HealthMay 24, 2023

Health equity: Transforming concepts into actions at Ohio health system

With a majority of its more than 300,000 patients on Medicare and Medicaid, The MetroHealth System in Cleveland, Ohio, has made health equity and inclusion a cornerstone of its mission. Operationalizing that has required a strategic, multi-prong focus on patient engagement programs and partnerships.

Note: At the time of the webinar, the UpToDate® Patient Engagement solution was named Emmi®.

Three architects of MetroHealth’s diversity, equity, and inclusion (DEI) strategy discussed the challenges and rewards of taking equity from concept to action in the Scottsdale Institute webinar “Equity First: A Strategic Approach to Ensuring Equity for Every Employee and Patient.” Wolters Kluwer Health sponsored the presentation.

“Equity, inclusivity, and diversity needs to be in the fabric of your enterprise,” Michelle Mencke, MetroHealth’s Manager of Patient Education and Accessibility Services, advised attendees of the webinar. “It needs to be weaved through every approach for every visit, every patient, every communication, and it never ends. It never ends because it's a way of being and a way of serving.”

Defining health system goals for equity and inclusion

MetroHealth, established in 1837, is considered an essential health system, “which means that we provide care to everyone, regardless of their ability to pay. We are the county's public health system,” explains Margie Diaz, MSN, RN, Director of Inclusion, Diversity and Health Equity. “We have the best patients in the world, we say. We've cared for anyone regardless of their ability to pay, who they are, their age.”

Diaz estimates that MetroHealth has over 100 community partnerships through which it provides care and outreach to patients throughout Cuyahoga County, even if they aren’t able to make it through hospital or ambulatory care center doors. “When we look at where folks get their health and wellness from, 80% is from where you live, eat, sleep, and pray and play.”

To approach DEI more strategically, MetroHealth set up Diaz’s Office of Equity and established nine formal equity and inclusion goals. Diaz highlights two elements of that initiative:

  • Being intentional about reducing health disparities among patients.
  • Working to recognize and address subconscious bias.

When addressing health disparities, Diaz notes that collecting patient feedback on treatment and interactions was key. Patients reported resoundingly that first impressions are critical and that they were looking for personalized care. “We don't want to be a care plan or a treatment plan, but we want to be treated as an individual,” she relates patients saying, adding, “Ninety percent of our employees are also patients at MetroHealth. So really, when I say patients, I'm talking about all of us in the community.”

To take on the issue of subconscious bias, MetroHealth had 60% of its 8,000 employees complete bias training so far. “We really have crucial and critical conversations and learn how to mitigate biases,” Diaz says.

The four steps to screening for social determinants of health

Another facet of MetroHealth’s approach to health equity is investigating ways to remove obstacles to pursuing or receiving adequate care – such as poverty, discrimination, and the lack of access to fair employment, quality education, housing, and safe environments. This is more commonly referred to as social determinants or drivers of health, explains Marielee Santiago, director of Transformative Knowledge & Education for the MetroHealth Institute for H.O.P.E.

MetroHealth screens patients and employees for social drivers of health “via various modalities,” Santiago says. It’s the first step in a four-part process:

  1. Survey patients through MyChart, during a clinic visit, or at a community event. There are also employee surveys embedded in the employee wellness portal.
  2. Connect those requesting help to a community health worker or a care coordinator who will follow up with patients and link them to the appropriate resources available in the community.
  3. The next step, Santiago explains, is to “build those relationships through partnership with community organizations. We leverage those closed-loop processes, such as our e-referral platform, Unite Ohio, where we can connect individuals to a community-based organization who can address those social needs.”
  4. Lastly, the team evaluates the impact of its evidence-based interventions.

To date, Santiago notes that the program has screened more than 90,000 MetroHealth patients and employees for social drivers of health.

Reaching out to at-risk patients with UpToDate patient engagement solution

One way the health system reaches out to at-risk patients is through its UpToDate® Patient Engagement solution (formerly Emmi), Santiago says. “Individuals that screen at-risk for physical activity, social isolation, as well as stress, receive an automated Emmi referral via email, text message, or their MyChart messaging, which is really integral in ensuring that individuals receive the information in an equitable way.”

Emmi programs, which deliver health and wellness information in ways patients can best understand, trust, and use to inform their decisions, complement direct programming, such as food distribution, wrap-around services, and Calls for HOPE, a program that involves volunteers with those experiencing social isolation.

Representing and engaging diverse patient populations

“If you want to engage someone, first and foremost, you have to be using material, education, and information that reflects who you're wanting to communicate with,” notes Mencke.

When applying DEI principles to MetroHealth’s patient education and engagement programs, Mencke began with patient and employee feedback on their Emmi patient engagement solution and found that reaction to the content they were sharing was positive. However, the overall sentiment was, “That represents what we do, but it doesn't represent who we are.”

Mencke and her team shared this feedback directly with Wolters Kluwer and Emmi, who worked closely with MetroHealth on implementing DEI-based changes to printed, audio, and video materials based on feedback and offering the health system more options from its capabilities.

“Skin tones have changed, body shapes have changed, accessibility differences have all changed. Gender-neutral images, terms and content, and voice talents have changed. We've expanded our language choices through Emmi, where patients can self-select their language,” Mencke says. “If you want to engage your patients, you have to meet them where they are.”

Language and voice are key factors in DEI to Mencke. “Think in terms of vernacular,” she says. “Are we using language and terms that are meaningful and understood by the patient population or community we are focused on? Is it in the patient's preferred language? We have approximately 1.5 million ambulatory visits across our system per year … that's over 100,000 visits with patients whose preferred language isn't English. If you want to engage your patients, you have to be patient-facing. You have to reflect who you serve.”

MetroHealth distributes educational materials to patients through:

  • Text (the most popular medium)
  • MyChart message
  • Email
  • If all else fails, a direct phone call

“Our phones are in our hands all the time,” Mencke says. “If we can get the information in front of them in the palm of their hands, where they're already spending a great deal of time, that's the best place.”

Mencke acknowledges that the health system originally believed many groups within their patient demographic wouldn’t respond to Emmi calls or videos and other patient engagement outreach. She says they were surprised by the impressive response, including from unexpected zip codes and demographic groups.

“Patients in the community want to participate in their health,” she says. “Do not underestimate your community. Engage them, reflect who they are in a means that they understand. And you will have patient engagement, and you will see your successes.”

Mencke adds: “Equity, inclusivity, and diversity is not an initiative. It's not a project. It's not an annual goal. It’s a paradigm shift in everything you do, and it is ongoing every single day. As you shift, you will see everyone around you make the same shift.”

Learn more: Watch the webinar

To learn more, watch the webinar “Equity First: A Strategic Approach to Ensuring Equity for Every Employee and Patient.” This webinar was first presented to the Scottsdale Institute Members.

Screenshot of Webinar-Equity First: A Strategic Approach to Ensuring Equity for Everyone at The MetroHealth System webinar
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