How do we operationalize equity? Dr. Alisahah Cole talks CommonSpirit's COVID-19 vaccine strategy

CommonSpirit Health is working on the best ways to "operationalize equity" amid the pandemic and beyond, Alisahah Cole, MD, system vice president of population health innovation and policy, told Becker's.

Chicago-based CommonSpirit Health, a nonprofit health system created in February 2019 through the merger of Catholic Health Initiatives and Dignity Health, operates 139 hospitals across 21 states and is one of the largest Medicaid providers in the U.S.

Dr. Cole joined CommonSpirit in June last year as the system's first vice president of population health innovation and policy. She leads initiatives focused on vulnerable populations, health equity and clinical care transformation through innovation with a focus on value.  

Pandemic effects on Black and Latino communities
CommonSpirit serves every type of population demographic, Dr. Cole said. Nationwide, Black and Latino populations have a much higher likelihood of being hospitalized or dying from COVID-19, Dr. Cole noted, adding that recent data show these communities are also less likely to have access to COVID-19 care or treatment. Dr. Cole is working to make sure CommonSpirit Health's outreach is thoughtful and effectively mitigates barriers Black and Latino communities face.

How CommonSpirit Health is creating more equitable access to the COVID-19 vaccine
Community partnerships are key, said Dr. Cole. Leveraging well-established, trusted partnerships in the community has been critical to educate and create awareness about COVID-19 and the vaccine, Dr. Cole continued. For example, CommonSpirit Health worked with the Los Angeles city government; Willowbrook, Calif.-based Charles R. Drew University of Medicine and Science, a historically Black college/university; LA Care Health Plan; and the NAACP to host a vaccination site at a Los Angeles sports park. The event, which included transportation efforts, spanned multiple days, with more than 20,000 COVID-19 vaccines administered to high-risk populations. Dr. Cole credited the success of the event to focused partnerships with trusted organizations.

The healthcare industry often expects people to come to them, which needs to be rethought when considering higher-risk populations, said Dr. Cole. CommonSpirit Health has expanded its telehealth platforms, as many systems have amid the pandemic, but are working to leverage the technology without unintentionally widening barriers to care. Reaching out may include Zoom or FaceTime, but it may also just be a simple phone call. The most important thing to remember is to connect with patients in the ways they want to be connected with, Dr. Cole said.

CommonSpirit Health developed an outreach stratification tool that generates patient lists around who is at high, medium and low risk. Everyone needs education around the COVID-19 vaccine, but the health system is strategizing the most efficient ways to reach different populations, with intentional outreach for high-risk patients via phone call. Dr. Cole also noted the importance of health literacy consideration.

CommonSpirit Health has also traveled to some farms, specifically in Northern California, Dr. Cole said, citing farm workers' higher incidence of contracting COVID-19 than the general population. Nursing leadership is working with the agriculture industry and providing vaccines on-site at the camps. For senior populations, CommonSpirit offers home visits to overcome potential transportation barriers. CommonSpirit already has infrastructure in place to best work with homeless populations, making it easier to reach out since the trusted patient-provider relationship is already established. For all these populations, knowing the local market dynamic and leveraging local partnerships are critically important, according to Dr. Cole.

Largest challenges when reaching underserved communities to improve vaccine access
One of the largest challenges is staffing. "Our front-line clinical staff has just been amazing," Dr. Cole said. "A lot of our staff members are stretched thin and still showing up every day and taking care of our communities." The pandemic has been challenging for everyone, including, if not especially, healthcare workers. Clinics and vaccination sites have to be well-staffed and robust to deliver equitable vaccine distribution. Dr. Cole said President Joe Biden's plan to fund up to 100,000 public health workers could significantly help the effort.

Supply shortages are another challenge, though Dr. Cole expressed optimism about the recent FDA emergency authorization of Johnson & Johnson's vaccine. She hopes the authorization will improve supply and accelerate the vaccination process within vulnerable communities.

Why vaccine equity should be prioritized by health systems
Part of CommonSpirit Health's mission is to care for the vulnerable, one of the reasons Dr. Cole joined the organization. Health systems must be mindful of the communities they serve. Different communities have different barriers, and healthcare leadership must build equity policies on the front-end of the process from the beginning, Dr. Cole concluded.


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