More than 50 local organizations across the health system have committed to making health equity a strategic priority; 15 are pursuing initiatives that address Kansas City’s historical health injustices.
To make meaningful progress, Health Forward Foundation and KC Health Collaborative, in partnership with the international Institute for Healthcare Improvement (IHI), launched the Kansas City Health Equity Learning and Action Network (Action Network). The Action Network has connected stakeholders from across the region to align positive intent with real action that will make health equity a reality for all Kansas Citians.
Neighborhoods across the Kansas City region, including rural communities, continue to experience systemic disinvestment and access barriers to mainstream assets that create health and wealth. One in four Black and Latino Kansas Citians live in poverty, and unemployment rates are three times higher for Black Kansas City residents than white residents.
The consequences of this economic and physical segregation are devastating to the health of residents in underfunded and resource-excluded communities. In 2019, the highest life expectancy in Kansas City (86.3 years) belonged to ZIP code 64113, whose residents were 93 percent white. In contrast, the lowest life expectancy (68.1 years) belonged to ZIP code 64128, whose residents were 86 percent Black. As of April 2021, eight of the top 10 Kansas City ZIP codes vaccinated against COVID-19 were between 73 percent and 95 percent white.
“We’re addressing deep, long-standing health inequities by helping leaders recognize the systems and practices that stifle health and health care — as well as the power and duty each of us has to take action. Together, we’re building the foundations for a better, culturally responsive health care ecosystem that meets our whole community’s needs,” said Qiana Thomason, president/CEO of Health Forward.
The Action Network engages leaders from across Kansas City’s region and health ecosystem to learn and understand what health equity and structural racism are. The learning phase is accomplished through a national, evidence-based curriculum that centers the experiences of communities impacted by health inequity in our region. Those engaged in the Action Network include a full spectrum of organizations and individuals involved in health and health care, including clinicians, health systems, community-based organizations, public health entities, payers, and researchers.
“Health care is integral to a community’s health, but that health does not begin and end with our medical system,” said Ron Whiting, executive director of KC Health Collaborative. “It will take our whole community, including businesses, schools, state and local government, and doctors’ offices to advance health equity. In Kansas City, we have an opportunity to create a high-quality health ecosystem grounded in equity and dignity for all Kansas Citians. Leaders in our region are committed to understanding the living legacy of structural racism and the devastating health inequities it has created. We are energized and prepared to learn together and take steps to improve our entire community’s quality of care.”
Earlier this year, more than 50 organizations completed a series of learning discussions facilitated by IHI. Following the learning phase, organizations committed to making sustained improvements toward health equity. Fifteen organizations identified specific steps toward antiracism that they are well-positioned to take based on their role in the health care ecosystem. Action Network participants will receive assistance with data, coaching, and facilitation support from IHI performance improvement faculty as they continue the work in their organizations and health care systems.
“Through this work, we are growing participants’ capacity to drive antiracist practices in their organizations and holding shared accountability to turn our collective learning into tangible improvements in Kansas City’s health and quality of care,” said Dr. Kedar Mate, president/CEO of IHI.
The following organizations will take these actions over the next year:
Centrus Health Kansas City
Centrus Health of Kansas City is committed to improving hypertension and diabetes care through a health equity lens for employees at Nebraska Furniture Mart who are experiencing health outcomes impacted by social conditions. This project will serve as a model for patient-centered approaches to care delivery and employee benefits.
Children’s Mercy Kansas City
Children’s Mercy Kansas City seeks to improve the health potential of its patients by collecting more accurate and representative race, ethnicity, and language (REL) data within its value-based care network. The improvement of REL data will allow Children’s Mercy to identify health disparities within its population and initiate work to address care gaps.
With an increase in virtual and telehealth options, communities without access to reliable, fast internet are now facing significant deficits in healthcare access. Given the historical context of redlining in Kansas City, this is largely segregated by neighborhood. First Call KC will partner with agencies that can provide space to bring in-person healthcare and wellness services.
KC CARE Health Center
KC CARE seeks to improve the overall patient experience by developing a Patient Journey Map designed around the lived experiences of specific patients facing historical health inequities. The Patient Journey Map is a management tool which immerses decision makers into the lived experience of patients and develops responsive, measurable action plans. KC CARE’s Patient Journey Map will focus on three specific patient profiles of diverse ethnicities, genders, insurance statuses, and factors related to Social Determinants of Health.
Mission Vision Project
The Physician Pipeline Project aims to increase the number of highly qualified students of color in Kansas City metro area medical schools. This program will be geared towards high school students from Lincoln Prep and Sumner Academy.
Newhouse is developing a campus model to support survivors of domestic violence who need wide-ranging services at multiple levels. Our goal is to partner across social services industries and governmental entities, and with community leaders, philanthropists, and law enforcement agencies. No standardized practice exists to collect or share client data between domestic violence agencies, which may result in incomplete and/or inaccurate profiles. A campus model reduces or removes barriers to access services, creates equity and increased capacity to high-quality and culturally grounded services, leads to better data collection and management around impact, reduces recidivism and future needs, saves agencies money through the efficiencies it creates in the social services system, and eliminates the re-traumatization of survivors having to repeat their story to access services from various agencies.
People living in Wyandotte County who are not currently insured, and are facing significant illnesses – such as a cancer diagnosis – face extreme barriers to accessing care. Latino residents especially have faced challenges due to bureaucracy around immigration status and a lack of identification documents. People without insurance coverage and citizenship documentation have been turned away, except in the case of an emergency or medical necessity as deemed by a provider. The ¡Ni Uno Más! (Not One More) project aims to change hospital policies so that they do not exclude patients based on their immigration status.
ReDiscover is working to create a sustainable Behavioral Health Equity Plan in the Action community. Through this work, the project will reduce barriers for Black, African American, Latinx, and Hispanic people accessing behavioral health services and mitigate the reasons folks end their participation in behavioral health services too soon. ReDiscover will partner with community members to conduct listening sessions that will inform the content of the Plan.
Race, Ethnicity, and Language Data Collaboration and Capacity
The collection and availability of disaggregated information about race, ethnicity, and language (REL data) is a vital component of the data infrastructure necessary to address and improve health equity. Building on the engagement and work of the HE LAN, there is an opportunity to further engage organizations across the health and health care ecosystem to catalyze a shared understanding of the importance of this data. We aim to advance regional capabilities, practices, and capacity to collect, store, and use REL data. The work will need to recognize and address the human interactions that are at the heart of data collection and this perspective must be represented across the practices associated with storage and use of REL data. This work will drive transparency and accountability around identifying and addressing care gaps and health inequities among those most impacted by systemic racism and health inequities.
Participating organizations: BioNexus KC, BlueKC, Health Forward Foundation, KC CARE Health Center, KC Health Collaborative, Vibrant Health, and Wyandotte Community Health Council
Saint Luke’s Health System
One of the primary goals of Saint Luke’s is to achieve health equity for all patients. Saint Luke’s seeks to allow every person to attain their full health potential. One area of focus is improving blood sugar control in patients with diabetes. Saint Luke’s strives to minimize racial disparity in blood sugar control by partnering with African American patients in a cohort to develop strategies to help improve their health outcomes. Participants will include adults diagnosed with diabetes who are enrolled in Saint Luke’s Longitudinal Care Management program and who are experiencing a high level of social vulnerability.
In recognizing the importance of Social Determinants of Health, Swope Health began collecting data on food insecurity in 2020. However, it does not have sufficient data indicating whether its referrals to Harvester’s Food Bank improved outcomes for its patrons. Through the action community project, Swope Health will analyze the data to identify gaps in care to ultimately improve chronic disease outcomes. Improved outcomes in food insecurity would identify a pathway for Swope to address other social determinants in the future.
The University of Kansas Health System
Using targeted data analyses, and patient-centered and evidence-based interventions, the University of Kansas Health System will identify and close equity gaps in health outcomes caused by historical structural racism in Kansas City. Through the action community, this work will be focused on the Primary Care and Obstetric population within Wyandotte County. It will accomplish this work by identifying health equity gaps, engaging patient representatives in improvement planning, and developing a plan to establish a Community Health Worker program in Wyandotte County.
Unified Government Public Health Department of Wyandotte County
This project is taking a clear and critical look at the Unified Government Public Health Department’s internal policies and practices to understand where structural racism is upheld in these policies and make recommendations while urging local government leaders to acknowledge structural racism and its impact on the health of our residents as a public health crisis.
Race-based medical practices are outdated, inaccurate tools that uphold individual and structural racism and have a negative effect on patients. The current method of measurement of one’s estimated glomerular filtration rate (eGFR) is based on the patient’s race. At present, many laboratories opt to use mathematical equations to estimate eGFR as opposed to measuring it using traditional methods. These equations produce two results, one for Black patients and one for non-Black patients. This weighted difference is causing disparate measurement of disease acuity, disparate referral for treatment, and disparate referral for kidney transplantation within Black patient populations. This project seeks to solve for equitable measurement of kidney disease acuity, increased access to equitable treatment options, and equitable referral for transplants within Black patient populations.
Historically, researchers and policymakers whose work impacts Black communities have not been held accountable for the results of their work. The Community Expert Review Board (CERB) works to make policymakers and researchers who are focused on maternal and infant health, and who work in Black communities, aware of the negative impacts of their work when research is done without accountability. The CERB offers community engagement, partnership, and leadership to help researchers and policymakers see Black community issues through an equity and antiracism lens.