Building Community-Level Solutions to Address Health Disparities: A Q&A With Dr Joneigh Khaldun

In aiming to address structural barriers to equitable care, CVS Health recently launched the Community Equity Alliance that will be partnering with academic and health care institutions that are representative of underserved communities nationwide to strengthen access to community health workers and health care services.

Disparities in cardiovascular health, mental health, and women’s health will be a major focus for the Alliance, which will aim to elevate and integrate the voices, needs, and experiences of local communities to drive evidence-based strategies, noted Joneigh Khaldun, MD, MPH, FACEP, vice president and inaugural chief health equity officer for CVS Health.

In an interview with The American Journal of Managed Care® (AJMC®), Khaldun spoke on current gaps in data regarding health inequities and disparities, how the personalized insights derived from community-level conversations will be integrated into CVS Health’s overall health equity strategy, and the short- and long-term goals for the Alliance.

AJMC®: ​​Can you speak on your goals and priorities in your role as Chief Health Equity Officer at CVS Health?

Khaldun: It certainly is an honor to be the inaugural Chief Health Equity Officer for CVS Health. My role is really to look across the entire company, looking at our processes, policies, and programs, and working to develop and implement strategies to help ensure that our members, customers, clients, the communities that we serve, are served in the best way so that they can be healthy.

So, we've really aligned our enterprise health equity strategy around 3 core areas. One is around empowering the over 300,000 colleagues that work for CVS Health, and this means making sure they have a robust understanding of the communities that we serve and how disparities may show up so that they can do something about it in their everyday work with the company.

The second pillar is around data and making sure that we understand with granularity how disparities across things like race, ethnicity, preferred language, sexual orientation, gender, gender identity, disability status—how we're seeing potential disparities show up in those communities so that we can then do something about it.

Then our third pillar is around those bold actions that address disparities. And we're particularly focused on heart health, mental health, and women's health in addressing disparities in those areas.

AJMC®: ​​CVS Health recently announced the launch of its Community Equity Alliance that will be partnering with health care and academic institutions, with the first 3 partners being Meharry Medical College, Sinai Chicago, and Wayne State University. Can you speak on how the Alliance will work with these institutions in identifying and addressing community-level health disparities?

Khaldun: I'm really excited about our recent launch of the CVS Health Community Equity Alliance. Through this alliance, we're bringing together health care and academic institutions across the country to really strengthen access to community health workers and to health care in underserved communities. So, the alliance is not only expanding access, but it's particularly focused on addressing heart health and mental health disparities, which are our core aspects of our health equity strategy.

So, it's important through this alliance we’re really partnering with organizations that are important pillars and providers of services in underserved communities. Really focusing on strengthening those health care and community relationships, but also elevating and integrating the local voices—those people who are on the ground—integrating that into health care so that we can address disparities.

It's important to know that for this alliance, each relationship and each partner—what they're doing in the community—is slightly different. And that's because every community is different, their strengths are slightly different, and what they need is slightly different.

AJMC®: ​​You mentioned how these strategies will be different based on each community. Health inequities have persisted for decades but the amount of research on their impact is limited. What quality metrics or data trends have CVS Health utilized in forming their evidence-based interventions, and how will these strategies be personalized to each respective community?

Khaldun: I agree, we know that inequities exist and we've known for decades the disparities in outcomes, but there's still gaps, as you noted. So, as part of our health equity strategy, we're standardizing and increasing how we collect health equity data across all of those demographic factors that I spoke about earlier.

So, we're seeking a better understanding of disparities within those groups. But also, once we have that information, getting very granular, so that we can make sure that those subpopulations aren’t invisible when it comes to disparities, and they're not ignored. We're understanding the local needs, the local experiences of health care, and what disparities may exist, and we're using that to inform how we show up in communities.

When it comes to the Community Equity Alliance, we're learning from people with lived experience within communities and that information is being shared back with us so we can actually inform how we're working with the members of our health plans, how we're working with our customers who are coming to our retail stores or our Minute Clinics. And so that local connection is really, really important when it comes to advancing health equity.

AJMC®: ​​In looking to the near future, what are some short- and long-term goals for the Community Equity Alliance?

Khaldun: So, we certainly will learn as we go, but one of the goals is really to just create those meaningful collaborations and investments in communities that really align with our company vision for health equity. It's also important for all of the first 3 partners of the Alliance who are doing this—supporting that pipeline of community health workers is a really key lever to connect communities to care, build trust, and to address disparities.

Then finally, it's about understanding those local drivers of health disparities in heart health and mental health particularly. The information that we learn from these partners will actually help inform how we roll out our health equity strategy and how we show up in communities.

AJMC®: ​​What is a disparity in health care that you think doesn’t get as much attention as it should?

Khaldun: That's an excellent question. One of the things I've noticed is that people think that all disparities are because of social or nonclinical determinants of health. So, things like access to a car, transportation, a good job, healthy housing—those things are really important, but they are not sufficient for us to be able to advance health equity comprehensively.

There's one particular disparity that I’d like to talk about, and that's around maternal mortality—the fact that a Black woman who has a Bachelor's degree or higher is 1.6 times as likely to die from a pregnancy-related complication as a White woman who does not have a high school diploma—that tells you right there, there's something else.

You can give everyone a house, a car, and a good job, but you will still see these disparities, and that is because of the bias and the discrimination that we see in our health care system, but also across other systems, including education, housing, etc. That's why we see disparities. So, if we're really going to advance health equity, we have to move beyond just talking about social determinants of health and really get at the bias and the discrimination that exists in our health care system.