When AtlantiCare opened a new, $38.3 million Medical Arts Pavilion Nov. 15 in Atlantic City, the regional health care system noted the event signaled its commitment to “addressing health disparities, communitywide health equity, and training the next generation of physicians.” For many people, health equity is a life-and-death matter — a resident in an upscale location, like New Vernon’s 07976 zip code, for example, can expect to live 22 years longer than someone who lives in Trenton’s 08608, according to a New Jersey Hospital Association report.
“‘Equity’ means ‘fair,’’ said Lori Herndon, AtlantiCare president and CEO, and chair of the New Jersey Hospital Association board. “We believe equity in health care means everyone, regardless of differences and diversity, has the same opportunity to achieve good health, and that the care and services so many of us take for granted are available to all.”
The three-story, 69,700-square-foot Medical Arts Pavilion – which received $15 million and land from the New Jersey Casino Reinvestment Development Authority – will play a big role in this initiative by enhancing “access to quality care for the Atlantic City community,” she added. “Here we’ll expand our Maternal Fetal Medicine, Family Planning and Safe Beginnings programs aimed at giving mothers, babies and families healthy starts to life. We’ll also expand our Federally Qualified Health Center services, including our pediatrics and family medicine clinics. We’ll add a dental clinic and other services next year. We also recently opened an LGBTQ+ Health Center in Atlantic City.”
To address barriers like lack of access to transportation and nutritional foods, “We offer transportation to medical appointments for residents of Atlantic City, a year-round food pantry and a summer lunch and learn program at our William L. Gormley AtlantiCare HealthPlex in Atlantic City,” Herndon said. “Health literacy is critical. Our employee resource groups host staff and community outreach educational, cultural and health and wellness events that engage the communities in getting care. We also look forward to increased collaboration and conversations with government and other regulatory agencies in creating data collection templates and guidelines aimed at achieving inclusive care environments.”
Defining the issues
In the health care context, there are subtle, but important differences between “equal” and “equitable,” observed Stephanie Fendrick, Virtua Health’s executive vice president and chief strategy officer. “Equality is where everyone is treated the same, equity is a lot deeper,” she said. “Our focus on health equity recognizes the diversity of life experiences within the communities we serve, and that we need to consider the societal, economic and other issues that impact access to care and quality of life. Doing so helps ensure everyone has the opportunity to be as healthy as possible.”
Virtua Health has responded to health care equity issues like food insecurity “with a portfolio of programs that position food as a form of medicine,” Fendrick added. “The Eat Well Mobile Grocery Store, for example, is a year-round, 40-foot mobile store store-on-wheels that offers fresh, healthy, and culturally relevant foods at below-market prices to residents of Camden and Burlington counties – particularly in food-desert communities that experience higher rates of obesity, diabetes, and other diet-related diseases.”
A sister program, the Eat Well Mobile Farmers Market, provides access to produce year-round with a 23-foot bus that sells fruits and vegetables at significantly reduced prices in communities throughout Burlington and Camden counties. Virtua also operates a Pediatric Mobile Services Program for children in underserved communities and mobile cancer screenings for individuals who are uninsured or underinsured. And for people who lack a means of transportation to their health care provider, Virtua provides access to rideshare and taxi services.
Other institutions are also tackling health care equity issues.
“I define equity as delivery of fairness, aiming to the highest standard, in quality, allocation of resources and accessibility to services based on the knowledge of the communities that we are engaging,” said Nicole Harris-Hollingsworth, vice president of social determinants of health at Hackensack Meridian Health. “It is not necessarily everyone getting the same thing, but everyone getting the resources they need to achieve their best health.”
Besides offering workshops, educational sessions and other services in multiple languages, “HMH also provides no cost access to an electronic community resources directory in 152 languages, which can be shared by email, print or text message,” she noted. “And the Healthy Connections program, which I lead, focuses on addressing the social needs that arise due to the social determinants of health, five non-medical factors that Hackensack Meridian Health determined impact a patient’s health, including food security, housing stability, transportation access, caregiver support and mental health/substance abuse treatment.”
Studies show patients are more likely to listen to the advice of a physician who shares the same race, ethnicity and culture as them, Harris-Hollingsworth added. “This means especially in a state like New Jersey with one of the nation’s most diverse populations, it is imperative to have a diverse staff of doctors and nurses who speak the same language of patients and can relate to them on a personal level.”
Toward that goal, nearly half of the class admitted in 2020 to the Hackensack Meridian School of Medicine “was female, and students speak 33 different languages,” she explained. Half of the class identifies as persons of color (other than white), and a quarter are from groups categorized as under-represented in medicine. More than half of School of Medicine graduates have gone on to residencies at Hackensack Meridian Health hospitals.
Saint Peter’s Healthcare System is also taking steps to reinforce connections with the communities it serves, according to Dr. Alma Ratcliffe, vice president and chief clinical transformation officer at SPHS. “At Saint Peter’s we serve a very diverse population, and we want our providers to reflect that.”
The process goes beyond simply “asking the right questions,” noted Ishani Ved, Saint Peter’s director of transformational population health and outcomes. “The next step is to put patients in touch with the right medical and non-medical resources. At Saint Peter’s Family Health Center in New Brunswick, for example, we have started to screen patients using the national PRAPARE [Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences] questionnaire, as a way to identify social determinants that may have a significant effect on their health outcome.”
In fact, physicians traditionally are limited to addressing only 40% of a patient’s total health determinants, Ratcliffe added. “No matter what we do, 60% of the outcome depends on socioeconomic, behavioral and other outside factors. So, our screening process helps to identify a patient’s entire health spectrum.”
New Jersey health systems’ drive to achieve equity is being noticed. “At Hunterdon Health, we view health equity as attaining full health potential for our patients regardless of socially determined circumstances,” said Dr. Geralyn Prosswimmer, chief medical officer at Hunterdon Health care Partners. “One example of our commitment to health equity is our ‘LGBTQ+ Health care Equality Leader’ designation from the Human Rights Campaign, where we scored 100 points in their Health Equality Index.”
That commitment to equity in health care includes “Spanish language initiatives, obtaining grant funds targeted at transportation for medically fragile patients, adding social workers whose role is specifically focused on addressing social determinants of health, language translation services, enhanced technology to support the hearing impaired and our collaboration with Grow-A-Row to provide fresh produce,” she added.
Hunterdon Health is also taking steps to quantify the success of its efforts. “Our robust and mature population health program is able to identify discrepancies in health status based on social determinants of health and devise interventions to improve,” she explained. “We create dashboards, for example, which compare health indicators for LGBTQ persons and Latinx persons to our general population.”
The next frontier
In June, coinciding with Pride Month, Virtua Health opened a primary care practice in Marlton. It’s designed to serve as a “safe space” for members of the LGBTQ+ community, while offering a range of specialized health screenings and services. “Our vision at Virtua Health is to be the region’s trusted choice for personalized health care and wellness,” said Dennis Pullin, president and CEO of Virtua Health (he/him). “Virtua Pride Primary Care reflects that intention by offering services that are meaningful and necessary in an environment that is welcoming and inclusive.”
Specialty services available at Virtua Pride Primary Care include gender-affirming care; HIV testing, prevention, and management; sexual health; medication-assisted treat-ment for opioid and alcohol abuse; and behavioral health services. Two Virtua physicians lead it: Dr. Shanin Gross (they/them) and Dr. Richard Levine (he/him).
Brandon Balcom (he/him) a travel-services professional in Collingswood, is among the many local people eager to receive care at Virtua Pride Primary Care. Balcom and his husband, Dane Cox (he/him), moved to New Jersey from Minneapolis in early 2022 for Cox’s work managing an insurance office. “In the seven years I lived in Minnesota, I never found a primary care practice that offered this type of specialized care,” Balcom said. “There’s a level of comfort that comes with an organization that thinks holistically about all aspects of health. It informs how the doctor interacts with you, the questions they ask, and the considerations they anticipate.”