Q&A: Leanne Berge on working toward health equity in Washington State

Leanne Berge is the CEO of the Community Health Plan of Washington (CHPW), Washington’s local not-for-profit Medicaid (Apple Health) and Medicare managed care plan.

CHPW recently annouced that it is donating $10,000 to twenty-three organizations that directly support communities of color and other communities disproportionately affected by COVID-19.

I spoke with Berge Thursday to hear more about CHPW’s approach to working toward health equity. We discussed the factors that contribute to racial disparities in health outcomes, what racism looks like in health care institutions, school-based care, and how the definition of health equity has evolved amid ongoing protests.

 

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Michael Goldberg: Communities of color have expressed that race continues to be a factor in the experience they have when engaging with the institutions meant to keep them healthy. From your perspective, what does racism look like in Washington State health care?

Leanne Berge: When I think about health disparities and our mission to advance health equity, I think about it very broadly. It is very much related to the health care institutions but it’s much more broad than that in terms of all of the other factors that relate to one’s health and well-being. Frankly some of the starkest disparities are related to factors outside of the health care system itself, but perhaps consistently contribute to disparities.

When we talk about what we’re seeing with COVID and the striking statistics with the rate of death, hospitalizations, and transmissions; that’s as much to do with factors outside of the four walls of the health care institution. We focus on those other factors, a lot of which are social and poverty related factors. We as a health care organization feel it is our responsibility to recognize and support improving those factors, and we have a long tradition of doing that through our community health centers.

In terms of your direct question, I think there is a lot of evidence that medical institutions have failed people of color. From the perspective of health coverage, there’s a long history of people without coverage not receiving adequate access to care. That’s a very fundamental factor. Medicaid is such an important program because it allows people to access quality care they didn’t previously have. Of course, there are so many undocumented immigrants that don’t have access to coverage. Even when people do have coverage, they often encounter racism, and it’s often very subtle. It’s in how people speak to patients, it’s in how they listen to patients. There are a lot of studies which show that poor outcomes related to infant and maternal mortality for people of color, and Black women in particular, is very much related to how the patient has been received by the health care institution.”

MG: Just as with the protests that kicked off recent broader conversations about health equity, there is this way in which health equity has taken on a new meaning. The protests began in response to the murder of George Floyd, but they’ve really morphed into much wider calls for social and economic reform. Health equity is not a new concept, yet with new attention amid the protests I’m wondering if the definition has widened. Can you talk about whether the definition of “health equity” has changed in recent months and if so, how specifically?

LB: In conjunction with what triggered the George Floyd protests and broader outcry about police brutality and injustice, the COVID pandemic has really brought to the forefront health disparities that may not have attracted the same level of attention as what we have been living through year after year. I think we’ve reached a crisis point that has enabled us to have a broader understanding of what really amounts to a public health crisis. Racial injustice is its own public health crisis due to all of the associated consequences of racism

When we think about health equity, we think about all of the associated socioeconomic factors. Immigration is another area that is very much in the forefront because of policies like the Trump administration’s public charge rule, which has made it much harder for immigrants to access care. So, I think we’re seeing a reaction from folks who are concerned with the outcomes that have resulted from these policies.”

MG: Can you speak to the way developing new centers of care relates to health equity? For example, school-based care is gaining purchase as a policy solution for providing under-served children with services they may not be able to obtain at home.

LB: Community Health Plan of Washington as you know was founded by community health centers around the state. Community health centers have been at the forefront of providing school-based care because of their integrated care model, which looks at all the needs of an individual (behavioral health, social and physical health) and how to provide care with all of those needs in mind. That is particularly important when you’re looking at complex populations because of all of the social factors that need to be taken into account.

Schools have provided the opportunity to address a lot of needs that might not otherwise be accessible, especially around behavioral health. This approach allows you to get a fuller picture of the problems a person might be experiencing and provide direct services that might otherwise be difficult to obtain due to transportation issues, language issues, and so forth.

I think one of the many consequences of the pandemic is that students have lost that avenue for assistance and support by not being able to physically attend school, which has deepened inequities as well. Not everyone has access to the same devices, internet, digital resources, etc.”

MG: Health care systems often contain a number of siloed organizations. Yet, many would argue that achieving health equity requires an intersectional approach. How instrumental is bridging health care silos in the broader efforts to achieve health equity?

LB: It takes a community to solve these problems. It has to go beyond health care but definitely across the health care system, we have to be aligned and thinking about what the root causes are of some of our biggest problems. We also need to be thinking about these problems from an equity lens. It starts by having conversations together.

I think in the state of Washington we are better equipped than other states to work on these more difficult problems together. We do have alignment at the government level across the state and Health Care Authority with local governmental entities. There is tremendous work being on health equity at the Accountable Communities of Health (ACH) level. There are opportunities today that there haven’t been in the past around Value-Based Contracting – how we can provide funding that helps progress these goals. I’m much more hopeful working in this environment than I would be elsewhere because I feel a commitment to change, to recognizing the problems and coming together to make progress. That’s certainly what we’re all about at CHPW and that’s why we have been providing this additional funding to community based organizations. We know equity takes a community. It’s not just about health care institutions, it’s about all of the support individuals need to have in order to get past barriers to their health and well-being.”

This conversation has been edited for clarity and length.