Chiquita Brooks-LaSure—Administrator for the federal Centers for Medicare and Medicaid Services (CMS)—visited the University of Alabama at Birmingham (UAB) to discuss health equity with subject-matter experts. With its long-standing history in health disparities and goal to achieve health equity, the UAB Minority Health & Health Equity Research Center was selected to host visitors at the special event. During this multi-part panel, our nation’s leaders heard about the impact programs such as Grand Challenge winner Live HealthSmart Alabama are having in the community.
CMS, which oversees health coverage for over 150 million people, is committed to learning more about how communities address health equity at the individual level. In an open letter from Brooks-LaSure, she said, “I’m committed to engaging with you as we develop new strategies to reach our goal of better health for all people.”
The visit started with tours of the Mobile Market and Mobile Wellness Unit, two services offered by Live HealthSmart Alabama. Operations Director, Lemeshia Chambers, PhD, MSW, explained the capabilities of the organization’s grocery-store-on-wheels and informed visitors of its stops in over 20 communities across Birmingham. Next, Dalton Norwood, M.D., Director of Prevention and Wellness for Live HealthSmart Alabama, explained the comprehensive health screening abilities of the van.
After the tour, guests gathered on campus for a roundtable discussion. Moderated by Kathy Boswell, CEO of B. International, LLC, the panel focused on health equity and the role of community engagement in improving health.
To start the session, Boswell asked speakers about how their work has impacted residents of rural areas, citing transportation as a barrier to proper health care. Gabrielle Rocque, M.D., Associate Professor of Medicine in the UAB Division of Hematology and Oncology, explained, “One of the things we are proud of is UAB has a very strong navigation program—which Mona [Fouad] initiated long before I came to UAB—and it has been foundational in screening patients for basic and health care needs, including the Social Determinants of Health… and connecting people to resources such as social workers.”
Shifting the conversation to statewide organizations, Boswell inquired about how community members learn about the services available to them.
Robyn Hyden, Executive Director for Alabama Arise, responded to Boswell's question. She explained, “We convene the Cover Alabama Coalition, which includes over 100 partners, working to expand Medicaid.”
Hyden added, “Access and affordability are two key issues, but they're not the only issues. Quality is another issue, and we work with Medicaid members to ensure they receive quality care and advocating for that care…but the number one lens we are increasingly bringing to this work is that power is a social determinant of health.”
Building on Hyden’s statement, Boswell guided the conversation from the power held by individuals to the power found within the walls of some of Alabama’s largest institutions.
David Randall, Chief Strategy Officer for Cooper Green explained, “We’ve recently launched a community health equity function within UAB Medicine, where we focus on equity and engagement. We look at insight, discovery, partnership, and action.”
“For insight, we’ve created our own social determinant index and mapped—to the census level—the Jefferson County market. Now, we can answer questions like, ‘What are the most vulnerable zip codes?’ These areas actually align with Live HealthSmart Alabama’s demonstration zones,” elaborated Randall. “We looked at our UAB utilization data—ER visits, admissions, etc.—to identify differences and racial discrepancies with the un- and under- insured. We found that audience used the ER four times more than patients with insurance; and their top procedural code was ‘left without being seen.’”
This data begged the question, so where—if anywhere—are our vulnerable populations receiving healthcare?
Panelists joined the conversation on how organizations at the advocacy and institutional level can use their positions to address inequity and social determinants of health. Whether using data to drive strategy or linking businesses together to drive change, one theme remained central: trust is paramount.
Mona Fouad, M.D., MPH, Director of the MHERC, stated, “Businesses understand that improving people’s lives, their health, is the right thing to do. To run their company, they need a healthy workforce, which requires businesses to engage their employees and the communities in which they build their workforce.”
“You can’t just go into a community and make promises. The problem many people who try to do community engagement face is that their plans don’t take root in the community. That’s because there’s no trust—nobody took the time to listen to them. Using 20 years of research conducted by the MHERC, Live HealthSmart Alabama has created a model that puts trusted relationships with residents, leaders, and partners at the center,” finished Fouad.
As CMS works toward advancing health equity, expanding coverage, and improving health outcomes at the national level, institutions such as the UAB MHERC and Cooper Green, and organizations like Alabama Arise and AIDS Alabama will work to address the social determinants of health in our state.
Together, we will achieve health equity.
