Q&A: Mikelle Moore on health equity in Utah

Mikelle Moore has worked with Intermountain Healthcare since 1998 and currently serves as the organization’s senior vice president and chief community health officer.

Named one of 2021’s top 25 women health care leaders by Modern Healthcare magazine, Moore will be participating in the 2021 Utah State of Reform Health Policy Conference on April 14th to speak on our “Facing the challenge of racial inequity in health care” panel. In this Q&A, she discusses the unique nature of her job title, the health sector’s need for more equity-focused initiatives, Intermountain’s community outreach and more.

 

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Eli Kirshbaum: As chief community health officer, what are some of your key responsibilities? What is your role’s main purpose?

Mikelle Moore: “The role is really a unique one. There aren’t a lot of chief community health officers in health organizations across the country. But it’s really appropriate at Intermountain, where we’re trying to ensure that we use our resources as a health care organization to improve the community’s health, and that we’re also partnering effectively with the community to do that. We recognize that our health outcomes as individuals are only in a very small way attributable to the health care services we receive, and most of what determines our health is our individual behaviors, and then the society and economic environment that we’re born into. So, even [though], being a healthcare organization, our mission is absolutely going to be focused on delivering high quality affordable health care services, we’re also much more in tune with the social factors that are influencing health at an individual level, and then thinking about, ‘How are we contributing to a healthy society and community?’

So my role is really to think of that broad scope of the organization. I work closely with my partners who are involved in health care delivery and all of those different components, but my job is to really ensure that we’re using our other resources as well to improve health. So I lead our community health team, which is a group of individuals whose job is to partner with community-based organizations to address complex issues like behavioral health and air quality and chronic disease… I also partner with human resources. I help hire vulnerable community members and then give people opportunities for increasing their wealth attainment and education while they work for us. I work with our treasury department on how to make sure that we’re doing investments that have social impacts — not just for the financial returns of the organization. Or, how are we purchasing so that we’re supporting local companies, minority-owned companies and helping to grow the economic sector in the communities where we work?

The role is kind of broad, and that’s respective of the responsibility I have, to really think about health disparity and the opportunity to create health equity with all of our resources and the community.”

EK: Intermountain recently gave $2 million to the Utah Department of Health to fund community health workers. What are some other recent examples of Intermountain’s work to improve health equity?

MM: “We work on a number of different levels. The story you’re referencing is an example of making a charitable contribution in the community, and we’re really pleased that we could do that because community health workers are so valuable to connecting the most vulnerable in our community to health care resources. But we’re also thinking about, ‘How do we hire within our own organization in ways that create opportunities for vulnerable community members to have employment with Intermountain through their lifetimes?’

An example that we’re working on right now is hiring refugees to be trained as phlebotomists. Refugees often work in unskilled positions, positions that require less English language, and hospitals and health systems have had refugees working in food services and housekeeping for a decade. We’ve partnered with the Division of Workforce Services here in Utah to figure out a way to really elevate the opportunity for refugees because refugees are often highly trained in the country they come from and, certainly, as [do] all individuals, have the potential to become highly professional positions, and we can be a part of creating those opportunities. 

So the current work focus is on identifying refugees who have high potential to work as phlebotomists, giving them training to learn the skill of phlebotomy, and then supported by refugee services in language learning and learning how to navigate working here in the U.S., and giving them that support. We’ve just hired our first couple of phlebotomists from the refugee community, and we hope this is the beginning of many.

Another example, to give an idea of the dimension of the work, is we know that one of the biggest issues that people face, is when we meet a patient, for example, who is struggling with health issues, and then we [ask], ‘Okay, do you have a safe place to live, do you have access to a place to store your medications in a refrigerator, access to health food, consistently for every meal?’ We often learn that people are facing lots of struggles. The most difficult one for us to help them solve is housing. Affordable housing is getting more and more difficult for people to find, particularly in Salt Lake City. While we’re not a housing solutions organization, we have been using some of our investment dollars recently to help fund the development of affordable housing. So these are dollars that we would be investing anyway so that we have funds available for the building of a new hospital or replacement of equipment five or ten years down the road. And while those dollars are invested we need to get a return on investment, but we can also do some social good with those dollars. 

So we’ve been making investments in affordable housing — the example I love to talk about is an investment in the Utah Housing Prevention Fund. [Some of Utah’s affordable housing] is at the point that it’s shifting from affordable housing to a market rate, and the fund buys those housing units, upgrades them to make them livable and then sells them to individuals at the affordable rate rather than would become a market rate. So our investment enables that housing to exist, in partnership with some other donors and investors who are involved in the fund as well.”

EK: You mentioned that not every health care organization has a position similar to yours — a position or department dedicated to alleviating health disparities. Do you think the Biden Administration’s recently formed COVID-19 Health Equity Task Force is a good example of an impactful health equity initiative?

MM: “I think COVID-19 has helped more people see the health disparities that exist because it’s played out in such a rapid way, that we’re able to see those disparities when they’re happening. And yet, it’s an indicator of something that’s happening in every disease. Diabetes has the same health disparities, or behavioral health conditions, [or] substance use disorder. So, not that I’m pleased that COVID-19 happened, I’m certainly not, [but] it’s giving our country, our health care organizations and the general public the opportunity to really think about, ‘What do we want our world to be like?’ 

So I’m really pleased to see the task force formed, and I do think it takes that type of intentional focus to ensure that we don’t leave people behind. We know that, even when we have good intent to treat all people equally, to ensure everyone has access to health care regardless of ability to pay, we know that that isn’t what happens. There are disparities for lots of different reasons, and when we use data to help us understand the disparity, and when we’re listening to the voices of the people who are experiencing the disparity, we come to understand it in a really different way, and we can change it. And we’ve proven that throughout COVID, that as we saw disparities in testing rates, for example, earlier in the pandemic, we could get really intentional about going to test in those vulnerable communities. Ensuring we were doing a good job translating educational information, using advocates and community health workers that represent the population to really create that engagement and trust in testing.

I think that kind of intentionality that’s required to address the equity issues downstream, we also then have to really understand, ‘What are the factors that created the disparity to begin with? The working conditions, the living conditions, the access to education — those are the things that create the disparity, and we have to be willing to look at those as well, and I think that’s an important part of the work. So, yes, I think this [the task force] is absolutely a step in the right direction, and I think it’s a momentum-building opportunity for us as a country and as an individual community to have this opportunity to do better.”

EK: What are some accomplishments you are most proud of, that you feel contributed most to advancing health policy in Utah?

MM: “I’ll just comment on behavioral health, because it’s really cool to see how far we have come in the last few years as a state. We still have a really long way to go, but it makes me optimistic. At Intermountain, I mentioned that one of the things I oversee is our community health team, where we identify the biggest community health issues and then establish strategies to address them. Behavioral health, or mental health and substance use, has been a priority for about several years now in our organization. The specific focus areas have evolved in that time frame, but the first steps were around access to behavioral health, and we focused on ensuring everyone who came to our emergency rooms or was an inpatient for behavioral health admission had an outpatient resource to see after discharge, even if they were uninsured. So we built a system — we call it a behavioral health network — where we paid for those visits so that there’s no appointments within seven days of their discharge. This has been really critical for ensuring that people have a place to go.

About three years ago, we started creating access centers that were different from the emergency rooms, which would help us see people in a more friendly environment that was more suited to if you were in a behavioral health crisis versus a medical visit, to come in to an access center and then get stabilizing care, but also be connected to treatment after discharged because we knew that that ongoing plan of care was really the most important thing. As we’ve developed this, we’ve also been working on suicide prevention and opioid misuse prevention and lots of other things, and I’m really proud of the way all of the work has come together [and resulted in] in more behavioral health legislation in the last two years than, probably, the last two decades before that.”

This interview was edited for clarity and length.