Derek van Amerongen, MD, MS: For the benefit of our listeners, are there any down-in-the-weeds, nitty-gritty things that you're instituting at your organizations from the peer perspective, or from the front-line offices, that would facilitate this?

Sharon Deans, MD, MPH, MBA: That's a good question. I think the most important thing is I have doctors reporting to me, and we always have questions when the clinical trials come through. They say, “We don't cover clinical trials.” And I say, “We don't cover their medication, we don't cover experimental [treatment], but we do cover all of the services.” We encourage them. If our members have been selected for these trials, we do everything we can to support them during the course of treatment so we all can learn from that. We want to make sure that everyone is well-informed on the payer side and exactly where we stand. It's curious that you bring this up, because we just had a chat about this a couple of days ago, on whether or not everybody was aware that we covered the services for clinical trials and experimental therapy. And we had to update folks to make sure everyone is well-educated within the payer space around that. And then we do our own studies. We've done some studies around telehealth and enrolling patients. Looking at their race and ethnicity, looking at ZIP codes, whether you're rural or urban, and understanding the needs in those areas, and then, how do we get them enrolled in telehealth, and targeting those particular populations to get them to engage in that way. In our Missouri plan, we set up kiosks at our storefronts and brought them in to learn how to use the iPads and how they can access these telehealth resources, so they can get services when they weren't able to get to a doctor's office as well.

Derek van Amerongen, MD, MS: And learning how to leverage that new technology.

Sharon Deans, MD, MPH, MBA: Exactly.

Derek van Amerongen, MD, MS: Dr Wells?

Roxie Cannon Wells, MD: We spend a lot of time talking about how we educate the patient, but I think there's still education needed for providers, for physicians, for hospitals, for clinicians. And I think the primary care piece is extremely important. That's a source of trust for individuals, particularly Black women, or women in general. I think that that's a source of trust and in our system, we work very hard to make sure that our primary care providers and just our providers, in general, understand the importance of them understanding the importance of clinical trials, and being open to talking with their patients about it, so that patients understand that they can be a part of these clinical trials. I think making sure that we're not only educating the patient, but we're educating providers as well, is extremely important.

Derek van Amerongen, MD, MS: Dr Hawkins, any final comments?

Soyini Hawkins, MD, MPH, FACOG: For us, as a private practice and on that level, it's about the culture. It's about the culture of my staff. It's about them understanding what the trials are, or even looking at disparities and identifying them and how we, at our level, could be impactful in making sure that we're not missing places where we need to meet our patients. It's a culture. It's a culture that I try to emphasize to everyone from my front desk, where I'm going to make sure that I have Hispanic-speaking staff so when my patients come in and they need that to break that language barrier, that's accessible to them, all the way to the individuals who are conducting my clinical trials. I'm hiring and investing my time and efforts for our practice, but also for the trial and the subjects and the patients that we have into people who are going to be valuable enough to make sure that we're ethical and absolutely upstanding in everything that we do in those aspects of the trial.

Derek van Amerongen, MD, MS: Reiterating the concept of transparency.

Soyini Hawkins, MD, MPH, FACOG: Absolutely.

Derek van Amerongen, MD, MS: Yes. Excellent. Well, thank you, doctors. Excellent discussion.

Soyini Hawkins, MD, MPH, FACOG: I have a question. Do you guys think that it has been asked and answered as to why individuals do not check the box when it comes to race and ethnicity? Is there a fear that if they tell us their race or ethnicity they may be marginalized, or the information not be recorded as is? Is there distress there as well?

Sharon Deans, MD, MPH, MBA: I do think so. I think it goes back to trust and whether or not they'll be excluded from opportunities if they answer the question, whether or not their application will even be received if they answer the question. I think the other thing is it's almost a little bit of too much big brother, particularly for Medicaid patients. They're asked a lot of really intimate questions along the way. Some of it's a little bit of power. It's something they don't have to answer. They go on to the next question. The other part of it is that the applications are quite complex. They're not easy to navigate. I think folks could just be skipping over because there are more complex questions or they've answered a whole set of complex questions. But I do think it boils down to trust and whether or not they'll be marginalized if they answer the question, excluded, or if the application will even be picked up. None of that really plays out, but this is the environment that we live in and the trust that we have to build.

Roxie Cannon Wells, MD: I think it's not only about whether they will be excluded, but there's a consideration of if they will be included in something that they don't necessarily want to be included in. I think that we've seen that in other industries where, whether it was banking or what have you, where they were included in areas that they did not necessarily want to be included in. I think it's both. Am I going to be excluded? But on the other end, am I going to be included?

Derek van Amerongen, MD, MS: Excellent points.

Transcript edited for clarity.