Pursuing Health Equity

Announcer (00:04): Welcome to 340B Insight from 340B Health. David Glendinning (00:12): Hello from Washington DC. And welcome back to 340B Insight. The podcast about the 340B drug pricing program. I'm David Glendinning with 340B Health. This episode is sponsored by SUNRx. SUNRx offers a comprehensive 340B solution to get the results your 340B program deserves. With program requirements being complex, SUNRx helps covered entities optimize their 340B program with transparent fees, compliance solutions and high touch customer care. It's 340B simplified. Visit sunrx.com to learn more. David Glendinning (00:52): Today is the first of two episodes focused on how 340B hospitals are pursuing health equity. Concerns about equity in healthcare are long standing, but the COVID-19 pandemic has shown a bright spotlight on the significant disparities in healthcare and patient health outcomes between white people and people of color. It's also a major focus of the Biden administration. Black history month is the perfect time to focus our attention on this vital matter. The three hospitals we will hear from in these podcasts also were featured in a new report. 340B Health released last week describing the work that nine 340B hospitals and health systems are doing to pursue equity. A link to that report is in the show notes, and I encourage you to read it. David Glendinning (01:39): We appreciate the efforts of all these hospitals and many others across the country that are taking similar actions. But before we hear some of the voices from those three hospitals, let's take a minute to answer one of your questions about 340B. One of our listeners asks, "Exactly how many lawsuits are there and the fight over 340B contract pharmacies?" That's a good question. And for the answer we went to our own Chris Crosswhite, the Senior Vice President of Legal and Policy at 340B Health. David Glendinning (02:10): Chris tells us that as of this recording, there are at least eight pending federal lawsuits related to drug companies refusing 340B discounts on drugs dispense to contract pharmacies. One of them is the joint lawsuit filed by 340B Health, Allied Health Organizations and individual 340B hospitals, asking the court to order HHS to end this pricing behavior. Two other lawsuits were filed by representatives for community health centers and Ryan White Clinics. Four of the manufacturers refusing 340B pricing filed their own lawsuits, challenging an HHS advisory opinion stating that their actions are unlawful. And most recently, Pharma the largest lobbying group for the pharmaceutical industry filed a lawsuit seeking to block a 340B administrative dispute resolution process that HHS is promoting, as a pathway for resolving this fight. We know this issue can be confusing, which is why our legal team here is on the case for all of you. Remember, hospitals can find out the latest about all this court activity on the manufacturer updates page on our website. Check out the show notes for more. David Glendinning (03:23): And now for the first of a two-part series on hospitals featured in 340B Health's new health equity report. Myles Goldman sat down with some of the experts at these 340B hospitals who are working to help eliminate disparities in our nation's health system. Here's Myles with the story. Myles Goldman (03:41): Thank you, David. Over the past year, conversations around social justice and racial equality in America have prompted a much greater focus on the importance of pursuing health equity and addressing the often substantial gaps in care for people and communities of color. This isn't a new issue for 340B hospitals who share a mission to meet the healthcare needs of patients who struggle to access health care and good health. Prior research indicates 340B hospitals serve a larger percentage of African American patients and people with disabilities. They can play an essential role in reducing health disparities and pursuing health equity. Many 340B hospitals report using savings to support comprehensive language interpretation services and nurse navigator programs that help patients with medically complex challenges. This often includes help with transportation to the hospital and establishment of satellite facilities in underserved neighborhoods. Myles Goldman (04:42): I recently spoke with three hospitals featured in the 340B Health report, Brigham and Women's Hospital in Boston, Rush in Chicago, and St. Louis Children's Hospital, about how they have taken concrete steps, both during and prior to the COVID 19 pandemic to measurably work toward progress. Let's start with why health equity is essential. Dr. Cheryl Clark, Director of Health Equity, Research and Intervention in the Brigham and Women's Hospital Center For Community Health and Health Equity uses this definition. Cheryl Clark (05:17): Health equity is defined in many ways, but I think the definition we can all relate to is the ability for all people to reach their optimal health. And that artificial barriers such as the ability to access care and forward care really shouldn't stand in the way of being able to achieve your best health. Myles Goldman (05:41): Rukiya Curvey Johnson, Director of Community Health and Engagement at Rush explains why 340B hospitals should prioritize health equity. Rukiya Curvey Johnson (05:49): It's so important for 340B hospitals to work towards health equity, because we know that health starts in our homes, our neighborhoods, our schools, and at our jobs. And as anchor organizations in the community, 340B hospitals provide vital jobs, purchasing power and resources to treat the whole person. And in many cases, 340B hospitals serve our most vulnerable, the underinsured, the uninsured, and serve as a safety net. And so having 340B hospitals at the table as part of a multi-sector collaboration to address health equity is critically important. Myles Goldman (06:28): Greta Todd, is the Executive Director of Diversity, Inclusion and Community Affairs at St. Louis Children's Hospital. She believes health equity is directly related to health core mission. Greta Todd (06:39): I think it's important actually for all hospitals to work, to achieve health equity, whether they're 340B or not equity, it goes back to the core mission of medicine and healthcare, right? First do no harm. And in fact, health disparities are a preventable harm. We can prevent disparities and the harm that comes from them. So achieving equity would mean eliminating preventable harm from our hospitals. Myles Goldman (07:06): COVID-19 has further highlighted health disparities with African-Americans and Hispanic people representing a disproportionate share of infections, diagnoses, and deaths. Brigham Women's knew they needed to act as their patients were at risk given the makeup of the community they serve. The hospital's Dr. Clark discusses. Cheryl Clark (07:26): We take care of a diverse group of people, including racial and ethnic diversity. Within the neighborhood of Mission Hill, for example, about 14% of our neighborhood here is African-American, 20% is Hispanic or Latino, 19% are Asian and 44% are white at the [seen 00:07:46] race. The Brigham and Women's Hospital created our COVID-19 equity, diversity and community health response, and the response team that put that in place, in part due to that I think really looking at what was really humbling in the press, seeing the reports that came out early on of how disproportionately the COVID 19 pandemic was affecting racial and ethnic groups, African-Americans, Hispanic groups with disproportionate infection rates and deaths. And our institution to adopt this response to help guide the way that we thought about the pandemic. Myles Goldman (08:26): When Brigham Women's became a participant in trials for remdesivir, to be used as a COVID-19 treatment. The need for health equity was an important part of the trial, says Dr. Clark. Cheryl Clark (08:38): At the Brigham, Francisco Marty, is an infectious disease doctor who was the leader of our trial at the Brigham around remdesivir. And you'd see him in the hospital at midnight and trying to make sure that he had conversations with people in multiple languages, making sure that all of our patients had an opportunity to join the research study if they wanted to. I think there were several lessons that can be learned by the way that Dr. Marty and his team approached, reaching out to our patients to offer treatment and participation in the clinical trial. He recruited clinicians like myself to talk to our patients where we already had a relationship. But he also brought in research assistance and other team members from very diverse backgrounds to make sure that we had ample opportunity to create a caring, culturally sensitive situations for patients to consider being able to participate in this research. Cheryl Clark (09:42): And I think being trustworthy and building that humble and culturally appropriate context for research, was an important part in being able to make sure that everyone had access to this emerging treatment. We worked very closely with Dr. Marty to make sure that we looked at the data in real time and at our hospital in particular. We were able to offer the treatment in proportion to race, ethnicity and other aspects of social identity as they were in the hospital. And so that was a really important thing to be able to look at the data in real time and have a deep commitment to having equity in that treatment availability. Myles Goldman (10:25): According to Dr. Clark, COVID-19 provided Brigham an opportunity to identify social determinants that too often are barriers to health. Cheryl Clark (10:34): Part of our work at the Brigham included, or if it happened even before the COVID-19 pandemic began, our hospital participated in as a part of our corporate institutions in the Massachusetts Accountable Care Organization. It's a strategy for taking care of patients who have public insurance, including Medicaid insurance. The thinking around this is that part of what we have to do as we take care of patients in Medicaid, is that we also have to think about these social contexts and part of what was required for our Massachusetts Accountable Care Organization was asking patients about social determinants of health in a really systematic way, and thinking about how to connect to patients to services. And we were able to use our strategies for asking patients about their social needs at the point of care of our COVID testing sites in community settings. Our colleagues and community partners were able to collaborate to provide food to folks, to help them to shelter in place. Cheryl Clark (11:43): And so all of this is a part of really having a broad, social justice, social equity perspective, to taking care of patients, making sure that we don't disconnect our human needs from our medical care. There are many different tools, including strategies that are developed out of the centers for Medicaid and Medicare, that help us to think about how to do this in a way that opens up the conversation and helps to build the relationship between a patient and their clinician, so that these issues can get explored and that we can work together in partnership to provide holistic care. Myles Goldman (12:21): Screening for social determinants of health also is important to Rush University Medical Center in Chicago, explains Julia Bassett, Manager of Health and Community Benefits at the hospital. Julia Bassett (12:33): What prompted Rush to start screening patients for food insecurity, we noticed that lots of our patients on the inpatient floors, they were hoarding foods in their bags, drawers, and in their closets. Rush screens patients for food insecurity through a screening tool called the social determinants of health screening tool. So my colleagues developed this tool and what they did was they worked with Hunger Vital Signs Questions. And those are two of the most valid questions that you can use in order to gain access or information on your patient population that needs to access food. The tool through Hunger Vital Signs ask two questions, "Within the past 12 months, are you worried whether food will run out before you got money to buy more?" And "Within the past four months, the food that you bought did it not last for the end of the month, and do you not have more money to buy more? Julia Bassett (13:26): And so these two questions alone make it very possible for healthcare providers to connect these patients to nutritional programs and other local services. And then we've been able to infuse another layer of work, which is NowPow. And that's a web-based tool. That's used to refer networks that power care and deliver data to bridge gaps in the community. So that allows us to make closed loop, direct referrals to agencies within specific zip codes and direct referrals to our partners, with Top Box to make home deliveries for nutritious food to communities that need that. Myles Goldman (13:59): Rush uses some of it's 340B savings to support these types of food insecurity programs. Julia Bassett (14:05): What we saw was that COVID had really exacerbated the access to food and we needed to act fast. So, once we received the green light in our directives on our efforts, we were able to stand up this process within six days. And six days, we were able to begin curating healthy mailboxes with our partner Top Box. We started recruiting volunteers to make phone calls to those who needed food and who had screened food insecure. And then we were able to make home deliveries on the eighth day of standing up this process. During that time, between March 25th and June 24th, we delivered 1500 mailboxes to those who have screened positive. Right now, we are doing pop-ups, which means that we're going into our communities, the communities on higher need, which are West Garfield Park and also communities. And we're also moving into North Lawndale, which we are doing food meal delivery to community members, where we host a site and we deliver food to community members. Myles Goldman (15:03): Social determinants of health are not just important during the pandemic. St. Louis Children's Hospital's, Greta Todd explains how her hospital has worked to bring health care services to children in need in their communities. Greta Todd (15:17): St. Louis Children's Hospital, first began talking about our mobile pediatric units in 1999. Our fleet of buses help to take healthcare into the community where the children are, and remove that barrier of transportation that makes it sometimes so hard for families to get to us. And instead we take the care to them. We do hearing and vision screening and immunizations, and we serve our historic purpose of making sure our headstart centers stay open. Our second bus is a dental bus. It's a full service dental unit. We do everything in there, including cavities and x-rays and extractions and baby root canals. Our third one is an asthma bus. And our asthma bus travels to different schools. And we have nurse practitioners who provide on the spot asthma care. They tweak medication. We have asthma equipment for the kids. We refer folks to asthma coaches if they are particularly high risk. Greta Todd (16:19): And then our fourth bus, which we're launching this year, we'll focus on diabetes. And working with our partners at Washington University School of Medicine, we will visit high risk diabetics in the schools, and while she will provide the physician and we will provide the diabetes educator, as well as a community health worker that is focused on diabetes. We know that health goes beyond the four walls of the hospital and the care you receive there, and we know we have to address these social and structural issues for our health outcomes to be successful. David Glendinning (16:54): In our next episode, you will hear the other key trends in the 340B health equity report. In the meantime, please be sure to check out the full report. Follow the link in our show notes, to learn about all the inspiring work 340B hospitals are doing throughout the country to eliminate health disparities and move toward equitable care for all. When you hear from us next, we will be in our virtual podcast booth at the annual 340B Coalition Winter Conference, which starts February 16th. So time is running out to register for this important event. If you haven't already, please visit 340bwinterconference.org and sign up today. As always, we welcome your episode ideas and feedback as we plan out our full 2021 season of 340B Insight. You can email us at podcast@340bhealth.org. We'll be back in a few weeks. As always, thanks for listening and be well. Announcer (17:53): Thanks for listening to 340B Insight. Subscribe and rate us on Apple Podcasts, Google play, Spotify, or wherever you listen to podcasts. For more information, visit our website at 340bpodcast.org. You can also follow us on twitter @340Bhealth and submit a question or idea to the show by emailing us at podcast@340bhealth.org.