Safety Net System Models to Advance Health Equity

Safety net health systems ensure access to care for all individuals, regardless of their ability to pay, delivering critical health services to those who are disproportionately uninsured, underinsured, or reliant on Medicaid.

The third panel of Yale’s health equity summit spotlighted how these systems played a pivotal role in advancing health equity during the COVID-19 pandemic. Panelists offered strategic insights on how health care organizations can foster trust and effectively advocate for meaningful change within their communities.

During her presentation, Ngozi Ezike, MD, highlighted the importance of understanding the local community's needs.

For example, when the COVID-19 vaccines became available, federal guidelines prioritized seniors over 75. Ezike and her colleagues pushed back on the guidelines because they knew that the average life expectancy in many of their local communities was in the 60s. Following federal guidelines would have exacerbated disparities.

“We can’t follow this,” she said. “You would have whole communities of people where many people in their community will not even have a chance to touch the vaccine. The data spoke for itself.”

Ezike also urged health systems to get into the community to build trust and meet the unique needs of the communities they serve. She specifically highlighted how Mount Sinai Hospital in Chicago expanded the use of community health workers, which has helped improve trust and the quality of care while building up the local community.

Unfortunately, Ezike notes, safety net hospitals often lack the financial resources for capital improvements or program expansions that would help address health equity.

“Mission-driven work can often be at odds with the economics,” Ezike said. “We need to find a way for these two things to work together in parallel and not against each other.”

Health systems can build strong relationships in their communities, said Celeste Philip, MD, during her talk. However, trust must be earned over time. Health systems must continuously show they value the opinions of the community.

Philip pointed to her work in establishing a Health Equity Action team composed of 80% community members and 20% health department members. That group helped stop initiatives that they believed would threaten the health of the community and advocated for changes to improve health outcomes.

“In difficult situations, if people in the community have an opportunity to speak, they can be very influential and powerful,” she said.

She challenged health leaders to include more voices from community members in their existing boards and organizations to involve the community, build trust, and ultimately address health equity.

Philip also highlighted the need to more fully integrate physical and mental health care and recommended health systems implement a “No Wrong Door” policy. This approach can create smooth transitions between hospitals and behavioral care facilities and help patients access social assistance programs more easily.

“If we are focused on closing gaps in life expectancy, we need to think about the whole person and the whole community through all of our actions and all of our planning,” she said.

Israel Rocha Jr., MPA, noted that the problems leading to inequities have been well-established. He urged health care providers to avoid getting bogged down in the scale of the challenge and instead focus on what they can change immediately.

“Don’t get blinded by the fact that it’s an ocean,” Rocha said. “If we could have a hundred spheres of influence, all tackling their part of the ocean, then we’ll really start to see change.”

Especially in a resource-constrained environment, there is a need for policy changes to address some of these longstanding equity challenges. Advocating for policy changes requires buy-in from other stakeholders, including community organizations, safety-net partners, foundations, health care systems and hospitals, policymakers, and other officials.

Rocha shared specific tactics that health care organizations should use to advocate for what they need. For example, he and his team improved care at the United States-Mexico border by sharing robust data and using messages specifically tailored to resonate with the decision-makers.

“Everyone has something that they care about,” he said. “Your job is to figure out what drives them and then show them the data to help convince them. Align your goals with their goals.”

• Community voices have value. Make sure all boards and programs include members from the community and truly listen to insights and guidance.
• Think about each patient’s journey and identify problem areas. Try to improve transitions, wraparound care and create warm hand-offs.
• Stay encouraged despite the enormity of the challenge. Focus on the changes you can make in your own sphere.
• Health systems have a unique role in influencing their broader community. They can help advocate for investment and policy changes to improve political and social factors of health.
• Doctors and other health care providers can be strong advocates for policy change. Training programs are available to help health care providers understand how to share stories and data to influence policymakers.
• Cross-sector collaboration is essential. Partnering with local organizations, government, and stakeholders can amplify the impact of health equity initiatives
• Data-driven approaches are critical. Utilize real-time data and patient feedback to continuously adapt and improve health equity strategies, ensuring resources are allocated where they are needed most.