Episode Transcript:
LaShawn McIver
Everyone assumes it's someone else's job to do health equity…But it's all of our responsibility within our organizations.
Pleasant Radford
We have to see ourselves in this work. We have to personalize this work, and we can't treat it as someone else's work.
Robert Traynham
All right, here's a big question. If you were to leave this meeting right now and go anywhere in the world, where would it be? Pleasant, let me start with you.
Radford
I would love to go to Dakar, Senegal. I've never been. And I'm learning French, so it's an opportunity for me to use my French, and explore the food, the culture, the music, the fashion. I would go there.
Traynham
Dr. McIver?
McIver
Well, I will be getting on an airplane soon going somewhere that I'm excited about, and that's to Japan. So, I lived in Asia years ago and I'm going to go with my family for the first time. So, we are all very excited. But if I weren't going to Japan, I would be headed to a beach somewhere, just to enjoy the seaside.
Traynham
Thanks both, for sharing. Dr. McIver, let me start off with you. You have said on more than one occasion that health plans are uniquely positioned to be a part and lead the conversation in health equity. What do you mean by that?
McIver
Well, I think health plans are uniquely positioned to advance health equity because we are payers within the health care system. And so, when you hear the word payer, it can be polarizing because people don't always see a payer as a positive contributor to the health care system. They think about the cost of care. But in how we, what we pay for, how we design the benefits that we pay for as a payer — all have the potential to advance health equity.
I was really honored as the director of the Office of Minority Health at CMS to look at that through the lens of a public payer. So, we have these major programs that impact millions of people in our country, and what would happen when you look through a lens of equity and as we started down that path years ago, it has helped to transform what we're doing in the health care system. And so, in this space within AHIP and how we focus on the private health insurance system, we have that ability as well. And a lot of incredible work is already underway. So as a payer, we play a role in paying for care, so it's not just the access. So, payment creates access. However, we also have the ability to design what that access looks like, and to address health inequities and disparities through the work that we do.
Traynham
And speaking of what health equity looks like, I'd love to go to you, Pleasant. Your impact in your work has taken many different paths. Can you walk us through some of those paths for us, please?
Radford
Absolutely. The current, or the string across all of my experiences, is really driving systemic change through community engagement, through training, through policy, through advocacy, through evaluation. And the different places that I have been, that's been a focus of my work. I am currently the Health Equity Officer at UCare, and my role is to lead the organization on our efforts to advance health equity for our most underserved populations. We serve over 600,000 Medicaid and Medicare members in the states of Wisconsin and Minnesota. And there's a lot of challenges, but there's also a lot of unique opportunities once you uncover those challenges. And so that's one area of work. I worked for the United Health Group as well as a consultant looking at the Affordable Care Act and how to ensure that our members, particularly in Florida and Vermont, had access to health care. At Blue Cross Blue Shield in Minnesota, I had the opportunity to lead evaluation for efforts in healthy eating, physical activity, and commercial tobacco prevention. And so, through all of those efforts, the thread has been, how do we drive systemic change to advance health equity through a number of different areas to ensure that we are improving the health and the health outcomes of the lives that we touch?
Traynham
Question for you both. I'll start with you, Dr. McIver. Pleasant alluded to a lot of the opportunities, in health equity. What do you see some of the enormous opportunities that, quite frankly, we need to start thinking about?
McIver
So, I'll reflect on some of the things that I'm learning as I progress in my role as Chief Health Equity Officer. There are so many opportunities across our industry to advance health equity. There's a lot of data collection efforts that are underway that are helping plans who aren't just — they don't just have plans, but they have other products as well — to better understand the populations that they're serving, and to design unique interventions and services that can help their members thrive. And so, I would say, some of the data collection efforts that are underway are helping us design the right interventions. A lot of our plans are currently doing, for example, a lot of great work in the social determinants of health / social drivers of health space, and we're seeing the outcomes that are coming from some of those efforts. And so, when you pull that lens back through a lens of equity, it allows us even more opportunity to impact the populations served across the industry. So, I'll just sort of start with, I'm really excited about that aspect of it because as we are working together, better data, it is helping us to think differently about populations, and I'm excited as well that AHIP is a part of that. We've been leading a national effort for a few years now to help in standardizing data. So, we're helping as well in engaging with multiple stakeholders from across the country.
Traynham
Pleasant, what surprises you or inspires you?
Radford
There's so many opportunities for us to now acknowledge the history of how we got to where we are today. I think if we don't do that, then we do ourselves a disservice in understanding how we can move forward. And that's what's exciting is that we are finally acknowledging that there are some mistakes. There's some errors. There's been deaths. There have been a lot of things that are ugly about the health care system, but we are doing our best to move forward and to make sure that we have the right people at the right table, having those deep, hard conversations about, how do we move forward? What do we need? How can we best support you, and working together? Because we can't do this by ourselves. The problems, we didn't create the problems by ourselves. And we can't solve those problems by ourselves. It's going to require work.
Traynham
It sounds like acknowledging the truth and acknowledging just the facts. Are there any examples where you say, "hmm, that surprised me."
Radford
Yeah. I think what still surprises me is that when we talk about disparities, we obviously need to talk about it from a racial, ethnic lens, but then when you look at it from a global perspective, the U.S. still is not performing very well when it comes to life expectancy. And so, when we look at other countries, for example, South Korea and Japan, when we look at Europe, for example, Spain and others, the life expectancy is a lot better than it is in the United States. And so, it's important for us to understand that we collectively are suffering, and that we collectively need to understand how we can move forward to improve the health of everybody.
Traynham
Dr. McIver?
McIver
Well, I just add on to what he was saying about when you look at our performance globally, not only do we have a different life expectancy than other nations, but we pay the most for health care compared to other high-income countries. And so, when I think about the things that are concerning, as you're going through this, it is that history is repeating itself in some of these circles. And as we are learning more about the history of our industry, this is our opportunity to course correct. And so, we are seeing course corrections across many different spheres in the health care sector. And so, what inspires me about this moment are the conversations that I've had the pleasure of having across, not just our sector. What's inspiring is, I can, I'm now having these conversations in the IT sector, in the transportation sector, in the social justice sector.
We have brought in this conversation, and that means we have diversity of thought towards the solutions, and so that's very inspiring, although we're still dealing with the difficulties of all of the things that seem so far away. I know, for me, it seemed very far away. But as I have progressed over my career, realizing that we're still dealing with things from the past, but what's inspiring are the solutions that are coming from this moment.
Traynham
Pleasant, I would love to learn more about your impact and also your work in the LGBTQI+ community. Walk us through that, please.
Radford
Yeah. So as Dr. McIver was saying about data, data is so important. We need to understand who we're serving and provide the right solution, at the right time, at the right place for the right community. And for us, we're removing the curtain to understand how we can better serve our LGBTQI+ community. There's a paucity of data, unfortunately, about the community and we need to do better to collect that. So, we're in the process now of collecting that data. This has been nearly a two-year effort where we started with the community to understand what are those questions that we, that you need us to ask in order to be seen and heard? And then from there, let's add those questions into our, in this case, health risk assessment forms so that our members are able to answer questions about gender identities, sexual orientation, pronouns and sex at birth. And then once we collect that data, we also need understand, how are we training our staff and our leaders on how to use that data? How to make sure that we're not adding additional harm with the data that we've collected? So that comes through training, through webinars, through education, things of that sort. And so, it's a multi-year effort. At least that's how I envision it. But we're looking at that, taking the important steps, and then going a step further to work with the Minnesota Department of Human Services to understand how we can make sure that the data that we're collecting is also being collected at a state level so that we are capturing the data at the same time, and that we're getting better information about the Minnesotans that we serve.
Traynham
It feels like, as we have this national conversation around health equity, what's missing from the conversation, if anything, substantively? Can you think of anything, or do you think we're doing okay in terms of having this conversation across the country?
McIver
I think, I think we have broadened the conversation, which is what I alluded to earlier. And that, I think, is the thing that is inspiring as we look forward. But the thing I'm always challenging people to do is to look around the rooms that you're in and see who's not there.
You know, health equity is not a new thing. It is a new, we have, we're in a moment where people understand it more acutely, they can feel what this means in a different way. But disparities, we've been working on this work for years and health inequities. And so, when you look around the room, if everyone has the same opinion and thoughts or view that you have, you have to ask yourself, “Okay, are we going to be able to move the needle in this in this setting?” And so inviting diversity of thought, as we're sort of moving this forward, is, is going to be important. So that's one piece. And then the other thing I'll add to that is what I think is missing in some conversations, is everyone assumes it is someone else's job to do health equity. They assume it's my job as the Chief Health Equity officer, but it's, it's all of our responsibility within our organizations, especially if you're in the health care sector and you are delivering care on any continuum from benefits to administration to providing direct care and services. And so, from wherever you sit in your organization, there's a role that you can play whether it's educating yourself on what this actually means. A lot of people confuse DEI diversity, equity inclusion efforts with health equity. DEI is your workforce. What does your workforce reflect? Health equity is about the populations that you're impacting, and how are you delivering your service or care that will impact many different populations. And so, I would just challenge people to engage in these conversations with that in mind that you actually have a role to play if you're in communications, how do you communicate with others? Are you thinking about ways that you can be more inclusive in your communications, which will bring people into the health care fold in a different way? If you're in budget, I like to call it my finance people. If you're responsible for funds and resources within an organization, do you know what the health equity initiatives are within your organization? And how, how we're building budgets to support that across enterprises? So those are some of the things that come to mind when I think of that.
Traynham
Pleasant?
Radford
Yeah, and this is hitting more close to home, is aging. I think that we're not talking a lot about aging, and especially dementia. I think that's something that unfortunately a lot of people are dealing with. My dad has dementia, and so as a caregiver, I'm going through that process right now and seeing the support or the lack of support — that dementia patients have. And it's so important to make sure that we're thinking about that, because we're all going to age at some point, and dementia is increasing worldwide, and so how can we make sure from a health care perspective that we are treating people with dementia with dignity, that we're also designing environments for them to still be alive instead of, you know, assume that they're dead. So those are things that I think of, as well, that are going to be important in the long term.
Traynham
I'm hearing a common theme here, and that's different voices at the table, literally and figuratively having a seat at that table to build that equity. And so, what else can we be doing? You mentioned, Dr. McIver, looking – my words – in in the mirror and seeing how you show up with respect to this conversation. But is there anything else that we should be doing, Pleasant?
Radford
We've touched on it, I've touched on a lot of those things. Yeah. And Dr. McIver said it well, we have to see ourselves in this work. We have to personalize this work, and we can't treat it as someone else's work, we have to make sure that we are putting people at the center. We're finding ourselves in that work, because we all have a stake in this and the more we're able to work together, then we're able to accelerate change.
Traynham
Yeah, I think I call it being empathetic and walking in other person's shoes and having that conversation. And when you walk with that person throughout that journey, the way you show up is to walk just as fast or as quickly or as or as slow as you so choose. But let's walk on this journey together. Dr. McIver?
McIver
Well, to your point, I love that analogy, because I use it to describe my role in this work. So, you know, as a thought leader, as an executive that's doing these activities within an enterprise, I always start with, it doesn't matter where you're starting today, as long as you're on that journey, and our role is to meet you where you are. And to help you walk along that journey. When we look across our health care system, we don't, we don't technically have a mature system yet. And so, our there's work in this space that only began a few short years ago. And so, a lot of entities are still building growing and working. And it, it takes that first step, making that first step, towards building a more equitable health care system. And we've, we've taken it across our sector, and so is the next step. And then the next step that's going to help us advance health equity for everyone.
Traynham
Speaking of the next step, this thing is called the Next Big Thing in Health. In your words, in your mind, what does that look like for you?
Radford
Climate change. Climate change is the next big thing that we need to address. Personally, I suffer from allergies, especially with ragweed, and it was everywhere last summer because there wasn't a lot of rain. And so generally my allergies usually are bad in April and September. But April, May, June, July, August, September, it was nonstop. And that's just on a personal level. But when you think about it from those who suffer from asthma, those who have respiratory illnesses, those who have other different things that they're suffering from, climate change has in impact on that. And then even on the food that we have, the food that we eat today may not be the same food that we eat 20 to 30 years from now. And so how are we thinking about that from a health perspective to ensure that we are providing what we need to remain healthy for the next 100-200 years?
Traynham
Dr. McIver?
McIver
So the next big thing for me in health equity is going from vision to sustainability, sustainability, sustainability. Health equity is not about checking a box. It's about deepening this work throughout your enterprise. And we, as I said, most of the system is in motion, and there's certain things that can slow us down. And so, in order for us to continue forward, we have to be thinking, in this moment right now, about how are we going to sustain and evolve this work over time? And so, the next big thing is going to be the actions that will really help us sustain and catapult this work, for years to come.
Traynham
Thank you. Thank you.
