Leaders discuss building trust and addressing the social determinants of health

Abner Mason, CEO of ConsejoSano Health, Beau Hennemann, Director of Special Programs for Anthem Blue Cross, and Kelly Bruno, CEO of the National Health Foundation, discussed building trust and addressing the social determinants of health during the Southern California State of Reform Virtual Health Policy Conference last month.


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All three panelists agreed that while the health care system has come a long way in addressing the social determinants of health (SDOHs), there is still a long way to go in gaining the most vulnerable populations’ trust. Historically, minority populations have distrusted the medical field due to the mistreatment they have faced at the hands of the very providers they were supposed to trust, says Mason. Bruno specifically points to the fact that BIPOC have different health results because they experience SDOHs at a higher rate than white populations. 

Mason says a key part of gaining the trust of these communities is to engage with them how they prefer, such as through the expansion of the use of telehealth in Medi-Cal populations. Medi-Cal is 81 percent multicultural. He also says that the United States is on the path to becoming a majority minority country, and that California is already a majority minority state. But the providers available to communities often do not reflect the communities they serve. 

“It’s really important to stop treating people like who they are doesn’t matter,” said Mason.  

Mason also says that providers and plans need to be willing to create an environment where people are comfortable telling them where they have barriers to health care. He says the health care system needs to be willing to listen more than they talk, especially because populations that are struggling with SDOHs are more likely to view those barriers as shameful. 

“When all you’ve got is your sense of self, it’s hard to say I need help,” said Mason. “To raise your hand and say ‘I need help’.” 

Mason says it is imperative that the health care system gain the trust of these marginalized communities, especially during the COVID-19 pandemic. This is because with the vaccine rollout currently happening, the communities that are most at risk of catching the virus are the ones that also have the most distrust towards the vaccine and the system that created it.

But, the question on the panelists minds was how to help communities overcome social determinants once the plans and providers have gained their trust. Hennemann pointed to the need for plans to invest in the community and community-based programs. He said that because the community already trusts these programs or the leaders in the community, they are more likely to use those programs. He says it is important to build strong partnerships with these leaders.

Hennemann also stressed that plans and providers should point their patients towards the state run programs available. Anthem has leveraged CalFresh and the California Food is Medicine (CalFIMC) programs to help with food insecurity in their populations. He said that CalFIMC saw a 300 percent increase in usage after the start of the pandemic, which indicated that in California, food insecurity is a major issue that they hadn’t noticed yet.

“We thought that in California, homelessness was the major issue,” said Henneman. “But it became clear through the pandemic that food insecurity was also a major issue.”

Hennemann added that there is a need for recuperative care for the homeless. He said that if the hospitals discharge them and they have nowhere else to go they will just end up back in the hospital. So it’s in the hospitals’ best interest to work with plans and shelters to have a care plan in place for the chronically homeless, which was mandated by Senate Bill 1152 in 2019. Especially now because California and the nation are on the brink of adding to the homeless population if the eviction moratorium is lifted without structural supports in place.

Moving forward into 2021, Hennemann said that now that Anthem and the state have some programs in place, they need to make sure that the populations of these programs reflect the population of the communities supposed to be using the programs. Specifically, Hennemann referenced that 34 percent of the homeless population in Los Angeles County is Black. This means that the programs intended for the homeless population should be representative of the population. 

“Into 2021 [we need to] take a step back and make sure programs are equitable and are serving the populations, and make sure that everyone is getting equal access,” said Hennemann.