Paving the Way for Health Equity with Vanessa Guzman

In recent years, the call for health equity has driven healthcare systems to champion better care and well-being of their patients and the communities they serve. However, this aspiration brings with it a series of social and cultural challenges. Join us in the latest episode of Value-Based Care Insights as we sit down with Vanessa Guzman, CEO of SmartRise Health, a healthcare thought leader on the frontline of change. Vanessa highlights the key priorities and challenges encountered by provider organizations and offers actionable solutions for effective integration of health equity into care delivery models. Gain valuable insights on leadership requirements, data collection, and what it takes to bridge the disparities gap and promote health equity.

• The pursuit of health equity requires strong leadership commitment, cultural alignment, and effective data collection.
• Quality care is only possible with equitable access to it.
• Top issues faced by health providers include budget allocation, health equity return-on-investment, and integration of health equity into existing revenue streams.

LISTEN TO THE EPISODE:

 

 Transcript:

Daniel J. Marino: 

Welcome to value-based care insights. I am your host, Daniel Moreno. As organizations are advancing into value, based care. Of course, they think about a lot of the issues related to chronic diseases, and how they manage the population and stratifying risk, and so on and so forth. We we've talked about all of those items in depth on our program. But one of the areas that has definitely gained a lot of attention over the last couple of years is how health equities plays into population, health, and the management of patient care related to different types of health equity issues, whether it's lifestyle or social determinant factors, socio economic issues, a whole host of things that are out there. So health, equity definitely is an important factor. And not only is it important to the care that we deliver in our own communities. 

But it's gaining a lot of national attention. Last spring, some of you may know Cms released a lot of their framework for health equity, and then included 5 priorities which I thought were really interesting. They're sort of taking the perspective now of trying to create a little bit of a structure around what health equity is. And those 5 priorities focus on expanding collection data reporting. 2 is access causes of disparity. Priority 3. Is building capacity of healthcare organizations to really focus on reducing healthcare disparities within the community. Within the patients they serve priority. 4 is advancing language, access, health, literacy. Priority. 5 is increasing all forms of accessibility to healthcare. 

So again, I think it's a great framework. It's a great start. I think it touches on a lot of the elements that are important to help us begin to manage a lot of the healthcare challenges related to some of the inequities that we see within our community So, to help us talk through this today, I'm really excited to have a great guest, Vanessa Guzman. She is CEO of Smartrise. She works with organizations all around the country health systems, Acos payers, other partners to identify some key trends, such as health equities and many others, and she's done a lot of work on helping organizations. Think about what the strategies are to begin to kind of. Put some of these things in place and really provide a lot of the change management. Vanessa. Welcome to the program. 

Vanessa Guzman:

Thank you so much, Daniel, for having me. I'm excited to share and exchange some thoughts with you. I think this is a really important topic, and we're often frazzled with where to start so hopefully, we can shed a little bit of light today. 

Daniel J. Marino: 

Well, thank you. I agree. So maybe we could start with what you're seeing with some of the top issues, with some of the healthcare providers around the countries, particularly those that you're starting to work with, who maybe come to you and said, Look, you know, we're interested in advancing some of our health equity initiatives. What do you see? Are some of the top issues that they're struggling with. 

Vanessa Guzman:

yeah, I know Daniel, I think they're pretty. They're pretty standard across right, even regard it regardless of size and resources. They're key challenges that are coming across the old stakeholders. One, for sure, is the appropriateness of allocating budget and resources. To the topic of health equity especially when there's, you know, already, limited resources, limited reimbursement, and folks are trying to understand. You know, what is the Roi associated with making such investments. So that's probably one of the top reasons we see as a barrier to implementing.

Daniel J. Marino:

And that's a big one, I think, particularly in population health. When you're when Cfos are being asked to invest in capabilities, you're investing in things with the idea that you know, hopefully, you're gonna prevent them from occurring. That's hard to be able to wrap an roi around it. I think in health equity is as you mentioned. I think it falls in in the, in the same type of perspective, where it's hard to really invest in it. Hard to get an roi. 

Vanessa Guzman:

Absolutely. So we try our best. Our model really is designed so that it connects with existing revenue streams existing infrastructure. So there's the least amount of resistance like, if you connect health equity with quality is probably the best starting point, just because if you participate in any value based contract or MIPS, or any other, any other similar program like shared savings, there's at least the fundamentals to build upon it. I mean, I see health equity as a more tailored, more specific approach to improving quality of care. I think one can't exist without the other. And that's if we bring that mentality forward. I think there's a lot that we can do.  

Daniel J. Marino:

Yeah, that's a that's a good point. How about some of the leadership requirements? What are you seeing in terms of maybe the culture alignment. I can't help but think that that this is really, you know, in some cases could be really a paradigm shift for how leaders think about serving patients within their community and kind of breaking down some of those disparities.

Vanessa Guzman:

Yeah, for sure. I mean, most of the leadership, either leadership teams that are being assembled or those existing have stories right? Like myself. Which is why we're in this business, which is why we wanna see things change over time, and that gives them the motivation and the knowledge of what community should we serve? What type of data do we need? How you know, how can we mobilize our resources to do the right thing while still keeping the lights on? Because that's our main responsibilities. If you oversee any health system or pay your organization. But I think because it's everyone's responsibility. Part of leadership's role is also to build that culture of equity that you reference by having the tricky dialogues that we need to have around? Why do a a disparities exist? What are the root causes of disparities in our organization and the population we serve without understanding those gaps is hard to know where to start.  

Daniel J. Marino:

Yeah, yeah, I agree. You know many organizations over the years have invested a lot in, let's say, different levels of accessibility. Right? I think the really brought that to our attention and force organizations to make changes. But if you're if you're really gonna be addressing a lot of the health inequities that are occurring, I really feel like you need to do more right. You need to really expand that accessibility area. What do you see are some of the challenges that that our provider partners are struggling with?

Vanessa Guzman:

Yeah, the probably the probably the number one is around data collection, and when we hear that term being used, we immediately think Hr. Discrete fields right? What we know biometrics. But we're talking about engaging members and patients and their and caregivers and families right? In a dialogue, so that they understand why we're asking some of these questions, how this information is being used. And, more importantly, how is it clinically relevant in meeting their needs. I mean, that's really, ultimately what patients want or seeking and that's, you know that that process of collecting data does include it infrastructure, you know, caregiver experience. And asking some of these questions and education forward to the patient. So I think the data piece which sheds light right to what is. The problem we're trying to solve is is probably the number one challenge at the moment. 

Daniel J. Marino:

So let's dive into that a little bit. Because again. I I'm a huge proponent that if you can't get the data, if you can't measure what's occurring, you can't impact the change. When you when you think about the data, where does the data come from? Does it developed in terms of the providers getting it? Is there ways that you can get some of this data from, let's say, the quality of the claims data. Or is this externally external data that we need to bring in?

Vanessa Guzman:

Yeah, I think that's a great question. So if we focus our attention and standards of care that have been developed by some of the measurements towards like the national community of quality. Like Ncqa, for instance. the common denominator is collecting demographics such as race ethnicity, language, sexual orientation, gender identity, disability, or abilities just to start right as to start and then integrating that into existing quality measurements that providers already generally have in their Ehrs. If there's especially if they're already reporting on quality measures and heat as measures. Most organizations start there and then apply some of those demographic variables deep, diving a little bit into like, well, you know, are there differences in how different races engage in flu shot right? Just to make something up, or blood pressure control. 

So the data is, is somewhat there to some extent, because you should be most of providers already reporting it. The demographic piece it will require additional questions, but a lot of the providers already had some of this data as part of registration, for instance. But where we see the biggest gaps is especially in Gen. In sexual orientation, gender identity. And the challenges with asking those questions sometimes become tricky because some patients are not ready to answer. Those questions are not certain why they're being asked the questions and also culturally, they're not ready to engage in that type of conversation. And that becomes, even trickier for providers to feel comfortable asking those questions. A lot of it, because it's a lot of misinformation out there and building trust with patients is key is not just asking the questions.  

Daniel J. Marino:

Well, and it could be a bit of an uncomfortable conversation. Right? 

Vanessa Guzman:

Absolutely.

Daniel J. Marino:

You know, I can't help but think. Let's say, if a patient has challenges with transportation, right? So you're asking the question, you clearly want to capture that I think many providers feel like if they get asked that question, they have to do something with it.

Vanessa Guzman:

Right, So the second part is if you know something, do something. And that's where community resources come into play. Right? If we're talking about social determinants of health screening questions like the prepare, for instance, and many providers ask. My suggestion is always start with maybe a couple of those questions. So once where you have an immediate resource, or an immediate support, or a referral or a partnership out there. Don't ask all 10 questions, if you know we're not there yet, but also start with the questions that you know are most relevant to the population. If you have, you know, social workers or other or other form of resources. It's important to recognize what you're able to do and what your capacity is to support some of that work.

Daniel J. Marino:

If you're just tuning in. I am Daniel Marino, and you're listening to value based care insights. I'm talking today with Vanessa Guzman. And we're talking about the issues facing provider organizations as they advance into health, equity, and the delivery of that within their patient care model. 

So when we think about those questions, and that's a great point. Right? So start small, start impactful and then and then kind of build from there. Is, you know, is, is there? Is there training recommended, is there? II would think there's got to be approaches in terms of you know, 2 types of training one. How do you ask the question, gather the information, and then what do you do with it? Right? How do you put it into? How do you put it into the care model? So it becomes relevant to your outcomes or your performance, or, frankly, just helping the patient.  

Vanessa Guzman:

Yeah, absolutely. And that's part of change management. That's the second, probably most common challenge Daniel that we see with integration. And so we certainly recommend training for caregivers, but also training for patients and their families, because, like, I say families, and because it's so important that the patients seek resources wherever they feel most comfortable. And sometimes that's their family. Especially when we're talking about people of color. That's probably the most predominant resource that they have. But there's also has to be work flows established, so that everyone who's engaging patients is following the same mantra right? And following the same lighthouse. Because then, with consistency, we have the ability as a system to say, Do we need to modify? Is it having the impact we're intending to have? But still having that personalized touch that each person as as individuals bring to the table, which is beautiful, at which attracts patients generally to payers and health systems.  

Daniel J. Marino:

Yeah. And frankly, that's what I think many physicians appreciate right? You got to incorporate it into their own practice and connecting with the patient. So when you're working with organizations around the country who's taking on this responsibility? Kind of a leading the charge within health equity, is it? Is it the medical officers? Is it the chief nursing officers? Who are you seeing really leading the charge? Within the provider organizations.

Vanessa Guzman:

We see a lot of new appointments with health equity officers these days. Which may be new leaders into the industry, who have been proven to be superstars and other areas like quality, like medical officers, or even community health workers right in the community partnership piece. But they all have something in common. Generally they're people of color. Generally, they're people with lived experiences and diversity, but also they have some sort of connection or social connection to the community. And I think that it's intended to build trust right across the organization from a person who who's likely have lived through some of the challenges that they're we're trying to solve to for the patient. But the challenge we see there is that these folks are often not given enough resources to do their jobs effectively, because it's not a one person job and so where we come in generally to help is what type of roles and responsibilities do we all have the collective, we in the organization, although there's some centralized function, perhaps, that this person plays. 

Daniel J. Marino:

Yeah, that's a that's a great point. We've done a lot of work over the years with community health organizations and really bring in Karen to the community, particularly with social workers. And to your point, social workers have really struggled with the right level of funding to not only help the patients, you know, when they're in the office, but to kind of address. A lot of those other out issues that, you know frankly, may even have a more significant impact on the overall health of those patients. But it, it does come down to it does come down to the funding. So when you think about that level of investment, if an organization is really thinking about moving forward with putting a lot of these health equity initiatives in place. Where does the where does the investment start? Doesn't start with the data? Does it start with training? Does it start with maybe hiring an individual to kind of lead the charge?

Vanessa Guzman:

Right. It. It all depends on where the core. Competencies of that organization exist right, the path of least resistance. But generally we recommend it look at the area that already generates revenue, like, for instance, quality and many organizations have relationships with payers, for instance. So there could be potential collaborations between the payers and providers to identify well, how can we share resources so that the investment is intelligent and smart, and goes a long way because it's now but a bit more collaborative. But I would think. There's 3 areas that I would recommend. Investing the collective “We.”  

One is in data infrastructure collection engagement, patient engagement. Everything we talked about. 2, I would say investment in leadership, and organizational structure. That means making sure that the workforce is very much representative of the population, that you're serving, that there's accountability structures that you're able to report on. What are the disparities and understand what is the problem you're trying to solve? Right? And then 3, making sure that you have sufficient funding to now close the gaps right. So there is beautiful disparities that are that are not beautiful at all. And we often try to normalize, because, you know, that's just how what makes sense and is comfortable to for most of us. But you know, I think looking at you, just investing dollars in those 3 areas is is really where we all start. You know how we go about. It could be differently through assessments, data, whatnot. But those generally are the are the 3 ones, and where we see gaps is is, is making sure that there's culturally and linguistically appropriate services available as we tailor right our programs to patients. So that I is the big ask for me to all of you listening. But that gets integrated into whatever your plan is. 

Daniel J. Marino:

Yeah. Those 3 points, I think, are absolutely right data leadership. And then, you know, just having that that funding path, I think, is really key. So when you're when you're working with organizations around the country, and we see this all the time in the work that we've done. We've you know, we work with folks in the in more of the rural areas. I have a number of clients in Western Nebraska and done a lot of work in South Dakota as well as then the heavy metropolitan areas, right Chicago, New York, and so forth. I would think, and more than I think II know that the health inequity issues are. Some of them are the same, but some of them are very different between and rural. 

What are you seeing there in terms of those types of disparities? Are? Are there some clear differences, or do you kind of approach it? The same? Because again, we're trying to solve a lot of those same issues across the gamut of health, equity.

Vanessa Guzman:

Yeah great question. When we look at studies across the country, we see that metropolitan urban areas. Have more, have more health, equity gaps or disparities in you know, clinical diseases, such as asthma and hypertension and diabetes. Those highly dependent on things like food access or access to healthy food, and stable housing and finances, whereas of those residing in rural less connected communities. We see more challenges with things like behavioral health and substance abuse, alcohol use. And I think where the gaps really fall apart is that each of these settings have limitations, right of different things, whereas of like rule settings have challenges, things like transportation in urban areas, you have such a diverse group generally of people of color. That, you know, is not homogeneous, right? So it's not like a one size, fit all approach to the work that we do when it comes to things like food access. Because, culturally, and even linguistically, that changes right. How those conversations, and what diet and exercise means totally different things for these different groups.

Daniel J. Marino:

Great point, I mean, you're you are spot on. So I guess. Really, looking at some of those drivers, those factors that are really important in in your particular market, your particular setting. And you know a. Again, I think, trying to create that path. The plan to really address some of those. But it has to be very different, right? It can't be a one. 

I would also think that there has to be some culture norms that come into place as well right. You know when, when you think about different areas of the country. You know, there's some areas which obviously are much more conservative than other areas. And you know how you communicate and how you train around. That. I would think has to come into play.

Vanessa Guzman:

It's and it's different. You know, we work with in settings where gender affirming, you know, roles and resources can be tricky just because of policy making and regulations that are different, for instance, in those States. And they in those clients they hesitate to use the term health equity, because immediately gets shut down. So we really promote that is, really it's how, how is health equity relevant from a clinical perspective. And if we all look at it without making this political, just making it about the health of the patient. And what does that mean? Then you're strategically positioning your organization for success. Right? That that is, that is the key cause. It's all about the health of the patient, and good quality of care cannot exist without equitable access to care.

Daniel J. Marino:

Yeah, you're absolutely right. And you know, it's if you're doing a good job. I'm trying to incorporate lifestyle information, really understanding what's occurring with not only the patient but within the community raising the overall care of patients within that community. So II agree with you, II think we really need to focus on and removing ourselves from some of the political aspects and breaking down some of those challenges really about what's in the best interest of the patient and really building that into your overall care model. 

Well, this has been. This has been great, fascinating discussion. Obviously, it's an area that I have a lot of interest in if you were to give some advice to our listeners. II know many of our listeners are just starting to get into health equity, start to understand how they can incorporate this into their care model into their focus around value-based care, any pieces of advice that you might be able to share? 

Vanessa Guzman:

Yeah, absolutely. The first, the first part is understanding the communities and populations that you serve, no matter where you're at. You need to understand that so that you can make the most efficient use of your dollars and time. And you can use all the different data types that we discuss today and sources, or, you know, using quality heat as measures as the starting point. The second piece of recommendation is making sure that the leadership is accountable for making the right investments without the necessary budgetary app allocation, whether is of centralized resources like an officer or resources, the closest disparities, you're just talking a good game. But ultimately you're lacking action. Then the third is having dialogues right? We don't have sufficient dialogues with our partners whether there's payers or community providers, and that is so important. So I encourage having those tricky conversations, because without that we're really never going to get to the root of what is most important to us. 

Daniel J. Marino:

Yeah, you're really never going to advance a lot of the health equity initiatives. You're gonna be stuck. Well, Vanessa, I can't thank you enough for joining me today. Great discussion. If any of our listeners have questions or want to follow up with you directly. To share your information?

Vanessa Guzman:

Absolutely. You can visit our website at www.smartrisehealth.com. We're also on LinkedIn. And my email is Vanessa@smartrisehealth.com. So I wanted to thank you so much, Daniel, for the opportunity to share these insights. And in our websites, you'll find a ton of resources that hopefully help you understand where you can best start but also resources that can really help advance where you're at today. So I thank you for that.

Daniel J. Marino:

Well, thank you. II really appreciate it. And you know, obviously a very important topic. As we move forward? So thank you again. I also wanna thank our listeners for tuning in today. Certainly do appreciate this. And until our next insight, I am Daniel Marino, bringing you 30 min of value to your day. Take care.

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners