The following is an edited transcript of an MDAdvantage podcast with Steve Adubato, PhD, and DeAnna Minus-Vincent, MPA, that was recorded on April 1, 2021. DeAnna Minus-Vincent is EVP, Chief Social Justice and Accountability Officer at RWJBarnabas Health. She spoke to us about the RWJBarnabas Health Beyond the Hospital initiative, which is designed to address patients’ social determinants of health, and how this initiative can provide beneficial outcomes for physicians and patients.
ADUBATO: We are excited today to talk to DeAnna Minus-Vincent, who is talking about an important topic at just the right time. What is the RWJBarnabas Beyond the Health initiative and why is it so important?
MINUS-VINCENT: Health Beyond the Hospital is designed to address social determinants of health, which are the factors that people are born into that affect health outcomes, such as what we eat, where we live and where we work. These factors really affect the majority of our health outcomes. This initiative brings the consideration of social determinants of health directly into the clinical setting. Just as our doctor asks us about our weight, height and blood pressure, at RWJBarnabas Health we will be asking about people’s social and behavioral factors through a social determinants of health screening. It will help us to understand not just where people are but also what they are eating and how they are living. For example, when we give Mrs. Jones a prescription for her diabetes, we don’t just give her a prescription. We’re also going to ask her, “Do you have food to take with that prescription?” “Is there a grocery store near your house?” “Do you know how to prepare healthy foods?” “Can you afford the prescription?” In the past, when she came back into the emergency room even sicker, we may have perhaps blamed the patient for not following instructions, but we may not have known that she wasn’t able to fulfill her prescription and or eat healthy foods because she lived in a food desert.
ADUBATO: We weren’t asking all the right questions. What is your message to healthcare providers who are already frazzled and have too many patients? COVID-19 has affected physicians’ lives in so many ways. They are dealing with telemedicine instead of in-person visits in some instances. Long story short, if a physician questions whether he or she has to ask of all these new questions along with everything else they have to do, your answer is yes. Because what happens if they don’t?
MINUS-VINCENT: If they don’t, people will continue to be sick. We have to ask these questions. It’s critical that we ask everyone. Some of our colleagues across the nation are choosing to only ask the poorest and the sickest, but we know that everyone has social determinants that impact their health.
ADUBATO: We all do?
MINUS-VINCENT: Yes. I’m going to use myself as an example. When I worked in state government several years ago, I had my daughter, and I gained a significant amount of weight, which I couldn’t get off. I did not understand the correlation between stress, lack of sleep and not eating all day, and then, when I got home, shoveling food into my mouth. In addition, my father is a diabetic, and my grandfather died of diabetes. My mother has heart disease, and my grandmother died of heart disease. I am a black woman. I’m a Native American woman. I’m at high risk. Yet none of my doctors ever asked me about my weight. It’s not an easy thing to talk about.
ADUBATO: What changed it for you? What triggered it for you?
“We are asking everyone about how they eat, what they eat and how stressed they are, because these are social determinants of health.”
MINUS-VINCENT: I have a husband who I not only love, but I like a bunch. I have a daughter who is the center of my world. I owe them forever. It was up to me to not rush and not eat unhealthy foods. My mother is actually a dietician by trade. I needed to do better. I left that job and lost 50 pounds immediately. I had to work for the second 50. We all have social determinants. I have to watch my weight every day, and even more so since COVID-19. I think the more we get stressed, the more we need to know our triggers and how to control them. We are asking everyone about how they eat, what they eat and how stressed they are, because these are social determinants of health.
ADUBATO: Let’s talk about partnerships. You’ve worked closely with some health technology organizations, philanthropic foundations, government agencies and community-based providers. In connection with this initiative, Health Beyond the Hospital, here’s my question: Why are these partnerships and collaborations so critical to have any meaningful degree of success?
MINUS-VINCENT: When we were developing Health Beyond the Hospital, we knew that we needed to satisfy our ultimate customers, who, of course, are our patients. But our clinicians are also our customers. The research shows that although clinicians believe that addressing social factors matters, they didn’t want to do it, and they weren’t doing it. They felt they didn’t have the time, they didn’t know what resources were out there, they didn’t want to ask the questions if they didn’t have all the answers, and they weren’t getting reimbursed for it. On the other hand, for our patients, the process is cumbersome. There are a lot of barriers to getting health and social services to work together. Many times, the work is more than the benefit. We needed to create a product that was beneficial to both of our customer groups, so we needed partnerships that would get us there. What we’ve created is an end-to-end solution that is truly patient centered. It is a multi-modality where people can answer the questions in the way that they want that is culturally adaptive.
ADUBATO: Can you define culturally adaptive?
MINUS-VINCENT: It means that we can reach out to people in the language and in the sequence that they may need. For instance, how I’m going to answer the questions is a lot different from how you’re going to answer the questions or how someone in Trenton or Newark will answer the questions. It means that how an immigrant male feels about pride and stigma and feeding his family is a lot different from how a woman feels about those issues. The messaging needs to be specific and targeted for all groups.
ADUBATO: Explain to us why treating everyone the same and communicating with people using the same methods is not equity.
MINUS-VINCENT: We need to be able to reach out to people where they are. I may prefer to receive text messages, whereas my parents want a phone call or mail. We need to get to people in the method they want to be addressed and then walk them through the series of questions. Then, once we ask the questions and understand where they have needs, we need to seamlessly connect them to the services and support that will provide them with what they need, both internal to the health system and external. We also need to communicate this information to their doctors, so it resides within their clinical record and can be tracked, the same as we do for their blood pressure, weight or other clinical factors. We also need to work with our government partners to ensure that we are not asking people the same questions repeatedly. We already know that if someone is on Medicaid, they’re likely to be eligible for something like SNAP, which is food stamps, or HEAT. Why should they have to answer those same questions again?
ADUBATO: As I’m listening to you, I begin to realize not only how important Health Beyond the Hospital is but also how complicated it is, and how collaboration and partnerships are so important. No one organization can tackle this alone. What advice do you have for other hospitals or healthcare systems that are listening right now and say, you know what, we’d like to do something like Health Beyond the Hospital?
MINUS-VINCENT: First, you need to know your audience. Be patient. It takes a lot of work. We’ve spent a lot of time speaking to our internal stakeholders and gaining buy-in. It wasn’t easy to decide to do a universal screen; it was a continual process. Luckily, we have a leadership team that really believes in this, and they were invested in this process. COVID-19 really highlighted that this was necessary, and we need it to move in this direction. Our external partners have been great to work with, ensuring that we had the resources externally to send people to, so it’s been a continual process. Then, having philanthropic partners in place has been critical, especially now, as healthcare systems have just been hit really hard with COVID-19. We’ve had great partners with the Walmart Foundation and the RWJ Foundation to really incubate and innovate with these dollars to prove that it does have merit so that then we can scale it system-wide.
ADUBATO: RWJBarnabas Health President and CEO Barry Ostrowsky is fully committed to this Health Beyond the Hospital initiative, which means everything. You can have great team members driving the initiative, but without that leadership at the top, it’s not happening. Here’s my final question. As one of the country’s top experts when it comes to health equity, what do you see in the future, particularly as it relates to disproportionately black and brown communities that are so negatively affected by social determinants of health? Are you hopeful?
MINUS-VINCENT: I am hopeful. I think we’ve seen so many fluctuations over time, but for some reason, this feels different. I feel as if the country has made a shift as we focus on the social determinants. We are thinking about new strategies to fund and scale the services that are needed. As you know, we as a country have struggled with healthcare payment and the high cost of healthcare for years. As we begin to think about value-based care and value-based payment, and how we reengineer how the health and social service sectors work together, we have a true opportunity to think about how we can create savings and share in those savings with our partners so that we can create a continuum.
