collaborations between the two starting off with making sure there's cross-functional teams to build humility and curiosity. So it really starts with that because very often you bring in community members, but if you are not allowing and being prepared to drastically pivot, when you bring in community members to the table, you're not doing justice to that opportunity. So we often start with just building mindsets and for collaborations and teams working with the community around curiosity and humility and, and supporting leadership to be allowing, allowing things to go in the direction they originally didn't intend. And the reason I mentioned that is because every single successful partnership that we have seen has really been a result of leadership and teams' ability to pivot.
Sofi
They end up doing things they originally didn't intend to do. So one example was, um, CC a, uh, Venice clinic and food forward. They went through our catalyst program, which is capability building for human centered design. They originally thought about how they could improve just food distribution. Um, and then they did interviews with the community and realized that, oh, the food that they were distributing, wasn't really helpful for the community. They actually needed prepared food because so many of the people they were serving didn't have an ability to prepare the food that they were giving. So that was the first pivot, but where's the sustainability in that. Um, it was a excess of food to be distributed, but how are they gonna sustain this work? So they started to do interviews with health plans, and there was more than one health plan who said, I'm, I would be interested in making sure that this continues.
Sofi
If you can show me that this is benefiting the health of the community. So this partnership between three organizations became a data initiative where they started to collect data on what are the health outcomes. And they're starting to see some very, very promising results that then together with the health plan, they can look at actually, this is making financial sense for us to bring resources and support this. So this is an example of, of thinking outside of the box, taking input from the community to make sure that what your offer is actually what that community needs, but then also the, to think outside of the box and speaking to health plans and others to sustain the work. So that's one example.
Eric
Awesome. Thank you, Sofi. Uh, Mike, is there an example that you've seen from your experience?
Michael
Yeah. And, um, you know, ages in, in our almost 50 years existence, I've had, you know, strong, you know, partnerships with, um, you know, different, uh, community based providers, um, agencies and, um, has led a lot of, sort of strategic, you know, coalitions, you know, on trying to work on some of these things. And I'll just say is during COVID like, you know, making sure that, um, you know, working with providers to make sure, um, um, unhoused folks in our communities, we're, we're getting vaccinated. Um, and, you know, making sure working with some of the, um, affordable housing providers to, um, make sure, uh, folks had access to testing, um, and vaccinations and, you know, and, um, you know, one thing in particular that I like to mention is, you know, we heard from some of our, um, uh, uh, one of our community partners, the Asian Pacific Islander legal outreach team, um, who, um, they were during COVID, um, saying that, um, you know, for the managing their, uh, managing attorney at the time who works with a lot of, um, um, child custody cases.
Michael
Um, and they're saying that, uh, tender COVID there needed to be like the judge had ruled that there needed to be, um, clear, um, plans as far as COVID testing when dealing with the shared custody situation. And they had mentioned that, um, you know, um, having access to, you know, um, our COVID test site, you know, and, and having, you know, pretty quick turnaround time on tests helps, helps, um, helps make those shared custody, um, situations work. So definitely working, um, in partnership with the other, other service providers in the area to, um, you know, during this time make it work.
Eric
Yeah. I love that angle of the partnership as well. It seems like that out was an example of where there is a big health initiative that is needed for community benefit in this case, uh, Maxine rollout. And that kind of drove some of the partnership, which is in some ways, a little different than what Sofi shared, but equally as important. Um, Sylvia, how about from your end? Um, is there an example that you like to highlight?
Sylvia
There's a couple, uh, one was definitely centered around food security, probably something similar to, uh, the one that Sofi highlighted. Um, there was a for COVID had been a for-profit catering kitchen that was struggling during the pandemic to fit, figure out what to do. And ultimately, um, I think at first they sort of just charitably made meals and gave them away, but then they found that there were grants available to do that. And we partnered with them to get some prepared meals to particularly like our seniors, our, our senior community home bound, senior and, and seniors in general. Um, so that was one partnership. And we did have another partnership with, um, a church in, um, in west Oakland, uh, which was a trusted community partner around administering, um, vaccines. And it, that partnership improved the, uh, the, sort of the uptake of vaccines in one of the hardest hit, uh, communities in Oakland. Um, so, and so, you know, those partnerships, uh, those relationships going forward, I, I'm not personally privy to what's gonna happen next, but clearly those relationships, um, you know, change during the pandemic and, uh, can only be a good thing, uh, if we're work able to work together to, um, to do the kinds of things that Sofi talked about. Um, so those were two examples of some new partnerships for, for lifelong.
Sylvia
Great. Thanks for adding that Sylvia I'm recognizing time. Um, I am seeing a couple QA come in and I'd love to jump into those. Okay. Um, so the first one that I'm seeing is, uh, someone's asking how can private sector players, so startups in particular play a role in addressing some of the gaps you're seeing. How do you approach piloting new innovation?
Eric
That'd be a good one for Sofi to start with. What do you think, Sofi?
Sofi
Sure. I can try. Um, I mean, there's not lack of challenges to work on, so that's the good news. Um, there's a lot of opportunity to improve things. I think many startups are, are fueled by brilliant minds and hard work, and very often designed for a population where the money is and not to underestimate what it takes to actually serve the communities we work with. Uh, language was being brought up by Mike don't have that as an after to thought, but really lead with it. You and engage consumers and users early on to design your, um, your solutions, be committed to it. And if you're committed to it, make sure that you engage with the users and include it in from the, from the get, go in the design. And then it's about partnerships again. I mean, in order to pilot test something, you very often need a partner to pilot test.
Sofi
So how do you establish an those relationships and starting off by understanding the community on understanding Medicaid, uh, or medical in California, understanding the reimbursements and the bill, uh, how, how you can make it billable, make it easy for the FQ HC it's, it's some homework to do, but if you do that homework, Hey, that's, it's a huge market. Um, so language on the understanding, understanding the population and, and rebuilding the relationships after you've educated yourself on, uh, on what it takes to be successful and money, money speaks. So how, how to, how to be able to pay for it is a big piece.
Sylvia
I think that, uh, what Sofi outlined earlier in the partnership piece is just as applicable, if not out more so around the issues of curiosity, humility, and also human center design.
Eric
And that actually perfectly segues into another question then. So I had, they're asking Sofi, uh, if you could talk more about building mindsets of cultural humility and curiosity among safety net leaders, what challenges do you encounter in that work?
Sofi
I mean, start off with myself. I, I have to always remember to be humble and curious, and, and so that is it's for all of us. We can all work on, on that. I think that's the first piece, but if you look at leaders in the safe net today, what is one of the main challenges is retention? Uh, the workforce challenges we're facing are huge recognizing that, um, I think is an, is an opening to, to work with the leadership of building humility and, and curiosity, um, really lean into the biggest challenges. And what we hear from many of the frontline staff is they wanna serve their community better. They wanna feel empowered to change the way of working, to serve their community better. So the examples we have seen where, where frontline staff are given the time to do interviews and take input from the community and then really be empowered to make changes based on the feedback that helps retention. So if you can engage the leadership to see that opportunity that it's this work using, for example, human centered design helps retention of your workforce and helps you serve your community better. Then you build that muscle of humility and curiosity very often, if you, if you define a problem with a community and bring it to the leadership, very often, it sparks curiosity. You wanna find out more, but if you package it with a and how it actually is gonna support also retention of your workforce, I think you're more likely to build, be successful.
Eric
And if I can add to that, Sofi, I think continuing to be self-aware around who is making those decisions on a day to day basis. It is us or simply people and leaders. Then that is an, a challenge in itself. I know when we're talking to Mike specifically thinking about how we can be more community driven, how we can have a community be in positions of power and make decisions. And Mike, you're talking a bit about your board makeup. Can you talk a little bit about what that structure looks like?
Michael
Yeah. Um, so with federally qualified health centers, it's actually a requirement to have, um, patients, um, on your board of directors. And that's something that we take to heart in our, a health sources. And, um, not only do we have patients on our board members as our board members, but we have different, um, advisory groups, including what we call patient leadership councils. And we have seven different patient leadership councils, um, which are done in language. Um, that's Chinese Mandarin, Vietnamese, Korean Tagalog Burmese. And I can't remember the last one. Um, but, um, the, the point is, is to be able to, to really get direct feedback from, from the community and not just tell us what we want to hear, but, but really tell us about what needs are. And in, in, um, when I occasionally get a chance to interface with patients in my broken Cantonese, I know enough to be able to under, to hear, um, you know, what some of the things that they're going through and they'll mention not just things related to patient care, but they, they mentioned some of the needs right now that they're facing, um, including, you know, right now, just with some of the increased, um, tension in Asian communities about feeling, not safe to leave their houses.
Michael
Um, but think that it, it's definitely important to get that feedback. And during this time, you know, where, where a lot of us have had to transition to zoom or, or other ways, um, we've still been able to do that, get that patient feedback it's been harder be because our strength has always been the face to face the interfacing with folks at parks at face to face meetings, um, going to the cultural festivals, you know, in, um, in and around the community. Um, but you know, we tried our best to still be able to get a pu, get a, get an idea on the pulse of the communities and, and you know, what, what their great guess needs are. Um, wouldn't say it's perfect. I don't think anything can really replace the, the, the face to face interactions that go door to door, so to speak. But, um, we're trying,
Eric
Thank you, Mike. Um, I, one of the things that I've admired about a lot of your organizations is how you have used your organizations as a platform for the community. And I think a lot of our roles is in amplifying the challenges that we're seeing, not making decisions unilaterally, but how we can be, uh, promoting more of the causes and the care abouts of the people that we're trying to serve. So I see another couple Q and a, I think we have time for one more. Um, this one might be a tough one. Uh, so the question is with staffing challenges born out of the pandemic, how might safety net clinics rethink how they patient health information in an era of health information exchange, black health management, social determinants of health, et cetera. So this is in the context of the medical record management. I'm happy to repeat that, uh, if that'd be helpful. Um, so the question is with the staffing challenges born outta the pandemic, uh, especially I, I believe this is referring to, um, us seeing more and more staffing shortages. How is that affecting, uh, patient health information exchanges and some of the technology that we are and data collection that we're, um, introducing as it compares to the traditional way in which we're managing medical records?
Sylvia
I have to admit this is not an area that I feel very, um, able to comment on because it's, it's, it's in a level of operational, um, uh, you know, the questions, very operational. So for me, it's a hard one to answer. I, I will say that, um, we are focused on, um, really, I think again, the pandemic forced an injection of having to leapfrog quickly to newer, to newer, better, more efficient systems. Um, so I think, uh, we are doing a lot more training. Uh, we're investing partly that's part of do partly the retention, um, issue, uh, trying to really help our staff, um, that, that are, as you said, stressed out and, and in retention is a huge issue, doing everything we can to give them the tools they need from the provider level down to be collecting that. So sometimes that means investing more staff in, for example, more medical prescribes.
Sylvia
Um, on the other hand, it also means making sure that the staff that are dealing with some of these, uh, systems are, are better trained. Um, I don't think that's quite what the questioner was, you know, getting to, but that is something I know that we are doing. I also would say that, um, again, in the, in the macro sense, another thing we are doing with related to this data, um, is, is bring, you know, bringing it, uh, collecting it. I mean, epic was one change we made, but we're also working together in a Tableau system, which is an even greater, um, you know, uh, uh, input of, uh, collection of data. And then, uh, sharing it in more, much more real time. I'm in our system. Again, that's not quite what the question I believe is asking, but that's just an element of it that I can comment on.
Eric
I appreciate that. So, oh, Sofi, did you have so many chime in?
Sofi
Yeah, I can try. Um, this is hard. It's also framed very technical, uh, far more technical than I, than I normally operate at. But at one, as we talked about earlier, there's, there's more and more data and we have more and more systems and different forms of applications feeding that data. And then, uh, as the person is saying, this is in the context of a traditional medical record management office. I think it's important to, to recognize we don't need to do everything in house. There are many of our partners are for, for example, their remote patient monitoring, uh, work partnering with organizations that also come with the analytics. You don't need to feel that you need to do it all in house. And, and then over time you can figure out what you may want to insource, but there are partners that, and it's important to do the legwork, to know where is their interoperability with the systems that you have to, to not build additional legacy systems that will be hard in the future. But we have seen that work really successfully. Um, there are vendors that, and especially if you can start to actually do some, um, some work where you share the, the upside, if there's, you're, you're paying them based on improved outcomes, you get more payment from the health plan because you're improving the, um, blood pressure control together with this vendor and they bring the analytics. So they're being creative in how you work with partners can actually help also on, on the, on the side of, of managing the information systems,
Sylvia
I'd like to add. One more thing that I did forget about that may be pertinent, um, which is, uh, lifelong has, uh, implemented a sort of data governance committee, uh, that was brought together, um, by, um, a newly creative position. Um, we have a chief, um, I think it's medical information technology officer. Um, she's a nurse practitioner, but really, um, it it's about data transparency and governance. And that is one way, I think when you're talking about managing patient and health information, uh, making it more transparent to everyone that needs to see it, and also, uh, in much more real time so that we can influence better health outcomes. That might be a good topic for another conversation, cuz that's an, um, initiative. I would say that, uh, I know our CEO was extremely proud of.
Eric
Yeah, absolutely. And this may also relate to one of the first questions that bodies ask, how can private sector players, um, play a role. This may be an opportunity to really recognize what is your superpowers and how you can elevate a lot of the community health centers and the work that they're doing as well. Um, so I know we are coming up on time. We did have a question that we didn't get to, um, but we can probably circle back around with that, uh, or, and share the answer with the rest of this group. So final question for each of the panelists, uh, what advice do you have for people working towards addressing health equity, uh, Mike, when you want to start?
Michael
Um, thanks Eric, I think is, um, well, I I'm, uh, pretty sure that that hopefully a takeaway that, that you are watching have heard is about out to the importance of data, um, and the right type of data. Um, I'll just say is also, um, um, this'll be my plug for disaggregated data, you know, just knowing that, that the data points that, that, that are out there, um, really needing to dig to the level either a community level or by some other, you know, demographics to be able to really, um, you know, dig deep on the, the, the, the most underserved, um, communi and, you know, I think is, um, you know, uh, actually it goes back last question, but even less the data that we collect, but also, you know, at times we've tried to push for, um, you know, state and federal policy makers to increase, you know, sort of the, the, the data points that they collect, you know, and that can make things a little bit easier on everybody, but just, um, I'd say is, is, you know, um, right now it's definitely important to get more data and I'm, and I mean that to being like still feeling a way to, um, you know, connect with connect with people, you know, and, and, you know, we're, we're still doing that.
Michael
We're having, we're doing some of them getting some of our patients on zoom meetings or also just calling patients. Uh, we're finding even just when we call, do folks to have do short, the short, just like reminder calls for, for, for, um, for appointments, they end up being 20 minutes because the patients have a lot of stuff they wanna share, but this is all stuff that we need to hear. And, um, we need to be, you know, out there so to speak and, um, just seeing, you know, get out there, you know, and in the community and, and, uh, that will help illuminate where we need, where, where we need to do more as far as improving equity,
Eric
Thanks Mike and I really love the encouragement to really engage with the community. Sylvia, uh, what find advice you have.
Sylvia
Well, it's impossible to, I think, separate out right health equity from equity at large, and, um, again, bringing it to sometimes another, another current, uh, example I think about, uh, there's been a lot of discussion I've been hearing lately about obviously climate change is a big issue and the, um, notion between individual in and systemic change. And so, uh, when I put health equity into the context of equity at large, I think an important piece of advice I have is not to forget about the advocacy component and the component of collective action. Um, we all may be doing this in a different way. Somebody may be like know, on the health center, uh, floor with patients dealing with our, you know, health record system. And I'm, I'm doing broad communications and fundraising, for example, but we are, we're driving toward the same conclusion of, of, you know, quality healthcare for all.
Sylvia
And I think that, um, not forgetting about the need to put it into a, a collective action and advocacy context and taking whatever actions we can, um, you know, as an individual, of course, but even within our organizations, whatever we're allowed to do. And, and, you know, that is an important part of what FQHCs do. Uh, and it is really, um, at the heart of my career. I've been mission driven for my first job on, and, and I've been involved in advocacy, uh, for most of my career one way or another. So that's the piece of advice I would give you.
Eric
Thanks, Sylvia. Um, that definitely hits home for me as well. Sofi - final advice.
Sofi
I feel Mike and Sylvia have had made fantastic points. I was thinking along, along the lines, which is our vision around fair, just and inclusive opportunities to be healthy, starting off with Mike, we can't be fair if we don't look at the data and we have to disaggregate and really challenge ourselves of how we identify, where, where is it not fair today? And look outside of the datasets. You have yourself, uh, who is not being seen at all, making sure no one is left behind and really aiming for being inclusive, but to be just, data is not enough. We need to do, like Mike said, and, and Sylvia's point, it's not only within, within health care, listen deeply to the community to understand where the challenges are and feel empowered by what you hear and create space for people to bring that voice forward.
Sofi
You don't need to a, you should use that when you speak to funders, when you speak to leadership, but also create space for others. My a couple of a week ago, I realized, again, I made a mistake. I am the leader of this organization. I'm a white woman sitting on this panel. I could have created an opportunity for someone else. Um, because I think there's more systemic challenges in terms of power dynamics and who, who is speaking, where, and when, and many of us can do far more at an individual level to challenge ourselves of how we create opportunities for others. We don't need to speak on behalf of others. We can actually give the floor and, and lift others in, in other ways. So constantly challenging ourselves and supporting each other to, to really, really disrupt the deeply unjust system that we all work within.
Eric
Thanks Sofi. And specifically for the self-awareness, uh, that you bring, um, to your leadership. So, we are up on time - Sofi, Mike, and Sylvia, thank you so much for being part of the panel.