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By JULIE MINDA

Within months of the onset of the COVID-19 pandemic, it became glaringly obvious throughout the medical field that while the pandemic was having an impact on virtually all people everywhere, there were some populations that it was hitting much harder than others. Data and anecdotal evidence showed that in the U.S. the public health crisis was disproportionately impacting people of color, the poor, the uninsured and the elderly.

To ensure its 140 hospitals and 1,000-plus other care sites in 21 states were taking on such disparities, CommonSpirit Health in late 2020 established a Vulnerable Populations Council.

While the group first convened with a charge to broadly develop a vulnerable patient strategy it quickly pivoted to increasing vulnerable groups' access to COVID-19 information, screening, vaccines and resources. Since 2021, it has been exploring how to ensure vulnerable populations are aware of the importance of preventive care and can access it.

"We're looking at how do we make sure that a vulnerable populations strategy is embedded in CommonSpirit from a clinical, operational and strategic perspective," says Brisa Urquieta De Hernandez, system director of operations for CommonSpirit's new Lloyd H. Dean Institute for Humankindness & Health Justice. "We're sometimes having uncomfortable conversations about what patients are experiencing and we're amplifying the work that is happening" to address concerns.

'Incubator of ideas'
The Vulnerable Populations Council is made up of about 40 leaders representing clinical, operational and strategic disciplines. Among the council members are people with experience in community health, population health, value-based care, behavioral health, political advocacy and nursing care coordination. The council meets over videoconference. Dr. Alisahah Jackson, president of the Lloyd H. Dean Institute for Humankindness & Health Justice, helps guide the work.

De Hernandez says the Vulnerable Populations Council has become "an incubator of ideas."

Rachelle R. Wenger, CommonSpirit system vice president of public policy and advocacy engagement, is a member of the council. She says group members each bring distinct perspectives on issues related to vulnerable populations and are able to meld their expertise into coordinated approaches to challenges.

The advocacy team supports the aims of the council by working on policy issues that promote health equity and social justice, such as by addressing disparities in maternal health, housing and food security, immigration-related health access concerns, and climate change, Wenger says.

Members of the Vulnerable Populations Council have been exploring how best to define and categorize these and other priority areas and standardize data collection to inform their health disparities work.

Subcommittees are using the expertise and the high-level action plans of the council to assess CommonSpirit's markets, identify care gaps, inventory assets the markets have to work with in addressing those gaps and develop implementation plans.

A Vulnerable Populations Care Collaborative made up of frontline practitioners from throughout CommonSpirit's regions is championing the efforts.

Intentional outreach
De Hernandez says the Vulnerable Populations Council's first order of business was to convene experts from around CommonSpirit to grapple with and respond to the disproportionately poor health outcomes that CommonSpirit was seeing among populations experiencing the worst COVID outcomes. The council later took on challenges around vaccine hesitancy.

De Hernandez says the council considered how to acknowledge the distrust many African Americans, migrants and people with low household incomes have for medical providers, how to acknowledge discrimination and racism that often caused the mistrust, how to build trust with disadvantaged people, how to engage them and how to create resources that resonate with them.

The council and its subcommittees created tool kits for CommonSpirit frontline staff to use in undertaking the work. The council and affiliated groups also engaged information technology professionals in creating electronic medical record and data tools for identifying patients and community members at risk of missing out on COVID information resources, vaccines or treatments. Clinicians in CommonSpirit health care facilities used this information to conduct targeted outreach.

Dr. Monique Diaz, CommonSpirit chief medical information officer for the Pacific central coast health centers of its Dignity Health division, served on a care collaborative that developed information technology tools for reaching out to migrant workers. One subgroup that the collaborative concentrated on was Mixtec migrants; the indigenous Mesoamericans had come to California from the Oaxaca, Puebla and Guerrero states of Mexico. That migrant population was identified as especially at risk of COVID infections and poor health outcomes.

"This was truly a matter of life and death," says Diaz. She and colleagues worked with a local community service to translate important CommonSpirit COVID literature and videos into Mixtec, and then the CommonSpirit team got that information to the migrants, including by providing it through physicians who people in that community already trusted.

Turning the wellness visit on its head
Diaz says now that the Vulnerable Populations Council and related groups are devoting their time and energy to preventive care, the population health framework that she and her colleagues erected under the council's prior COVID work is being used in new ways. "We intend to build upon it as we educate on important health screenings, like those for colorectal cancer, which is the third most common cancer in the United States," she says.

She says every patient encounter is an opportunity to educate and encourage patients to seek preventative care and manage chronic disease.

De Hernandez says the Vulnerable Populations Council has turned its attention to primary and preventive care because it recognized that in part due to exigencies of the pandemic many people were avoiding health care facilities and had stopped seeking preventive care, including wellness exams and screenings.

Preventive care avoidance is most common among minority populations who already are at heightened risk for chronic diseases that can worsen if ignored, says De Hernandez.

De Hernandez says the council is working to better understand why populations of medically vulnerable people continue to stay away from primary care and what might persuade them to return. The work acknowledges that members of medically marginalized groups are not always able to access preventive care, and this problem was exacerbated during the pandemic.

The council also is thinking through how to use the annual wellness visit to assess not just physical health but also mental health and social needs.

As CommonSpirit gains traction around preventive care in medically underserved populations, it likely will use its Vulnerable Populations Council framework to take on other broad public health problems, such as smoking and diabetes.

The granddaughter of a migrant farmworker from Mexico, Diaz says, "this work touches upon all of my passions in medicine. It takes health information technology, plus population data and centers it on social justice in the name of making God's healing presence known.

"I can't think of anything else in a professional setting that can top that."

CommonSpirit explains more about the model in a Dec. 3, 2021, article published in the online edition of Number 6 of Population Health Management.