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Resource

Webinar: Approaching Advance Care Planning through Diversity, Equity & Inclusion

We spoke with Dr. Romilla Batra of SCAN Health Plan and Dr. Kimberly Bower of Blue Shield of California in May about how their plans approach Advance Care Planning, through the lens of diversity, equity and inclusion.

How did the pandemic make inequities more apparent, and how are you addressing those areas in the way you steer innovation? 

RB: As we galvanized our workforce in reaching out to our members, the thing that came to my mind as a primary care physician is that people must be lacking access. And what became apparent very quickly was it wasn’t the medical access they they were lacking. They were truly lacking around social needs. People were initially lacking food. People were initially lacking caregiving help in their home because informal caregivers could no longer come. And then people were lacking human connection. They were feeling lonely.

If you look at the disparities, this is not a new thing. But we started looking at certain zip codes and certain geographies, and we see all of these social needs. And we said healthcare equity is not going to be a COVID strategy, this is going to be the strategy, period. And DE&I is at the heart of who we are and how we serve our members.

KB: I agree – the pandemic really highlighted the social drivers of health in our communities and the importance of relationships. You think about our elderly who struggle with isolation, and you see this across the whole population. You think about what we can do for our members who feel isolated.We saw people losing their jobs, losing their employer sponsored health insurance, and the proportion of minorities who lose their insurance versus white people. And then as we went out and started engaging people to get vaccinated, the systems were hard to set up. You had to go online, register, drive your car, get in line, get your immunization. Those are not systems that are designed for ease.

The other thing we see is people don’t trust the healthcare system. They don’t necessarily trust their providers. This lack of trust has been there for a long time, but now it’s really showing up.

How is diversity, equity & inclusion (DEI) informing your work around advance care planning, especially when you think about the marginalized and the vulnerable populations?

RB: We’ve always used the lenses of culture, SES (socioeconomic status), gender, generational cohort perspective. CMS requires us to do health risk assessments on our special needs population, but over the past few years, we’ve pivoted and started doing a “mini-HRA” that is inspired by the social determinants of health. We are asking very specific questions to understand what languages they speak, what race do they self-identify themselves, and what difficulties they have around social needs — whether it be housing or financial or transportation or food. We’ve been building that database for a long period of time, to galvanize and do something differently.

We realize we have to hear first, and then be heard. We are a community-based organization, in addition to being a not-for-profit plan. We’re partnering with churches in the African-American high density arenas, partnering with community based organizations in the heavily populated Latinx areas. We’re training community health workers around The Conversation Project. I think this came into being because as we were thinking about partnering to get people over their vaccine hesitancy, we were also thinking about how to partner with them for everything — whether it’s taking medications or advance care planning.

We need people to feel that they’re in an environment where they can trust and have a dialogue.

So how do health plans build trust in the healthcare system?

KB: I think that’s the one big plan for all health plans – which is how does the health plan become embedded in the community and become a trusted member of that community. We’re opening community centers where we have social workers available, and we’re hiring people from the community, and working with community health workers who can be translators and understand the culture and how people communicate.

 

Watch the full webinar recording: