By JULIE MINDA
Marcos Pesquera searches for the stories behind the numbers.
As CHRISTUS Health system vice president of health equity, diversity and inclusion, he studies reams of data for the system's eight regions and presents his analysis to market leaders in a way that helps them understand and respond to the most pressing concerns facing vulnerable populations in their communities.
Community members take part in a CHRISTUS Health 2016 supplier diversity fair. The system held the vendor fairs in its Louisiana markets to show community members how CHRISTUS supports small and diverse local businesses.
"It's good to have data, but what's important is how we craft a story with that data so that leaders and associates can understand what's behind that data," says Pesquera. "We weave the story to help people visualize what's happening, so that we can be more effective, and put our resources to use to have the greatest impact."
The central story Pesquera is relaying to all CHRISTUS regions is that — like most U.S. providers — CHRISTUS facilities could do more to make their workforces look more like the communities they serve; and they could do more to make care delivery fairer.
He says, "Health equity is at the heart of our mission, and we all have to find a way with the resources we have, to be more effective and more efficient to help our communities achieve better outcomes.
"And, we all have a long way to go," he says. "But we are able to use a lot of culturally competent approaches to reach hard to get to populations. For instance, we plan to build upon the work many of our community health workers are doing."
CHRISTUS says it is aiming to ensure that facilities' associate makeup is proportionately representative of the communities the sites serve, that associates are trained to provide culturally competent care and that facilities are using data from the electronic medical record to understand the characteristics and needs of patient populations and how to respond to their needs.
"Achieving health equity requires all hands on deck," Pesquera says.
Fresh faces
Pesquera says CHRISTUS calculates the percentage that minorities comprise in three job categories: associates, managers and executives. It compares those percentages against its target — it seeks to mirror the ethnic breakdown of the general population in a given market. CHRISTUS conducts this analysis for each region, and also creates a composite analysis that includes all the regions as well as the corporate office.
Pesquera
A late 2016 analysis for CHRISTUS' Southeast Texas region, for instance, showed that whites are overrepresented in management and executive positions at CHRISTUS sites there, and blacks and Hispanics are underrepresented in these groups, as compared with the general population of the region.
Pesquera is sharing such analyses about every six months with regional leadership and making recommendations for addressing disparities. Some approaches for addressing the gaps include posting job openings on online job sites popular with the targeted ethnic groups and taking part in job fairs geared toward select populations and seeking out diverse candidates for internships.
Supporting and partnering with associations representing minorities is key to addressing this concern over the long run, says Pesquera. For instance, CHRISTUS is visible in and actively promotes the Dallas-Fort Worth African-American subchapter of the American College of Healthcare Executives.
Additionally, CHRISTUS leaders identify associates poised for advancement. CHRISTUS leaders seek to make sure minority staff are well represented in a mentorship program the system offers that pairs up-and-coming associates with executives for a year, to groom the associates for promotion. CHRISTUS also recruits minority candidates from among its staff to an executive fellowship program. The current cohort of executive fellows includes two Hispanic and one black associate.
Pesquera says purposeful discrimination is not necessarily at the heart of diversity gaps, but subconscious bias may come into play in hiring and promotion decisions. "It's human nature to be more comfortable with those who look and talk like us," Pesquera says, noting awareness-building can help counter such tendencies.
CHRISTUS has launched a "mini conference" discussion series in its regions to educate its leaders and community partners about topics such as bias, racism and stereotyping.
Fair care
To identify and address care inequities owing to age, race or income status, CHRISTUS employs the population health tools and approaches that it uses for managing the care of other defined patient groups, including those insured under certain Medicare, Medicaid and managed care contracts. CHRISTUS conducts a deep dive analysis of subgroups of patients within each group, studying the characteristics of those groups and identifying those at greatest risk of poor health outcomes, says Shannon Stansbury, CHRISTUS' senior vice president of population health and health plans. CHRISTUS then implements approaches, tailored to each population, to ease health care access and promote positive health care outcomes.
"In any population, it's about building engagement," adds Cary Fox, executive director for population health for the CHRISTUS system. "How do you employ tools to engage the patients in their own care?"
Fox says it is essential to focus on the segments of people within defined populations with the most serious health issues and to help them address their conditions and manage chronic disease.
Pesquera is guiding all CHRISTUS regions to apply these concepts and tools to high-risk subgroups of patients within ethnic populations. He analyzes electronic medical record data to determine which subsets of people who are in the minority ethnically or racially are repeatedly using the emergency department, particularly for nonemergency purposes.
He conducts the same analysis on low-income people using the emergency room to receive primary care. He shares the analysis with each region's leaders and works with them to come up with ways to improve the targeted populations' emergency room use, employing evidence-based approaches.
Candace Taylor, a certified hand therapist at the CHRISTUS St. Michael Outpatient Therapy Center in Texarkana, Texas, works with a patient.
For instance, Pesquera looked at emergency department use at one of CHRISTUS' San Antonio-area emergency departments and found that 16 percent of visits were repeat visits. He identified that those repeat visits were disproportionately made by people from four zip codes. He found that 80 percent of the visits for the people in those zip codes were for five conditions. Those conditions were hypertension, Type 2 diabetes, hyperlipidemia, coronary artery disease and end-stage renal disease. Pesquera then analyzed patient information for the people with those conditions, in those zip codes, and found 48 percent were Hispanic — and the vast majority of them were insured under Medicare.
Using this data, Pesquera has been speaking with CHRISTUS' San Antonio region about evidence-based ways of better reaching Medicare-insured and uninsured Hispanics with these conditions, to help them better manage their conditions and to appropriately access care. Community health workers and health educators might be part of the answer, for instance.
"The key is you need to go to them, to understand their social issues and what is making them sick," Pesquera says.
In the future, these population health efforts could include generating lists of individual patients who fall into the at-risk categories, and working with them on a one-on-one basis to improve their health and their access to health care facilities.
CHRISTUS is early in these efforts, but it already awards executives financially based on their ability to advance health care equity.
Fox says, "If we're being very targeted and can create systems to support people, we'll make a difference" for the health of these populations.
CHA is highlighting this and other ministry examples of promising ap-proaches to improve minority health. Information is available at chausa.org/minorityhealthmonth.
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