Vivian Anugwom presented on Allina Health's strategy to address health equity and eliminate health disparities. She discussed how Allina uses data analytics to identify disparities by patient race, ethnicity, language, and other factors. For example, data showed minorities are less likely to use hospice care. Allina provided implicit bias training to physicians to address potential biases influencing low hospice referral rates for African Americans. Vivian also outlined Allina's commitments in various roles to advance diversity, equity, and inclusion.

1. Addressing Health Equity in the New Normal
Vivian Anugwom, MS, CHES
Health Equity Program Manager, Allina Health
December 16, 2020

2. Agenda
• Review learning objectives.
• Discuss Allina Health’s strategy for eliminating health disparities.
• Share an example of how analytics supports eliminating health
disparities.
• Share results to-date.

3. Learning Objectives
Understand how Allina Health uses data to identify disparities.
Define bias and its impact on health disparities.

4. Poll Question
• What setting do you work in?
• Provider Organization
• Payer
• Government
• Vendor
• Other

5. Allina Health- A Snapshot
Our Mission
• To prevent illness,
restore health and
provide comfort to all
who entrust us with
their care
Our Mission Realized
• Serving our community
through seamless
connections, fluid care
— 24 hours a day, 7
days a week, 365 days
per year.

6. What is Health Equity?

7. What is Health Equity?
• Health Equity
“Health equity means that everyone has a fair and just opportunity to
be as healthy as possible. This requires removing obstacles to health
such as poverty, discrimination, and their consequences, including
powerlessness and lack of access to good jobs with fair pay, quality
education and housing, safe environments, and health care.” – RWJF
• Health Disparities
"Health disparities are differences in the incidence, prevalence,
mortality, and burden of diseases and other adverse health conditions
that exist among specific population groups in the United States1.“
— National Institutes of Health (U.S. Department of Health & Human Service, 2017, para. 1).

8. COVID-19 & Health Disparities
• Communities of color; particularly Black people are
disproportionately affected by COVID-19
• Existing disparities have been magnified by the pandemic
• Need immediate & long-term solutions to addressing structural
racism & health related social needs

9. Addressing Health Disparities at Allina Health
• Tie to health equity to key strategic system initiatives (Executive
Liaison)
• Identify & prioritize disparities
• Create an infrastructure for support and implementation

10. Defining Community Recovery
Improve the health of all people in our communities by
leveraging the collective strength of Allina Health as a care
provider, employer, purchaser and community partner to
eliminate systemic inequities and racism.
Definition of Community
Patients, employees, and people who live in the communities we serve
of all races, ethnicities, gender identities, sexualities, abilities and
economic means.

11. Allina Health’s Commitment to Diversity, Equity, & Inclusion
As a health care provider,
we commit to:
• Improve access to and
experience with care.
• Make investments that create
innovative solutions.
• Continue to build care
models that support our
patients.
• Eliminate health disparities
and unnecessary variations in
quality of care.
As an employer, we commit
to:
• Embrace and value different
perspectives.
• Eliminate decisions that
impact marginalized groups.
• Continue to hire locally and
promote leaders of color.
• Expand anti-racism and
implicit bias training for all
employees.
• Increase our leadership
visibility to enhance our
brand as the provider and
employer of choice.
As a purchaser of goods and
services, we commit to:
• Require the inclusion of
businesses owned by people
of color, persons with
disabilities and/or women.
• Review any investment
portfolio for alignment with
our equity principles and
values.
As a community leader and
partner, we commit to:
• Advocate for public policies
that address social justice
needs.
• Support the physical and social
recovery of South Minneapolis.
• Support collective action
among other health systems,
associations and organizations.
• Engage our leaders and
employees in support of
communities and community
organizations.
• Collaborate with and learn from
community residents and
partners.
• Continue to work to improve
the health of our communities.

12. 12
Key opportunities
• Train leaders to use the REAL filter to identify disparities in access to
care & quality outcomes
• Develop tools to help leaders address disparities
• Normalize working with diverse patients and communities to co-
create solutions
• Increase visibility of disparities and the work being done to address
them
Current State: 1 health equity goal for the entire system

13. 13
Our commitment to care:
Working together to provide equitable care
Equitable
Care
Addressing
Disparities
Communication
& Transparency
Value &
Accountability
Capacity &
Capability
Building
- Sharing learnings across the
system
- Sharing opportunities &
progress with community
- Identifying health equity metrics for
BCBS/Allina partnership
- Including health equity goals into
dept. level & system-level scorecards
- Health Equity tool-kit
- Culturally Responsive Care
Training Pilot
- REaL & SOGI data quality
- Process for co-creating solutions with
diverse patients & community members
- Engaging depts. in identifying & addressing
disparities

14. Using Data to Identify Inequities
• Standard practice to include REAL filter on all dashboards
• Need data to understand the health inequities that patients are
experiencing
• REAL filter uncovers the unique experiences of historically
underserved populations & opportunities to reduce health inequities
• The REAL data, and data in the EHR, does not include important data
regarding other factors that influence health, such as:
• patient values and beliefs about healthcare
• specific healthcare interventions
• housing stability
• financial resource strain
• Culture
• gender identity
• food insecurity
• social connectedness
• and other social determinants of health.

15. Process for Addressing Disparities
Implement & Resource Tactics to Measurably Close the Gap
Understand Root Causes and Identify Solutions Within Sphere of Influence
Identify Disparities

16. Prioritizing
Are there solutions within
Allina’s current sphere of
influence?
Do we have the ability to
reach the target populations
across geography?
Is the disparity
statistically
significant? Is it
clinically
significant?
Is there strategic
alignment,
momentum and
readiness?
Could the
solutions drive
value?
Is the change
operationally
feasible? Can
we resource
interventions?
Is there meaningful
impact to
community?

17. Hospice Disparities
Allina Data
1. Minorities disproportionately die in hospital setting vs hospice
setting.
2. Disparity in hospice length of stay for minority groups
3. Fewer minorities in hospice program & lower hospice referral rates
amongst minorities
Goal = increase referrals to hospice for African American patients

18. What the Research Says:
• African American patients are more likely to prefer aggressive
treatment than white patients1
• African American patients are more likely than white patients to
mistrust healthcare providers2
• African Americans prefer to care for family members till the end of
their lives3
1 – Fishman J, et. al: Race, treatment preferences, and hospice enrollment. Eligibility criteria may exclude patients with the
greatest needs for care. Cancer. 2009;115(3): 689-697
2 – Johnson KS: Racial and ethnic disparities in palliative care. J Palliat Med 2013; 16:1329-1332
3 – Payne R: Racially associated disparities in hospice and palliative care access: acknowledging the facts while addressing the
opportunities to improve. J Palliat Med 2016;19:131-132

19. Making the Case for Bias Education
Based on research, internal data & physician feedback:
• African-American pts receiving less referrals
• Research says that African-American pts request hospice less
• Providers past experiences shaping when/if they discuss hospice
• Bias could play a role in referrals to hospice by physicians

20. What is Implicit Bias?
Implicit Bias:
Also known as unconscious bias, is “the bias in judgment and/or behavior that
results from subtle cognitive processes (e.g., implicit attitudes and implicit
stereotypes) that often operate at a level below conscious awareness and
without intentional control.”
It is automatically activated, and often unintentional. It is a normal
aspect of human condition.
Reference: IHI http://www.ihi.org/communities/blogs/how-to-reduce-implicit-bias
We ALL have implicit biases

21. Implicit Bias: Impact & Consequences
• When a clinician has a pro-white implicit bias, interactions with black
patients are characterized by
• High verbal dominance, slower speech and less positive affect when
compared with interactions with white patients
• Less involvement of patients in decisions, less patient centeredness in their
interactions
• Patient outcomes; less satisfaction with visit non adherence to plan , lower
trust and confidence in clinician
Source: *Cooper L,Roter D,etal. Am J Public Health 102 (5) 979-987,2012; Blair IV Steiner J, et al. Ann Fam Medicien,11 (1) : 43-5102013

22. Hospice Implicit Bias Training – Learning Objectives
1
Provide perspective on
African American patients’
perceptions of end
of life care
2
Explore bias and its effect on
communication related to
hospice services
3
Provide resources for effective
communication around
hospice services

23. Key Learnings and Recommendations
To confirm patient
understanding of
Allina hospice, you
must do teach back
Understand the
intersections of
culture & bias and
its impact on patient
outcomes
Understand and
respect the
tremendous power
of implicit bias
Individuate your
patients; recognize
and push aside
stereotypes
Recognize situations
that magnify
stereotyping and
bias

24. Closing
Have the courage to support the work of
eliminating health disparities within your
sphere of influence!

25. October 2020 Results
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26. 26
Q&A
• Vivian’s Email: vivian.anugwom@allina.com