the health disparities podcast

173: Hospitals & Health Equity: A first-of-its-kind statewide initiative aims to center equity in health care operations

Hospitals and health systems can play a big role in addressing healthcare disparities in our nation. It's the focus of our latest podcast series. Today, we zero in on a statewide health equity initiative that is first of its kind in the nation. 

 

Through a historic 1115 Medicaid waiver, Massachusetts hospitals have made a commitment to come together with the state to embed equity into the foundation of their operations. 

 

“This really does entail an intentionality on the part of our hospital systems that I think is unmatched in many ways — an intentionality and a will and a drive and a desire to do this work", says Izzy Lopes, Vice President of health equity for the Massachusetts Health and Hospital Association.

 

Health Disparities podcast host Dr. Mary O’Connor speaks with Lopes about the statewide initiative that aims to address healthcare disparities. Lopes explains why it’s important to prioritize people over percentages, use data to drive health equity strategies, and collaborate with community partners to address patients’ health-related social needs. 

 

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The transcript from today’s episode has been lightly edited for clarity.

Izzy Lopes: Thinking about ways to, to empower patients in a way that allows them to have more control over their health. And so when we're talking about educating patients in a way where you can activate the care team around them, but letting them know, it's like, Hey, you don't need to necessarily call 911 for everything, but you know, to be able to call your care team. And so there are such so many pieces to the waiver that I think, you know, I want to be able to highlight and we could talk for hours about but I think that piece also is important, in terms of being able to meaningfully transform our healthcare system. It does require not only change internally within the four walls of the healthcare system, it also entails us changing our posture in terms of how we have traditionally engaged patients in this system and engage them in conversations about their own care.

Mary O'Connor: You're listening to the Health Disparities podcast from Movement is Life. I'm Dr. Mary O'Connor, Chair of the Board of Movement is Life and cofounder and Chief Medical Officer of Vori Health. Hospitals and health systems can play a big role in addressing healthcare disparities in our nation. It's the focus of our latest podcast series. And today, we're going to zero in on a statewide health equity initiative that is first of its kind in the nation. Through a historic 1115 Medicaid waiver, Massachusetts hospitals have made a commitment to come together with the state to embed equity into the foundation of their operations. To learn more about this exciting initiative, I'm joined by Izzy Lopes, Vice President of health equity for the Massachusetts Health and Hospital Association. Izzy, welcome to the Health Disparities podcast.

Lopes: Thank you so much for having me, Mary. I appreciate it. It's such an honor to be here.

O'Connor: I'm really excited about this one. So. So let's start with a little background. So last year, Massachusetts hospitals really began this nation leading commitment of addressing health disparities through this Medicaid waiver. And the effort is being spearheaded by your organization, the Massachusetts Health and Hospital Association, in partnership with the state of Massachusetts. So can you tell us a little bit about what this is and what some of the key points and goals are over the five-year span of this project?

Lopes: Yeah, certainly. I love talking about the waiver. So this is, I'm really elated to be able to come here today and to and to share kind of the progress since we started and began this journey, which continues. So the 1115 Waiver is geared towards Medicaid patients, it's a $2.2 billion effort over the course of five years. And of that pot of money, our hospitals actually tax themselves, and the other portion of the money does come from the state and the federal government. And the aim of the 1115 waiver is to really seek to advance equity across various domains of which there are three. And so I'll briefly go over those domains. And within each of those domains, there are subdomains. And again, the aim here is to advance health equity so that the patients that are served across the Commonwealth can achieve optimal health, because that is ultimately what we want. 

And so with regards to the domains, and so this speaks to what our hospital systems have to do. As I'm talking about the domains just kind of have that, that thinking in your mind of, okay, the work and the effort that goes into being able to or having to achieve some of the things that I'm going to mention within these domains. So we have, for example, collection of demographic and health-related social needs information of our patients. It also entails ensuring equitable access and quality. So this entails kind of looking at disparities, for example, and seeking to close those disparities by developing meaningful interventions that speak to the patient population. 

So this requires, you know, needing to know who the patients you serve are. And then the last area of focus being capacity and collaboration, which speaks to kind of external relationships and partnerships with entities outside of the four walls of the healthcare system. And also entails, kind of, how do we treat patients in a way where patients can feel valued, feel like they're being treated courteously and feel like they are being treated with dignity as well. And so as I said, across these different areas, these core areas, there are subdomains within each of those. And with those domains, our hospital systems have various milestones that they have to effectuate on over the course of five years. And there are measures of success attached to those. 

And again, this is with the aim of, you know, being able to advance health equity, and make sure that you know, all of the patients that enter the hospital systems, and again, this is focused on Medicaid patients, specifically, are able to achieve optimal health. So this really does entail an intentionality on the part of our hospital systems that I think is unmatched in many ways, an intentionality and a will and a drive and a desire to do this work. Because it does also entail, you know, the ability for hospital system to look at internal processes, and workflows, and procedures to really ask the question, Are we serving our patients in a way that is going to achieve outcomes that is going to result in in a patient being healthy as defined by the patient? And so I think that it's critically important to to keep in mind, so there's this kind of internal work that's happening, a mirror, if you will, on the hospital, that they're putting to themselves to say, let's review our policies and processes to make sure that, you know, we are continuing to to serve our patients in a way that, you know, will promote and advance health equity.

O'Connor: Izzy, let's take a step back, because I just realized that, you know, some of our listeners may not be as familiar with Medicaid, right? And understanding why do Medicaid patients have more health disparities? I could ramble on this, as a surgeon about that. But let's, let's, as I'm gonna ask you the question: Top three reasons why Medicaid patients have greater levels of health inequity, compared to others?

Lopes: There are a lot of issues at play or reasons at play, I think here, I think that, you know, in terms of, you know, economics, and patients being able to have access to adequate care, you know, Medicaid patients tend to be those that, you know, their income levels are not necessarily conducive to, you know, getting access to certain certain types of care, or certain levels of care within the hospital system. And so I think that the economics play a role here in terms of looking at, you know, the Medicaid program, and the provisioning of care to Medicaid patients. 

Also, we know that, you know, in terms of looking at, you know, behavioral health issues and different comorbid conditions, there tends to be an increased percentage of, you know, comorbid conditions within the Medicaid populations, we're talking about, I just mentioned families, individuals that, you know, in terms of their income level of being a certain percentage of the federal poverty level, for example, and kind of being under that level, and that being kind of the their entry point into the Medicaid system, as well, as, you know, some of the things that, health challenges people might be be contending with their care with regards to, you know, behavioral health issues, or, you know, substance use disorder, and, you know, a sundry of other medical health conditions, as well. 

So, there is a particular, you know, profile, if you will, in terms of the Medicaid patient, and then needing kind of, you know, a more specialized touch, if you will. And again, I'm gonna you're gonna hear this word of intentionality being mentioned. And I think that it's really important to keep in mind that, you know, although the waiver program is focused on Medicaid patients, particularly that we are really looking at this program in general as essentially kind of the litmus test or the test that will that will pivot the Commonwealth as we think about the health ecosystem, and people being able to look to our program to identify the areas of promise and the different ways that we have made strides so early in the program. 

 

So I think that it's important to note that being able to have this program that is focused on patients that are in need of service, and have such complex issues and then taking into account kind of the cultural nuances into play, right? And so another component of the waiver is being able to assess, you know, the language needs of patients and being able to be mindful of the cultural background of a patient to be able to develop these interventions that are really targeted to particular populations. And then I also don't want to lose sight of the fact of, you know, LGBTQ+ populations, those that are differently abled as well, because that is also part when we're talking about, you know, equity, being able to target those populations as well. 

So it really is, you know, looking at patients that have traditionally have had disparate access to the health care system, or for whatever reason are contending with different care issues, health care issues, behavioral health issues. And in trying to really meet them where they are in order to get them the best service and make sure that their needs are met.

O'Connor: That's great. And of course, one of the challenges is basically that traditionally, Medicaid payment to hospitals and clinicians is less than what a hospital or a surgeon or doctor would be paid if that patient was insured through a commercial plan. So that's also, and as you said, the patients tend to be lower socioeconomic status, and sicker. So all these factors, really combine to create this access problem, and they have resources for your personal resources to help them navigate their health challenges.

Lopes: Very true, very true. Another piece of this is being able to as part of the program, is thinking about ways to empower patients in a way that, you know, allow them to have more control over their health, right. And so when we're talking about educating patients in a way where you can activate the care team around them, but letting them know, it's like, Hey, you don't need to necessarily call 911 for everything, but you know, that, you know, to be able to call your care team. And so there are such so many pieces to the waiver that I think, you know, I want to be able to highlight, and we can talk for hours about but I think that that piece also is important in terms of being able to meaningfully transform our healthcare system, it does require not only change internally within the four walls of the healthcare system, it also entails us changing our posture in terms of how we have traditionally engaged patients in this in the system and engage them in conversations about their own care.

 

O'Connor: Absolutely. Just one more background question. How long has the 1115 waiver been in effect. When was it created?

Lopes: Yes. So thank you. The waiver program officially kicked off or launched in January of last year, that's considered to be performance year one. And as I stated before, it's a five-year program. So we're currently in performance year two. But conversations about the waiver and the realization that, you know, initiatives such as of this magnitude was essential and critical conversations had been happening prior to 2023. And I want to say, they began in earnest in 2019, even most preliminary conversations about how can we really, you know, propel change forward, hence, the structure.

O'Connor: All right, now, I'm gonna ask a really important question. How in the heck did you get the entire state of Massachusetts? No, I'm serious, right? Healthcare systems tend to be competitive with each other, right? They're all seeking the patients that have the best insurance that's going to provide them the most, you know, financial resources to help them with their mission. And I'm very careful here not to like demonize hospitals and health care systems, because we know that a lot of services they provide are not reimbursed and they need to to basically shift funds from service lines that are more financially positive to those that aren't right, nobody can, no health system makes money taking care of children. So I am a little bit, I don't, I try not to demonize them, although I am critical, plenty critical of them in other areas. So honestly, what an incredible achievement to get all of these healthcare systems that are essentially competitors to work together. Can you give us some background on that's like, like a miracle, right?

Lopes: And I think,I really enjoy getting this question, I when I do get the question posed, I think it'd be a surprise to folks that I think if I were to, if you were to be a fly on the wall, Mary, in our learning collaborative calls, which hopefully I'll have an opportunity to talk talk a little bit later about, but it's basically our support structure, we have a support structure, very intensive and rigorous support structure in place, as part of the waiver work to support our hospitals, as they're kind of seeking to achieve these various milestones over the course of five years. 

 

But essentially, and not to kind of oversimplify things, I think that, you know, being able to corral folks around kind of this vision of, okay, we know that things aren't really working well, right? And particularly, we know that things are not working well for people of color, for those that are differently abled for, you know, LGBTQ+ patients, for example. And so how do we move the needle, we, a communal 'we,' move the needle forward. So I think that, you know, being able to across the system have that will, right have that will to know that, and that acknowledgement of like, this is critical work. And we are only successful if we band together band are kind of that brain that collective brain trust, our, you know, what we've learned and some of the challenges, and to really try to identify, in a collaborative way, how we can solve some of the pressing issues that plagued healthcare today with regards to, you know, these persistent and prevalent disparities that exist in communities of color, for example. 

And so I think that, you know, to answer your question, it really does or it did consist of, you know, this level of, again, intentionality to come together to say, things have to change, we have to operate in a different way. And then also realizing that the patient being central to this, that everyone has this will, this intrinsic, willing desire to to make sure that, you know, we are being very thoughtful about how we are providing care in a way where people really feel like they are being supported in their health. And again, this is not just relegated to the four walls of the hospital system. We have to talk about care or the healthcare ecosystem. So again, this requires partnerships outside of the hospital, right? And so it really is a focused effort where the hospitals have come to an agreement and understanding this feeling of like, we have to do this together, we're in this together, it's really critically important to our success, as a Commonwealth for us to be a healthy, healthy state. And what does that entail? And so these are the conversations that happened, you know, prior to the official launch of the of the waiver, that I think it's important to know, but really, it is this kind of sense of 'we'-ness, you know, that we are in this together and that this is this should this should be a focus.

O'Connor: I think what I'm hearing is that, while sometimes change occurs because of external forces, right, like a new regulation, and so a hospital system has to make a change, because that's now the law or the regulation. What I'm hearing from you is this was really more of an of an intrinsic, more externally driven change, where the collective mindset was, we need to improve the health of our state, right? We will all benefit collectively, with improved health outcomes, and let's come together to to collaboratively make this change. We're stronger together, we're more effective together.

 

Lopes: That's exactly it. That's exactly it. And I would definitely say, you know, in summation that that captures it very well. 

O'Connor: So let me ask you, the MHA uses the term 'anchoring equity,' to help frame this mission. And I'd like you to explain, explain to our viewers what you mean by anchoring equity.

Lopes: I love the visualization of the graphic that our, you know, tremendous communications team developed as part of this branding initiative called 'anchoring equity.' And so you just have this vision of an anchor, essentially, and how an anchor essentially has this mooring property, right? It has a grounding property. So I think it speaks to kind of the importance of, you know, this foundational importance of equity, and how that is the essential foundation and the framework that guides you know, the work that we do in the various initiatives, I think that are related to kind of health care, improving, eliminating, excuse me, disparities that exist. And so if you have this vision of this, this anchor in your mind, it really is kind of a grounding principle that equity really has to be central to the work that we do, and the realization that, you know, for us to be able to eliminate these disparities, right, and to close these gaps that are that are kind of historic and systemic, in many ways that we really have to have this mooring, this mooring principle, this grounding principle, and understanding that that equity, equity is paramount to the work that we do, and it's critical.

O'Connor: I love that. I mean, I already had the visual in my head, and it's just a great way, I love that it's a great way of framing it, and really driving that message that it's so foundational, right? I mean, it just has to be, if we're going to improve health, in our communities, in our states, in our country. And, you know, I often come back to what we just lived through with the pandemic, where, you know, if there was one lesson, I hope we learned is that we are all together, you know, affluent communities cannot isolate themselves from less affluent communities, if one community is getting sick, everybody's gonna get sick.

Lopes: That's exactly right. And that's exactly an example of, you know, the pandemic COVID-19, I think is top of mind, for a lot of folks, when they're talking about collaborations of this magnitude, it's, you know, you think about the forces that came together and banded together with a pandemic, you know, faith based institutions, and, you know, the community based entities and, you know, hospital systems with the realization that we really have to come together and figure this out, to make sure that people continue to be healthy, and that people can get, you know, adequate testing and get vaccinated and educate people, as well. So it really did take a village, in order to spread that message of the importance of taking care of oneself during that time and being able to address the disparities that exist with COVID, with communities of color, particularly. So I think that's an important thing to mention in terms of the collaboration piece, and then harkening back to that time, because that's exactly, you know, what we're seeing today. 

O'Connor: Right. So take us through a little bit about how you're actually operationalizing this. I know that your team has several calls a month with hospitals and health care systems, where you're discussing the ideas and advancing the work. So can you give us a couple examples of those kinds of calls and the progress that you've made on some specific projects?

Lopes: Yes, definitely. So I think that, you know, as I mentioned, in the beginning, we have these learning collaborative calls, it's part of our overall waiver support structure that we have in place. And we launched our waiver support program last year in June. And we were able to have 17 calls last year, and these calls continue, and they will continue for the life of this initiative. And so it really is an opportunity, it's a forum, where our members have an opportunity to come together based on the various subdomain topics of which there are 10. And so they are aligned to the subdomain topics. 

So there's calls specifically on health related social needs screening, there's calls on RELD. And I'll say the acronym, which is race, ethnicity, language, disability. And then we have a SOGI component, which is sexual orientation and gender identity. So we have these conversations on a regular basis, there are about right now, three calls a month taking place, and it's an hour, where we kind of give an overview of what the expectation is for that particular subdomain. And we either have speakers come in to talk, outside speakers, so we've actually partnered with outside entities and organizations, as we realize that we need other players involved to have these conversations with our members and to be part of these conversations as we seek to move the needle forward with regards to equity. 

And so essentially, we ask discussion questions, there are opportunities for breakouts, but it really is a forum for them to come together to share promising strategies to share some of the challenges that they're experiencing, whether it be kind of discussion about workflow, and what's the best, you know, individual on the care team to ask this question, who's the best individual to kind of enter this information into the EMR? So it's really kind of getting into the operational pieces as you were kind of mentioning to be successful and to be able to have that again, collective brain trust on this call where you have folks on different places of this journey, right?, that are able to speak to their experience and to share, you know, this is what has worked for us, or conversely, here are some of the challenges and pain points that we experienced. 

Because some of these changes require, you know, change management, on the level of the hospital, the conversations with staff to say, Okay, this is why we're doing this, this is why we're changing the workflow, this is why we're doing this new thing. And I think that is so central to a lot of the work. And the conversations that we're having is to be able to let our members know, and to share strategies on how to get staff to be engaged, meaningfully engaged, in this process, as part of everyone being, you know, moored or anchored to the mission. And the goal of anchoring equity and advancing equity. Also, the education on the part of patients of what does our posture need to be, how do we need to change as an organization as a system in order to meet the needs of our patients? 

And so being able to have those conversations and leverage the patient voice vis a vis focus groups and the patient family advisory councils, for example. It's so critically important that both but the learning collaborative calls are essentially like where that happens, that ideation that brainstorming that, Hey, you did this and I'd love to hear a little bit more, can you share that resource. And this kind of speaks to what you were asking before, this kind of, never been seen before this, this level of partnership and collaboration, because we have members who are actively sharing information and sharing resources and tools that they've used in this setting. So I think it's been so tremendous, I think, to see the journey, the evolution of the journey, and the trajectory that our hospitals are currently on, because everyone is in this place of knowing and understanding and acknowledging that this is such critically important work, and that this is truly historic. And so everyone has really corralled around this overall goal that the waiver seeks to achieve.

O'Connor: I want to go back one minute for something you mentioned at the beginning, which is, because I'm not sure our viewers will really understand why this is so important. You talked about collecting the information, we use the term demographic information, but that's like, for those that aren't so familiar with, that's information about the patient, right? Their background, socioeconomic status, resources that they have family support. And I think that most of our viewers would think well, don't you already do that? I mean, health care systems already do that? We know, this is of varying degree, right? So speak to the importance of this standardization, right, that we're going to agree to collect this information on everybody, and why that helps so much with anchoring equity with advancing the mission.

Lopes: Right, thank you so much for that question. I think it's a great question. And I think that, you know, it speaks to the ability, a hospital system's ability to tell the story about the patients that they serve. So, you know, a lot of people sometimes, patients, you know, feel that information is just being collected on me, I don't know what you're gonna do with this information. There's a feeling like it's being collected just for collection's sake. And that is the furthest from the truth. And again, there is this purposefulness that is involved in this data collection, right?, of being able to have an understanding of your patient population, to then be able to develop interventions where you are noticing certain patterns. So if you have a certain segment of the population where you're realizing, hey, people are experiencing issues with with food security, you know, or transportation, and you're, and you're seeing these trends, and then you have the ability, once you kind of see these patterns, for example, then you have the ability to kind of strategize to say, Who do we now need to partner with in order to address that issue? And so, a lot of the question asking also lends itself to the forging of these really meaningful and robust partnerships and collaborations outside of the healthcare system. 

And again, I'm going to always make these allusions to kind of, you know, advancing health equity, anchoring equity does consist of this broader 'we' that is not just relegated, it's not just solely on the responsibility of the hospital system. This really is a cross sector, collaborative type of effort. And it does require, you know, those partnerships to be forged and developed and to be cultivated in a meaningful way. So being able to create those linkages and identify who are the entities outside of our four walls that we can kind of tap into, to support us with to support our patients, the collective are with this with this work. And then being able to then internally, once we are noticing, you know, these disparities or certain patterns, with certain members of the population, or certain segments of the population being able to develop those interventions, right. And again, the intervention development could entail also looking at internal processes, procedures and protocols to see how, in what ways are those dis aligned to what we're seeking to do, right. And so it does require kind of that internal work of looking at, you know, the operations, the operational structure, if you will, of the hospital system, the conversations and the partnerships that happen outside of the hospital system, and also kind of the data collection piece in the data analysis piece to be able to tell the story over time about, you know, certain things that are being noticed, by virtue of these questions being posed. So it's not just food security and transportation. It's, you know, questions about intimate partner violence, for example, it's about, you know, kind of what are some of the behavioral health, you know, needs or connections that we can make for you out in your community. You know, and also being able to ask about one's identity, I think, is really important in order to tell a story. And so I think that, you know, if you're thinking about the data collection piece, in aggregate, or as a whole, that really is important work, in order for us to understand, you know, how we can curtail, and eliminate some of these trends that we're seeing, with certain populations that are served in the healthcare system.

O'Connor: You know, I love the point that you brought up about how important the partners are outside of the hospital system. Because, you know, having been an orthopedic surgeon for decades, there's only so much an individual clinician can do, there's only so much even a hospital or health system can do. And really, I always say that, you know, we have a sick care system. And we need a well-care system with wellness rooted actually in the community. And so, this effort of pulling in other resources, this much broader concept of this health ecosystem, I think, is critically important. So kudos to you all for working on that.

Lopes: Right. And I think this is a, it's such a monumental effort, and it just speaks to the passion and the level of engagement, I think, on the part of our members. They're the ones that are doing this work, and are thinking really critically about how they can best address the needs of our ever-diversifying population, which I think is just an important conversation to have, so where, historically, you know, maybe perhaps there's been times where partnerships have not been made, or connections outside the hospital have not been made, and not to say it's happening now, I think that it's just, in terms of talking about the 1115 waiver, particularly, I think that hospitals are really kind of seeking ways to either reengage former partners or to look at ways to be creative to creatively address some of the issues that they're contending within the hospital system. And also, this desire to seek to create this idea of this neighborhood health home, being able to engage partners in a way where patients can be served within their community, so that there's services that can be that can be engaged and activated, again, outside of the hospital system, but a lot of that does entail this partnership, and these partnerships and these collaborations.

O'Connor: And just to maybe oversimplify this, but the way that I think about it, so you can cross check me here, is the 1115 waiver, allows an organization a health care system to take funds, that would have traditionally been restricted to things like direct patient care, right, the patient coming to see the doctor or the nurse, and use those funds to help support these more broader health ecosystem efforts. Is that in a nutshell, how it supports this?

Lopes: Yeah, so I would say the funds from the waiver are, you know, they're being leveraged by the hospitals for operational purposes. So to just to make sure that, kind of the internal engines continue to run, but, you know, part of that is kind of thinking about staffing levels, and how to leverage and position staff in different ways, how to, you know, looking at the policy and the procedures and to think about, okay, what is needed, what do we need in order to be successful with this work and to be able to, to address the needs of our member population, I'm always saying are because when, we have, MHA, we are constantly using those words, and the verbiage because we see it as like, this is us as well, like, you're not in this alone, you know, hospitals, like it's an 'us' it's a 'we' thing. So, but yes, I think that the intention is that the funds from the waiver will be kind of rolled back into the hospital system to not only continue sustaining operations, but to also, if we think about the kinds of places for innovation, the opportunities for innovation, and where technology can be leveraged in a different way, so whether that's using kind of kiosks, to act to, to ask where patients can use those kiosks, where you're, you're kind of going to the kiosk, and you're being asked questions on health related social needs, there's another way, for example, to get this information. And so, hospitals are constantly in this place of creatively identifying solutions that speak to their patient population, which is, in many ways, unique. And so even segments of the patients, we know, within their overall patient population, and the recognition that, you know, there are patients that require different touches, thinking about language considerations, or those that, for deaf or hard of hearing. And so it really does require for, like, what do we need to do now? What do we need to change? What do we need to purchase, in order to be able to address the needs of all?

O'Connor: Yeah, that's great. All right, so we'll close up with two final questions. What are a couple of the top metrics that you're tracking that you will know, at five years, you've moved the needle?

Lopes: I would say overall, there's this, that there's the, quote, The continuous quality improvement piece of this work in our hospitals, identifying quality measures, where they will, they identify the quality measures, and they basically stratify the information that they're getting based on that quality measure those quality measures, and again, telling the story of the patient population to kind of figure out kind of what are the interventions that need to be developed in order to address those particular gaps in care for example, and so, what needs to be changed, what are the conversations that need to happen with a with the patient to have them engaged in the care where the conversations that need to happen with staff, so staff understand the why, right? And so, this is a conversation that is continuous, but that is one of the areas in terms of the quality measures and looking at disparities across particular quality measures. Also, we have disability competency training and you know, being able to be you know, culturally sensitive to different populations, I think that the training piece that is involved with the waiver, I think, we cannot understate that because we know, like with a change of this magnitude, and again, it being over the course of five years, but, you know, there are various milestones that have to be achieved over time that our hospitals are actively working on. And so, the training component is so is so important in terms of understanding the staff that you have, and are staff equipped, are they resourced? Are they, you know, skilled in order to meet the needs of our patient population. But again, that requires wanting to know the patient population, hence, the data collection piece, right? The data collection piece is also another critical component of this. So again, me alluding to the, the RELD SOGI, the race, ethnicity, language, disability, sexual orientation, gender identity, seeking to understand the health related social needs of the patient population, kind of what the disability accommodation needs are of the patient. And again, going back to this place of what is the picture being told, what is the story that is being shared right now, as we look at, as a hospital looks at their patient population to then develop these interventions. And to actively close these gaps in care.

O'Connor: So final question. So I'm asking have other hospital associations in various states reached out to you, I mean, I would hope that other groups would be interested in learning from your experience and trying to basically reproduce the program that you are leading?

Lopes: Oh, definitely. So, Oregon has a waiver that is very similar to ours, as well. And so we've been, and I know that in the nascent stages, we were in conversations with them about some of the metrics that they were leveraging, and some of the, kind of the specifications around their waiver. And so I know that, you know, there has been internal conversations there that actually continue. And there are different forums where, that I know that I sit in, for example, as part of MHA being a member of the American Hospital Association, and there are monthly calls that take place that I'm a part of, and so anytime that I'm sharing information about the waiver, which I love to yell from the rooftops and share broadly with as many people as I can, because it's something that brings us such pride, I think, but constantly being asked questions or being pinged after the fact of, hey, can we kind of pull your ear can we have a conversation, because we're seeking here to do X, Y, and Z, and we'd love to hear what your experience has been. And so, that definitely has happened, we had a few hospital systems reached out to us last year to kind of just have those type of conversations, which we're always happy to have, because I think that, you know, critical to this work is being able to spread, right?, and to share things, strategies and practices and where we can do so, and have another system adopt those or spread them themselves. I think that is part of this work, right? This is all part of the effort to anchor equity. And we'd love to hear those stories as they occur outside the Commonwealth.

O'Connor: Yeah, that's wonderful, Izzy. All right, I'm going to ask if there's any last comment you'd like to make to our viewers, because you're doing such incredible work. It's very inspirational. 

Lopes: I would just say that, you know, this truly has been, I think, you know, from me, someone being fairly new to MHA, and having been doing this work for for quite some time, I won't date myself, but it's been a while, and to see the evolution as we're having these conversations about advancing equity, and what does that mean? What does that truly mean? And, you know, especially now with kind of conversations around DEI, DEI being kind of, at the forefront on a national scale of just kind of a magnifying glass being put on DEI. To know that this, this level of work is happening, and there's so many partners and collaborators that we work with at MHA that, you know, I think, just just constantly inspire me, and I and I feel like our members and being able to be in the room with them, where they're having these conversations, and I can just sit back and just listen and chronicle a lot of the conversations that they're having, and the stories that they're telling. So I think that it's important to know that behind the percentages that we share of disparity with this population being this or that in the form of a percentage, there are people, there are faces, there are families, there are individuals behind those percentages. And I think that, you know, being able to have that understanding that we're talking about people right at the end of the day, um, because it's easy to be in those spaces where you know, these percentages and the data and the statistics are being talked about. But it's another thing entirely to be in this setting and to be doing this work with such committed individuals, where they're telling the stories about patients and the benefit gleaned from some of these, the things that are happening on the ground level at the hospital systems by virtue of the waiver, and to hear those stories, and those advancements has really been really powerful.

O'Connor: Well, this has been fantastic and fascinating, and I'm going to share with our viewers that you can learn more about the Massachusetts Health and Hospital Association Health Equity commitment at the link in our show notes from today's episode. I want to put a quick plug in for our upcoming annual summit. Registration is now open this year. The Movement is Life summit will be in Atlanta, Georgia on Thursday, November 14, and Friday. November 15, at the Whitley Hotel in the Buckhead area of Atlanta, you can go to our website to register, and there'll be more information and of course, that will also be included in the show notes. So, I want to thank our amazing guest, Izzy Lopes, thank you so much for being with us.

Lopes: Thank you so much. It's been such a pleasure and an honor and we appreciate the opportunity to share our story with your listeners and your viewers. So thank you.

O'Connor: You're very welcome. So this brings us to the end of another episode of the Health Disparities podcast from Movement Is Life. I'm Dr. Mary O'Connor. Until next time, be safe and be well.