From Crisis to Opportunity: Partnering to Address SDOH, Health Disparities

Creshelle Nash, MD, MPH, CHIE, medical director for health equity and public programs at Arkansas Blue Cross and Blue Shield, shares how the pandemic has given the national healthcare system a vehicle to address social determinants of health and health disparities.

More than one year into the coronavirus pandemic it has become painfully clear that minority communities are especially vulnerable.

A recent McKinsey & Company report, for example, found that during the pandemic, rural communities with diverse populations experienced 1.7 times more COVID-19 deaths per capita than other rural communities around the country. The study also found that in rural counties where the population is comprised of at least 33% of racial or ethnic minority groups, deaths from COVID were 1.5 times higher than in other communities.

Creshelle Nash, MD, MPH, CHIE, medical director for health equity and public programs at Arkansas Blue Cross and Blue Shield recently spoke with HealthLeaders about how she saw these disparities first-hand, and how the COVID-19 crisis has given the national healthcare system a vehicle to address social determinants of health (SDOH) and health disparities.

This transcript has been edited for clarity and brevity.

HealthLeaders: Through your work with the Arkansas Blue Cross and Blue Shield, what did you witness in Arkansas during the pandemic?

Creshelle Nash: Like the rest of the country, we have seen the disproportionate impact of COVID-19 on communities of color throughout the pandemic. What it has done has illuminated the health inequities that already existed, from food insecurity, housing insecurity, behavioral health needs, all of those things, varying by race, ethnicity, income, and geography.

We specifically saw increased hospitalizations and deaths in minority communities early on. We even saw facilities and healthcare providers in minority areas having a harder time getting PPE, or even other resources [such as] paycheck protection. We saw increased COVID-19 exposure with essential workers.

It has been a trajectory that has opened the eyes of a lot of people, and that's a good thing. This crisis should ultimately lead us to opportunity.

HL: What lessons did you learn during the pandemic around addressing health equity and what steps has Arkansas Blue Cross Blue Shield taken to address those?

Nash: There were so many lessons, sometimes on the daily. The pandemic at the highest level has shown us that many of the structures that we have in place enable health inequities, and these put people at risk. It has shown us by example not only in infectious disease, but in population health overall. We're all in this together, and we have to reach those most in need to protect us all.

The healthcare system has long talked about SDOH. But these were real-world examples of how policy can impact health.

[For example,] the digital divide came out loud and clear as we were rolling out the vaccine. Initially, people would sign up to get a vaccine online. Well, if you don't have access to broadband, the internet, or have experience with digital platforms, you couldn't get an appointment.

If we're thinking about how people get to the vaccine or mass clinics, transportation barriers were loud and clear in rural areas in Arkansas and across the nation.

The disparities won't disappear with the end of the pandemic. We have to continue to ensure that those who are in the most need can get access to resources and receive care.

When I think about what Arkansas Blue Cross Blue Shield is doing as a health plan, it is all around community engagement. Not only is it with our members and businesses as a corporate partner, but it's also with local communities and working side by side with organizations who have been working in this space of health equity and the health of communities for a long time.

In Vaccinate the Natural State, our campaign, it can look like a PR campaign, it can look like supporting a vaccine, it can be data-driven approaches. It's all about partnering with local communities, and one specific example we have is a partnership that we're doing to focus on vaccinations in the Delta in the state of Arkansas. It's a partnership with the Arkansas Faith Network; Arkansas Medical, Dental and Pharmaceutical Association, which is an organization of minority healthcare providers; and the Arkansas Health department, all coming together to address community concerns around the vaccine, educate, and encourage uptake of the vaccine through a faith-based model. That is an example of taking the lessons that we're learning to address health inequities, not only in the COVID-19 pandemic, but leading to longer-term efforts for other disease states.

HL: What can health care organizations do to improve health equity in their own community?

Nash:  A common theme is partnership with community leaders. It's important that trusted voices are at the table because those trusted voices will set the foundation for understanding those SDOH, but also understanding how to address them most effectively in local communities. A diverse workforce within this partnership will help with that. A link to the existing community resources through community health workers, for example, can bridge the gap between the community and the healthcare system organization experience is critically important.

As healthcare organizations, we have to be intentional about addressing health inequities. There are many people that have been working on this for years, but the pandemic and its crisis is an opportunity for renewed focus of organizations on how we do this; it's harnessing that renewed focus at a hyper-local level all the way up to nationally.

HL: Speaking of the national level, what will need to change in our current healthcare system in order to address and eliminate Healthcare disparities across the nation?

Nash: When I think about what healthcare systems need to do to make an impact, it is to develop and implement evidence-based approaches to addressing health disparities, to be intentional about it with will and with resources. To look at quality measures by race and ethnicity oftentimes, for some reason, the quality improvement arena is different from the health equity arena in functionality. For me, by definition, I don't think you can have a quality health care system if it varies by who you are and where you live. Bringing those two camps together to examine quality measures by race, ethnicity, and other factors, language access, income, geography is critically important. Systems need to evaluate if and how their current practices might exacerbate or mitigate health disparities or health inequities.

The [COVID] crisis provides an opportunity for us to move forward and to make sure that our policies don't exacerbate disparities. As large healthcare systems across the nation function and understand SDOH, it's an opportunity for the leaders of those entities to support and advocate for policies that impact and improve those. It's important to use this crisis to look beyond the pandemic and to build health equity solutions into the healthcare system in the long term. No one system or one sector can address health inequities; it'll take partnership across sectors [and] multi-level interventions with the political will and commitment over time.

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Editor’s note: Due to an error in our reporting, we have removed the Kaiser Family Foundation data about Arkansas. We apologize for this oversight. This story was updated on July 19, 2021.