The Pennsylvania system sets tangible goals and is seeing progress. WellSpan’s Mike Seim spoke with Chief Healthcare Executive about closing disparities.
More hospitals and health systems are using data to address health disparities in minority groups, but WellSpan Health has been doing it for years.
The Pennsylvania health system began taking a closer look at its data before the COVID-19 pandemic, said Mike Seim, WellSpan’s senior vice president and chief quality control officer.
“Even starting in 2018, we started to try and make sure we had an accurate database of our patient population,” Seim said. “We were looking at language of choice, collecting data around race and ethnicity as well, and focusing on making sure that we had a data bank that allowed us to really take every quality metric we had and really assess if we had any disparity in the care we provide.”
WellSpan’s board of directors didn’t just support the effort, Seim said. The board wanted to see improvement.
“Our board of directors is really engaged and they set measurable outcome goals for us around health equity and disparities,” Seim said. “And that’s gone back for five-plus annual plans. It’s not just, ‘Are you doing it?’ It’s, ‘Are you getting results in your equity work?”
WellSpan is seeing progress, and those data-driven efforts on health equity are drawing attention in the hospital industry. WellSpan was named a finalist in the American Hospital Association’s Quest for Quality prize this summer.
“We applaud your diligence in digging into the data to drive your health equity and quality improvement efforts,” said Rick Pollack, president of the American Hospital Association. “Congratulations and thank you for providing exceptional care, day in and day out.”
WellSpan appreciated the recognition. “Especially in COVID, you’re just going from one crisis to another,” Seim said. But he said it was heartening to take a look back and assess progress.
Seim spoke with Chief Healthcare Executive about WellSpan’s use of data, its approach to improving equity in diverse populations, and what healthcare leaders should think about as they try to close disparities in care in underserved communities.
“One of our guiding principles is to improve health through exceptional care for all,” Seim said. “That care for all is really critical as part of our mission to look at all of our patient populations and making sure we’re optimizing their healthcare.”
(Watch excerpts of our conversation with Mike Seim in this video. The story continues after the video.)
Setting clear goals
WellSpan Health operates seven hospitals and scores of physicians’ offices and care sites across central Pennsylvania. The system’s flagship hospital, with nearly 600 beds, sits in the small city of York. Its sprawling service area includes farmland, small rural towns and growing suburbs.
The system’s diverse population posed challenges in distributing the COVID-19 vaccine. WellSpan’s service area includes rural communities where vaccine hesitancy ran high, along with a significant Amish population that won’t be reached by cellphones or laptops. Some areas also have higher concentrations of Hispanic residents.
WellSpan focused on “partnering with some of the community groups that are well established within our service areas, to help them share the message around vaccination safety,” Seim said.
Teams focused on stressing the safety of the vaccine and debunking concerns that it would lead to sterility or changes in DNA. WellSpan worked at “really directly addressing some of the misinformation, and actually having trusted community members deliver that message is really important,” Seim said.
In the past few years, WellSpan has focused on reducing maternal mortality and morbidity. Seim said the system started strategically, collecting data and examining outcomes.
Over the last year, WellSpan focused on improving breast cancer and colon cancer screenings.
“We didn’t say we're going to improve it. We actually set percentages and goals that we were going to really work for, to achieve,” Seim said.
“So in this last fiscal year, we set a goal of improving breast cancer screening by 1.5% for diverse populations. We actually, we improved it by over 5%,” Seim said.
While they succeeded in boosting screenings in minority groups, WellSpan also recorded a 5% increase in screenings among white patients.
The data shows that improving healthcare in minority populations “is not a zero sum game,” Seim said.
“Some people think that with health equity, if you provide dedicated resources to improve the health of a population, it's at the expense of other segments of the service area or your market,” Seim said. “And by using data, we're able to show that that's not the case, that whenever we put a focus initiative on a health equity, or disparity, we've actually, every single time, seen dramatic increases in the care of all of our patients.”
Managing chronic diseases
Now, WellSpan is moving toward closing disparities in chronic diseases, such as diabetes and high blood pressure. Seim said that will pose a different challenge compared to screenings.
“That's going to take a different skill set for us to learn because it's about frequent checkpoints and touch points with populations,” Seim said.
As opposed to screenings, Seim said, the challenge will be, “How do we manage chronic disease, where you have to touch base once a month, and really making sure that we're creating a system that has accessibility to all of our patient populations?”
WellSpan wants to improve communities in its rural communities. Residents in rural communities are more likely to be diagnosed with chronic diseases such as diabetes and heart disease, according to the Centers for Medicare & Medicaid Services.
The system will be using telehealth to reach some patients. However, WellSpan also understands virtual visits won’t be an option for some patients.
WellSpan is working to improve healthcare in the region’s Amish and Mennonite communities. WellSpan has a department that works with those communities to provide healthcare services.
“You know, people think about healthcare disparities as race or language, but in our market, religion plays a role in it as well,” Seim said. “So really, how do we meet patients where they're at to try to drive better health care?”
Building 20-year plans
WellSpan’s Ephrata Community Hospital in Lancaster has worked with the Plain communities of the region for years. WellSpan also offers a behavioral health clinic that is sensitive to the values of the Amish and Mennonite populations. They aim to offer care that is “respectful to their religious beliefs,” Seim said.
It’s been “a 20-year journey” to build trust with the Plain communities, Seim said. And healthcare leaders focused on improving equity must realize it’s a commitment that could take years, even decades.
“If I'm going to tell leaders one thing, you can't have a 5-year plan,” Seim said. “You have to have a 20- or 50-year plan, if you're going to make significant, impactful sustainable changes."
“So, you know, as we start to think about, yeah, we can do these one or two projects," he continued. "But over the next 5, 10, 20 years, are they going to build on each other, to really eliminate the overall disparities in health care? And I think if you look at life expectancy, that's a great example where there's inherent disparities between different parts of our communities. So how do we build a sustainable program that spends time trying to close that gap?”
Since health systems are going to spend years on improving equity, they can still work with urgency, but they should focus on improving on specific areas, Seim said.
"Pick one measure," Seim said. "Start with it, figure out how you can make improvements in your health system, and then expand to the next."
“You have to make sure that we're not setting thousands of goals,” Seim said. “But what are one or two goals that we can rally people around? One of the unique things nationally with health equity is that it tends to be something that's popular to work on.”
Health equity isn’t a box that leaders can simply check off after a couple of years. He said leaders should focus on building “a program that will outlive me and my team.”
“You know, honestly, to see the lasting changes, I will be retired,” Seim said. “But I want to make sure that we're building a program that is so entrenched in everything we do, that it will be sustainable.”