Equity of Care Award Winner Meritus Health: Influencing Equity in the Community

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Tom Haederle
Twenty years ago, the Institute of Medicine released a landmark report titled "Unequal Treatment Confronting Racial and Ethnic Disparities in Health Care." The 2003 study ignited lots of valuable discussion, but in general, specific steps taken to improve equity and access to care came more slowly. That is changing nationwide, as an ever growing number of hospitals and health systems have committed themselves to working to eliminate disparities in care within their communities.

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Tom Haederle
Today's podcast is the story of one health system in western Maryland that has knocked it out of the ballpark. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Based in Hagerstown, Maryland, Meritus Health is the winner of AHA’s 2023 Equity of Care Award in the Transforming category. Please join us for this discussion hosted by Dr. Leon Caldwell, senior director of Health Equity Strategies and Innovation with AHA,

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Tom Haederle
as we hear about the health system's successful plan to reduce health disparities among the communities it serves. There is no secret sauce. With Meredith, it simply began with a group of motivated people wanting to make a difference.

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Leon Caldwell
This is Dr. Leon Caldwell, senior director of Health Equity Strategies and Innovation for AHA’s Institute for Diversity in Health Equity. I am very excited to be joined by Alan Twigg, the executive director of Behavioral and Community Health at Meritus Health in Hagerstown, Maryland. This is a special moment, a great moment for both of us, because, one, Alan's Meritus Health has just received the Equity of Care award

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Leon Caldwell
so I'm pleased to sit across from an award winner for one of AHA's prestigious awards here at the 2023 Annual Leadership Summit. So, Allen welcome.

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Allen Twigg
Thank you, Dr. Caldwell. It is truly an honor to be here today and be recognized for this award. Yeah.

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Leon Caldwell
So tell me a little bit about Meritus Health.

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Allen Twigg
Meritus Health is a freestanding hospital in Hagerstown, Maryland. We have about 300 beds inpatient. It's located in Washington County, western Maryland, population about 155,000 people. We have a workforce of 3200 team members with more than 300 physicians. We're at the narrowest part of the state, so we see patients from Pennsylvania, West Virginia. And although we're increasingly less of a rural community, we still are somewhat isolated in the western part of the state.

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Leon Caldwell
It's fascinating. I actually live in Maryland, but I'm from Philadelphia, Pennsylvania. And so you're covering a lot of ground that I'm familiar with. And it's the work of equity. We know that it's not geographically isolated, right? All of our communities can benefit from having a perspective on health care access and outcomes that really fit an equity framework. We've crafted our equity care award this last year to really reflect the dynamic spectrum of our membership.

00:03:28:26 - 00:04:00:18
Leon Caldwell
So we created really two additional awards from within the one Equity Care award, and we call those categories. So Meritus won the category for transforming, which that category recognizes a hospital system that is implementing strategies to influence equity in the surrounding communities ecosystem, not just in one space, but the ecosystem of the community. And you have done some phenomenal work with your LEAD program or council, I should say.

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Leon Caldwell
And that's, you know, if you think about what a hospital does or hospital or health system does, LEAD is actually a great acronym, particularly around diversity. But more importantly, your work in transforming health Care or transforming access goes beyond the walls, if you will, of the hospital. Can you tell me a little bit more about LEAD for the listening audience?

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Allen Twigg
Yeah, absolutely. Well, while you're right, we love our acronyms in health care, right? So LEAD stands for Leadership and Equity and Diversity. It was really born out of a call to action by our president and CEO, Dr. Maulik Joshi, back in July of 2020. He wrote an article "Hundreds of Days of Action as a Start to Address Hundreds of Years of Inequity," which was in the New England Journal Catalyst.

00:04:54:02 - 00:05:24:15
Allen Twigg
It was really looking back at the Institute of Medicine's "Unequal Treatment" landmark report. That was 20 years ago, where it properly identified the real differences in care that were stark, well-meaning, well-intentioned. But 20 years later, we had not made much progress in the area of health equity or disparities. So that was sort of the genesis of having a LEAD council.

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Allen Twigg
And the council is actually made up of representatives from across our hospital of team members. So we have frontline staff, we have leadership and providers that want to make a change, that recognize that we have issues, we have a challenge of health disparities. We want to make a difference. So it's really a group of motivated people that would come together and begin thinking about how to make changes.

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Allen Twigg
So some of the values I think that we did, one of the first things we put together was a charter. So what's the LEAD council's purpose? And it really exists to eliminate disparities in health care for patients and our community. Recognizing we are part of the community, the people in the community are the patients and families that we serve.

00:06:19:18 - 00:06:47:12
Allen Twigg
Our workforce is part of the community. So what needs to change? The LEAD counsel put together some steps that we want to help ensure would make a difference over time. So I think one of the most important things is that we wanted to create a diversity among our leadership and staff that really reflects our community. We have a 24% racial ethnic minority in Washington County.

00:06:47:14 - 00:07:22:22
Allen Twigg
But when we looked at representation and leadership on the board, nowhere near 24%. So that was one of our first objectives, that we wanted to put in place some policies to make a difference with diversity within the organization. And then going about how are we going to identify our health disparities? It's really data driven, we have an epic EHR, and we took the IOM's six domains of health care quality, safe, timely, effective, efficient, equitable and patient centered care.

00:07:22:24 - 00:08:04:01
Allen Twigg
And we stratified those quality and safety outcomes by race, ethnicity, age and language spoken. And what came back were certainly many examples of areas where there were differences. But some of the the primary quality indicators showed us that we had big differences with preterm birth rates among black, Hispanic, Latinx patients compared to white. Preterm birth rates were 27% higher for that group. And for Spanish speaking patients versus English, there were 50% higher for preterm birth rates.

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Allen Twigg
This was one of the most stark disparities that we identified in our first run through this information. And there were others like sepsis core measures that ... we had noncompliance for 44% of our black patients compared to white patients among providers. We looked at newborns who were visibly fed breast milk. Disparity there. Opioids administered in the emergency room for pain and poorly managed diabetes outcomes.

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Allen Twigg
So recognizing that these disparities exist in the data was really a first step to saying how do we improve? How do we make a difference with this?

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Leon Caldwell
That's pretty important to for any of our listeners, particularly those in hospitals or health systems, because we often hear like how do we collect data and then when we have data how do you turn data from really data storage to information? And your story...and I think your hospitals'use of data to inform and drive action, it's really a pivotal piece of what we expect from award winners, right?

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Leon Caldwell
Like taking this data and saying, here's how we're going to change policy, here's how we're going to first recognize and do things differently. So in that sense, when you think about the LEAD council and the thing I really love, what you said is recognizing 1) that your staff or your workforce is not as representative as you like. What were some of those measures to essentially cultivate talent for your hospital?

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Allen Twigg
Well, I think that one of the things that we're done is intentionally be present in the community. So working with recognized community leaders in different groups and having a presence in our community was sort of a first step to that. You know, there wasn't a lot of good that came out of the pandemic during COVID. But one of the things that we were able to implement was a community mobile vaccine program.

00:10:05:29 - 00:10:37:09
Allen Twigg
We administered over 11,500 vaccines throughout the county, many in underserved communities. And through that process, we built relationships with people in nontraditional community settings, such as grocery stores, churches, community centers. And it was through those relationships that people began to recognize, Hey, Meredith Health is invested in who we are in our health and wants to make a difference.

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Allen Twigg
So just an example. We had prior to last weekend in Hagerstown with our LGBTQ plus community, and we had many people come up to our table to say thank you for being here. As part of that, we had recruitment incentives available for people to learn more about how to apply for a job. We changed our minimum wage to $17 an hour at Meritus Health within the past year.

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Allen Twigg
So that's an investment in our community as well. So entry job at Meritus is $17 an hour. So that makes a difference in people wanting to be a part of who we are.

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Leon Caldwell
Yeah, I think the beauty of a lot of this work is we're hearing many of our hospitals turn ideas or concepts around equity into policy. And when you start talking about hourly wage recruitment and being intentional where you go, those are like policies and practices that advance equity. And that's really what the health equity roadmap for us at IFDHE that's our wins, right?

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Leon Caldwell
When we hear our members start to talk about how they've made changes to align with not only their mission but the intentionality around advancing equity in real concrete ways. So you've had some good success. It's a big award. I'm sure you'll go home with the trophy and have a nice community event to thank them for their participation in getting you to this, your hospital and health system to this level, if you will, of recognition.

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Allen Twigg
Yeah, absolutely. You know, we're really excited to share this award with the community here.

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Leon Caldwell
So here's a question, and I know we are just about out of time, but one thing that I wanted to ask you, like we often talk about this work from an institutional organizational perspective. Tell me personally, what is this work mean to you to be able to advance equity?

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Allen Twigg
Personally, I mean, it was really unacceptable to me that these kind of disparities still exist. You know, here we are in the 21st century and there are differences. Why are there differences? Many reasons. But I've been in health care for 29 years, and I felt as though two and a half years ago that it was time for me to step up, help to lead a change, to say, what can we do differently to solve this problem?

00:13:08:20 - 00:13:33:21
Allen Twigg
So I was given the opportunity by our CEO. We actually co-lead a LEAD counsel, Maulik and I, and to have that level of support makes a lot of difference in the organization. When it starts at the top to say we're going to effect change. So just having that opportunity and putting your best foot forward and believing that there is no problem too big to solve.

00:13:33:23 - 00:14:11:25
Leon Caldwell
Well, Allen I really thank you on behalf of the Institute for Diversity, Health Equity at AHA. You're a living testament that leadership matters. Intentional leadership matters, Compassionate leadership matters in leadership with humility actually matters. So this award is for your system and your community. And we hope that you get everything you all deserve by recognition of it, but more importantly, that you use this to continue to be the catalyst for the change you all want to see in Hagerstown in other parts of the state, because you now, as an Equity Care Award winner, you're a beacon.

00:14:11:29 - 00:14:30:05
Leon Caldwell
So thank you so much for your steadfast movement in this work and for really accepting the challenge with the health equity roadmap and pushing the work ahead. So on behalf of our organization, thank you, Allen Twigg, executive director for your hard work.