Tackling Health Inequities: A Recap of Elena Mendez-Escobar’s ACMA Presentation

Lindsay Tsai
ACMA Leadership Conference Banner

At this year’s American Case Management Association’s (ACMA) Leadership and Physician Advisor Conference, we had the pleasure of hearing from Elena Mendez-Escobar, the Executive Director for Boston Medical Center’s Health Equity Accelerator. At Boston Medical Center (BMC), the Health Equity Accelerator is particularly focused on race and ethnicity, given that the community they serve is predominantly comprised of individuals identifying as BIPOC. The Health Equity Accelerator aims to transform healthcare to deliver health justice and well-being through two main focuses: 

  1. Help BMC to intentionally to focus on racial inequities in all they do 
  2. Entertain multidisciplinary conversations by creating teams and spaces to facilitate interactions to ensure solutions are socialized and scaled. 

Acknowledging that structural racism such as redlining has had lasting consequences today, including direct results to health, Elena and her team take a multi-pronged approach. Outside the bounds of the healthcare system, they examine socioeconomic and cultural context and pre-existing disease burden. Within the healthcare system, they purposefully address bias in clinical decision making and unequal access, patient experience & engagement that creates a lack of trust. 

While looking at ways to address health inequities, BMC identified a startling theme in patients receiving urgent c-sections: there were much longer wait times between black and Hispanic patients compared to white patients. In response, BMC raised awareness of this issue and established a universal target: a 60-minute wait time. The result was the successful elimination of these wait time disparities. 

Boston Medical Center slide on C-section wait times

5-Key Lessons for Case Management leaders:  

In addition to her examples, Elena shared 5 key lessons for case management leaders to takeaway as they look to tackle inequities in their own systems:  

  1. Wealth is health: Black people face economic barriers that affect their health, and we cannot deny that. For example, the gap in median net worth in Boston is stark: $247k (White) vs $8 (Black), and black pregnant people are 3.2x more likely to die during pregnancy than white people.  
  2. Time is a luxury: When prescribing treatment, we must remember the situation in which someone exists and discuss all their options with them to find what is the best fit. Elena further explains, “2 out of every 3 of black children live in single parent households.  How can someone make time to address diabetes 3 hours per day, while balancing multiple jobs and childcare?” 
  3. Agency is essential: “Medicine doesn’t always know everything – there are usually nuances or options for a treatment path. Some patients express that doctors take options off the table based on assumptions.” Health systems need to trust patients in order to gain their trust – create more materials to empower patients to make informed health choices. 
  4. Timing is everything: Delays in diagnosing and starting treatment can lead to significantly worsening health outcomes. This is especially true for people of color, who are more likely to receive a later-stage diagnosis for problems like cancer and lyme disease.   
  5. Averages are Blind: Health systems can introduce inequities by catering to averages. Instead of basing on national averages, set priorities that are relevant to your community. Just as Netflix is tailoring its shows to different populations, we need to do that in healthcare. We need to move from a “broadcast” mentality to a “streaming” mentality in our care models. 

There’s no question that sometimes health inequities feel insurmountable, but Elena’s examples highlight how intentionality in key focus areas can make changes in a small amount of time. She challenged the audience: “Let’s not wait.” Time and academic research studies are not on our side. We need to address inequities now.