1. Anton J. Gunn, MSW Chief Diversity Officer & Executive Director of Community Health Innovation SC Executive Assistances in Health Care Annual Meeting Health Disparities, Health Equity and Diversity in Health Care

2. Affordable Care Act: Major Themes 2 1. Expanded Coverage (ACCESS) 2. New Consumer Protections and Choice (VALUE) 3. Health Care More Affordable (LOWER COSTS) 4. Improve Quality (VALUE) 5. Improve Prevention and Wellness (POPULATION HEALTH)

3. Implementation 2016 3 What Does It All Mean? Expanded Insurance Coverage to 20 million people. Delivery System Changes › Expanding Primary Care › More Care Integration › Broadening Access New & Different Patients (Changing Patient Mix)

4. Profile: The New Healthcare Consumer 84% - 19-64 Years old… Average Age 35-40 48% Unmarried 52% Men 1 in 4 Speak a Language Other than English 77% High School Education or Less 80% Employed ( $23,994/single or $48,528 family of 4) 58% White, 11% Black and 25% Hispanic/Latino 39% - No usual source of care 37% - Gone more than 2 years with no check up 29% - No connection with delivery system at all Source: Kaiser Family Foundation, 2011

5. Great Expectations What do these new consumers expect? What experiences have they had previously with care delivery? What are they going to see when they get care? Who are they going to expect to see? Does your organization meet those expectations?

6. ER (1994-2009)

7. Trapper John, M.D. (1978-1986)

8. Healthcare Reform Value driven by Patient Experience Patient Experience driven by Patient Expectations Achieving value more complex due to diversity of patient population

9. Healthcare Reform Healthcare Executives Must Embrace Leadership roles to: Improve Health of Population Improve Patient Experience Lower Costs

10. Triple Aim

11. Leadership Challenges To ACHIEVING VALUE Giving power to patients, communities and families as partners in improving health and well-being Resource allocation (how we invest) Silos and Institutional/Professional boundaries Financial and Fiscal Pressures Welcoming systems change while continually pursuing improved outcomes Acknowledging that health care is a service industry (Social Work as much as Medicine) “Closing the Gap” on disparities in care

12. Institute of Medicine Report 2002

13. Institute of Medicine (IOM) on Disparities People of Color receive lower-quality health care than whites do, even when insurance status, income, age and severity of conditions are comparable. People of Color more likely to be treated with disrespect by the health care system and more likely to believe that they would receive better care if they were of a different race. Major disparities found in many key diagnostic areas: cardiovascular disease, cancer, stroke, kidney dialysis, HIV/AIDS, asthma, diabetes, mental health, maternal and child health. Source: Unequal Treatment, Institute of Medicine, 2002

14. Institute of Medicine (IOM) on Disparities CALL TO ACTION Increase the public and provider awareness of disparities Decrease fragmentation of care and change financial incentives to improve quality Reduce barriers to care for people of color Increase diversity of providers Promote quality evidence based practice Promote enforcement of civil rights Source: Unequal Treatment, Institute of Medicine, 2002

15. 13 Years Later: Much More Work To Do AHRQ 2014 Report: Demonstrates that the Nation has made clear progress in improving the health care delivery system to achieve the triple aim but there is still more work to do, specifically to address disparities in care. › Access improved › Quality improved for most National Quality Strategy priorities › Few disparities were eliminated › Many challenges in improving quality and reducing disparities remain Source: National Disparities Report 2014, Agency for Healthcare Research & Quality

16. Disparities in Pain Management Linked to Racial Bias Researchers at the University of Virginia quizzed white medical students and residents to see how many believed inaccurate and at times "fantastical" differences between blacks and whites-- (e.g., black people’s skin is thicker; black people’s blood coagulates more quickly) They found that fully half thought at least one of the false statements presented was possibly, probably or definitely true. Black Americans are systematically undertreated for pain relative to white Americans, likely due to both the over-prescription and over-use of pain medications among white patients and the under-prescription of pain medications for black patients. Indeed, research has shown that black patients are undertreated for pain not only relative to white patients, but relative to World Health Organization guidelines. Proceedings of the National Academy of Sciences, April 2016

17. Racial Disparities Cost U.S. $57 Billion per Year Racial health disparities in infant mortality, chronic disease and many other metrics cost the U.S. health system more than $57 billion a year, according to a report authored by researchers from Johns Hopkins University and the University of Maryland. Source: Joint Center for Political and Economic Studies (a Washington, D.C. think-tank) September, 2009

18. Comparisons: South Carolina & U.S. Population South Carolina CharlestonU.S. People of Color36%31%37% Foreign Born4.8%4.2%12.9% Foreign Language at Home (Age 5+) 6.8%5.3%20.7% Notes: Source: U.S. Census Quick Facts. Racial statistics from 2010. Foreign born statistics from 2009-2013. Language statistics from 2009-2013.

19. The Changing Demographics in America US Population20142060% Change People of Color 38%56%47% Foreign Born 42M78M85% Foreign Language at Home (Age 5+) 21%30%43% Notes: Source: U.S. Census Bureau, National Projections 2014.

20. How do we as health care leaders meet these increasingly complex challenges in our increasingly complex organizations?

21. BLUE PRINT for Health Executives  Diversity and Equity as a Leadership Competency  Physician Engagement & Alignment  Total Organizational Engagement  Embrace Population Health Management  Understand Value Advantage: High Reliability

22. High Reliability Organization A high reliability organization (HRO) is an organization that has succeeded in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity.

25. High Reliability Principles PatientsFamilies VisitorsCommunity DO NO HARM

26. Principles of Anticipation  Preoccupation with Failure  Reluctance to Oversimplify  Sensitivity to Operations Principles of Containment  Commitment to Resilience  Deference to Expertise High Reliability Principles

27. Collect REaL (racial, ethnic, & language) data Understand global medicine Improve cultural competence of providers, staff and leaders Diversify your clinical team to reflect patient population Address healthcare disparities Understand impact of implicit bias

28. High Reliability Principles Patient Experience/ Engagement/Patient-Centered Care Work Effectively as a Team (interprofessionalism) Know civil rights and ADA law Joint Commission Standards & Culturally & Linguistically Appropriate Services (CLAS) Standards Using Interpretation Services Effectively and Consistently

29. Why Cultural Competence Matters… Reduction in Medical Errors and Legal Risks Quality of Care Patient Satisfaction/Engagement Positive Health Outcomes Reduction/Elimination of Racial and Ethnic Health Disparities

30. Why Diversity & Inclusion Matters… To ensure equitable care is provided to all patients To create an environment where employees are included, respected, and valued To empower a clinical workforce that breeds innovation To help build a better and stronger organization To engage the community in improving health outcomes (population health)

31. Questions ????

32. Contact Information Anton J. Gunn, M.S.W. Executive Director of Community Health Innovation & Chief Diversity Officer 843-792-2621 gunn@musc.edu Twitter: @AntonJGunn Instagram: @AntonJGunn