Addressing Racial Inequities Laid Bare by COVID-19 Requires a Renewed Commitment to Community Partnership

The person-centered care movement has been a critical part of efforts to improve health care in the United States. Direct engagement and partnership between health care organizations, providers, and the communities they serve is the cornerstone of person-centered care. In response to the push for more person and family-centered care, health systems have implemented various strategies to better engage patients and families in decisions about their individual care and some have gone a step further to involve them in organizational level decision making. As health care organizations struggle with the challenges presented by the COVID-19 pandemic, it is tempting to view consumer and community engagement as a secondary activity that can be paused until the pandemic is over; however, it is times like this when engagement is most important.

The reality of COVID’s disproportionate impact on Black and Hispanic people and low-income communities only adds urgency to the need for health care systems to establish pathways for community engagement. In October 2020, the Centers for Medicare & Medicaid Services (CMS) released data detailing the impact of COVID-19 on Medicare and Dual Eligible beneficiaries (low-income beneficiaries who qualify for both Medicare and Medicaid). The report found large disparities in the COVID-19 hospitalization rates by race and ethnicity with Hispanic beneficiaries hospitalized at more than twice the rate of whites; and Black beneficiaries at almost four times the rate of their white counterparts. Furthermore, the rate of hospitalizations for the dual eligible population was over four times greater than the Medicare-only population. Similarly, a recent Brookings analysis of CDC data shows that mortality rates among Black and Hispanic people are much higher than for white people across all age categories.

While there are undoubtedly numerous factors driving these disparities, it is evident that the consequences of systemic racism, implicit bias and income inequality play a central role in these outcomes. Case in point, it is a sad irony that many of the jobs deemed essential during the pandemic are the same jobs so often framed as low-skill, low-status, and – consequently – low-wage work prior to the outbreak. These essential, yet undervalued, jobs placed the most socioeconomically challenged members of our communities at the greatest risk during a time when the common refrain was “Stay Home, Save Lives.”

The health care sector can take concrete actions to advance the work of improving health equity and combatting disparities. These actions start with dedicating time and resources to working with – and learning from – the communities they serve, with special emphasis on engaging historically-excluded communities. This includes not only working to understand community needs and perspectives, but also incorporating these needs and perspectives into organizational decision-making. This type of engagement not only benefits patients and communities, it allows health care organizations to more efficiently and effectively address the intersecting issues of systemic racism, implicit bias, and the resulting inequities that impact COVID-19 outcomes health more generally.

Last year the Health Care Transformation Task Force and Community Catalyst developed a set of case studies and a change packageto help forward-thinking organizations with this important undertaking. While the work of developing these resources largely occurred prior to COVID-19 pandemic and the renewed attention on racial inequities sparked by last summers protests, the engagement strategies highlighted remain highly relevant to the current moment. This effort also identified best practices for promoting diversity, equity, and inclusion, providing health care organizations tools to more effectively respond to both COVID-19 specific challenges and the more ubiquitous impacts of systemic racism and inequality.

Investing in engagement efforts can offer immediate benefits for health care organizations dealing with the current crisis by creating an opportunity for patients and the community to inform the development of new policies in response to COVID. Patient and family advisors (PFAs) – collaborations between patients and families who work together with health care professionals to improve health care – are invaluable to informing the design of policies that balance organization-level concerns and patient needs and ensure that they are communicated in a manner that is clear, compassionate and effective. Most importantly, organizational policies that incorporate the voice and wisdom of the communities they serve can help to overcome a long history of distrust of the health care system. For example, in a recent webinar a representative of Children’s Mercy Kansas City, described how the hospital system worked with patient and family advisors to redesign policies and messaging for patient visitation, procedure scheduling, and virtual care options in response to COVID. She also described how an advisory board made up of Spanish-speaking parents, El Consejo de Familias Latinas/Hispanas, collaborated with hospital staff to overcome language barriers for non-English speaking families and built linkages with the Spanish-speaking community and to ensure that cultural differences were recognized, respected, and incorporated into the hospitals policies and procedures.

Successfully addressing COVID will push health care organizations to reach outside the clinical care setting and engage in sustained efforts with communities to implement strategies that inform the public about treatment, communicate strategies for slowing transmission, and combat misinformation about the pandemic. This can best be accomplished by working with and through those who are already trusted messengers within their communities. Health systems, public health, and state and local officials must work with community members and community-based organizations to identify common questions, recognize potentially harmful misconceptions, and prioritize the design and dissemination of strategies that address the needs and priorities of affected communities. These efforts will need to focus on slowing transmission, connecting those who have contracted the virus to treatment and supporting patients their friends and family members through the recovery or grieving process. In Massachusetts, for instance, Massachusetts General Hospital created an Equity and Community Health COVID Response Team and is working with community partners in some of cities most affected by the pandemic to address the social determinants of health, including the need for food, access to health care and recovery services, and youth engagement.

Now more than ever, given COVID and the renewed focus on racial inequities, health care organizations must partner – with authenticity and care – with the people and communities they serve.

Joshua Traylor is a director for the Health Care Transformation Task Force.

Hala Durrah
is an independent patient family engagement consultant and Founder of Patient Advocates Transforming Healthcare.

Pam Dardess is the Vice President for Strategic Initiatives & Operations at the Institute for Patient- and Family-Centered Care.

Thomas Leyden
is the Director of Blue Cross Blue Shield of Michigan’s Value Partnerships program.