By Ned Mossman, MPH, Program Manager, Value-Based Care and Social Determinants of Health
Last month, a diverse group of over 200 thought leaders from across the country in health inequities, including primary care clinicians, public health experts, educators, researchers, trainees, advocates, policy experts, social service organizations, and patients, gathered in Portland, Oregon at the Starfield Health Equity Summit to focus on primary care’s role in achieving health equity. The Summit, sponsored by OCHIN, Family Medicine for America’s Health, the Pisacano Leadership Foundation, OHSU Department of Family Medicine, NAPCRG, and the ABFM Foundation, was the second in a series of meetings established to honor and advance the legacy of the late Barbara Starfield, MD, MPH, a physician, researcher, and distinguished professor of health policy and pediatrics at Johns Hopkins University. Dr. Starfield was known internationally for her work on community health centers and vulnerable patient populations, as well as for demonstrating the importance of primary care to outcomes and health equity in the larger health care system. The first Starfield Summit was held in 2016 and focused on Advancing Primary Care Research, Policy, and Patient Care, and this second iteration aimed to bring together a diverse and dynamic group of people with interest in decreasing health disparities and achieving health equity.
The Summit’s opening keynote by David Williams, PhD, MPH provided a data-driven overview of the landscape and history of health disparities in the United States. Dr. Williams, a Professor of Public Health, Social and Behavioral Sciences at Harvard, also encouraged the audience to be personally engaged in making America healthier for all, and to be mindful that movements are collectively made up of individuals committed to making small impacts.
From there, a series of breakout working sessions took place on various aspects of social determinants of health (SDH) in primary care. The sessions were described in advance using 5-10 minute “Ignite” presentations that allowed attendees to consider where their interest and expertise would best fit. Topics ran the gamut from assessing and addressing SDH needs at the patient level to using community-level social data to design large-scale interventions, to clinician education and community organization and engagement through the lens of health disparities and SDH. After reconvening, note-takers from each session delivered summaries of the breakout discussions to the larger group, and time for reflection and discussion was provided. A key theme to emerge from the sessions was that although health care can bring new resources to bear for social needs interventions (due largely to the fact that in the U.S. it receives a comparatively high level of funding in relation to social services – see Exhibit 8 in this linked article), primary care should seek to serve a bridging role with social service organizations who bring much deeper experience and expertise to SDH issues, rather than inventing solutions from scratch or presuming to lead these efforts alone.
The afternoon brought a second round of Ignite presentations and breakout sessions, focused on vulnerable populations. The breakout sessions included discussions on unconscious bias in race and gender, immigrant populations, people with developmental and intellectual disabilities, rural populations, and intersectionality. I attended the session on unconscious bias, where Denise Rodgers, MD, led a frank, engaging, and often personal discussion among those present, and asked us all for a commitment: “When you discuss racial disparities in health, you must not leave out the discussion of racism.”
The next morning, economics and policy took center stage as Ignite presentations covered topics including: issues of access to care other than primary care, the potential of using SDH to pay for health care differently, the legacy of the ACA in the aftermath of attempted repeal, community-level SDH as “Community Vital Signs,” and what we can learn from efforts at reducing health disparities in other countries. The working sessions picked up where they left off the previous day, with highly engaged and insightful discussion and herculean efforts by each session’s note takers to assimilate and synthesize the conversation in real time and present it back to the larger group for reflection and further consideration. In the ACA session, Craig Hostetler, MHA placed Oregon’s Medicaid Alternative Payment Model and other approaches in the context of the uncertainty around the national landscape for value-based care and payment reform.
The last round of Ignite sessions laid the foundation of a framework for social accountability in primary care, focusing on current and ideal state of measuring, assessing, and designing social accountability into the health care system at various levels: clinical practice, residency programs and health professional schools, professional organizations, and advocacy. Each working session group discussed one of these levels exclusively, and assessed ease versus impact of each identified or proposed means of measure for current and ideal states, challenges or barriers to implementing them, and stakeholders who should be engaged.
The general session wrapped up with closing remarks by Viviana Martinez-Bianchi, MD, FAAAFP, Jen DeVoe, MD, DPhil, and Erika Cottrell, PhD, MPP, three lead members of the Starfield Health Equity planning committee, who each acknowledged the opportunity the last two days had afforded to work with an incredibly engaged group of organizers, presenters, facilitators, and attendees. That level of passion and engagement remained high to the very end, with expressions of interest in continued collaboration and sharing, and discussion of how best to operationalize the many learnings from the previous two days. In her remarks, Dr. Cottrell brought things full circle and connected the enthusiasm directly back to Dr. Willliams’ keynote from the day before by displaying one of his slides with the following quote from Robert F. Kennedy:
“Each time a [person] stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice, [they send] forth a tiny ripple of hope, and crossing each other from a million different centers of energy and daring those ripples build a current which can sweep down the mightiest walls of oppression and resistance.”
You can find more information about the Starfield Health Equity Summit, including slides, issue briefs, and other articles here. In addition, video of all presentations from the summit will be available soon.