A new guidebook drafted by experts convened by the Robert Wood Johnson Foundation (RWJF) has set forward to provide actionable recommendations for how healthcare organizations can address health equity.

The guidebook, Raising the Bar, outlines a set of five foundational principles that RWJF and partner organizations said can help healthcare organizations actually deliver on the promise of health equity. 

Health equity has become something of a buzzword, particularly after the COVID-19 pandemic exposed the latent health disparities that have long plagued US healthcare. Provider organizations and health systems responded to growing discussions of health disparities by making health equity pledges.

But although likely well-intentioned, committing to health equity can be an abstract goal, the report authors noted.

“Broad transformation remains too slow and often focused on narrow fixes to the most visible problems; the healthcare system, as it has evolved, is not delivering on key health goals, frustrates many of its participants, and often fails those most in need,” they wrote.

READ MORE: Risk of Hospitalization Tied to Food Insecurity, Social Determinants

“The COVID-19 public health emergency and the national reckoning over equity and racial justice have amplified the importance and opportunity for change and shows the need for a new path for healthcare in recovering from the scope of overwhelming need.”

Raising the Bar was authored by experts convened by RWJF, including folks at the Funders Forum on Accountable Health, Health Care Transformation Task Force, National Association of Community Health Centers, the National Partnership for Women & Families, RESOLVE, Social Intervention Research & Evaluation Network, Trust for America’s Health and Well-Being and Equity (WE) in the World.

“Healthcare leaders have made a significant shift in how they view the importance of equity, but operationalizing the commitment requires a very bold and comprehensive approach. Ultimately, it requires taking actions to improve the community, patient care, workforce policy and other areas,” Donald Schwarz, MD, MPH, MBA, senior vice president at the Robert Wood Johnson Foundation, said publicly.

“Achieving equity in healthcare is multi-pronged and must ultimately be integrated throughout all operations,” Schwarz continued. “This new framework outlines how healthcare can approach its work differently to achieve much-needed change.”

Together, the organizations put forward five core principles that should guide organization health equity work, including:

• Mission: creating a mission to improve health and well-being of all patients
• Equity: pursuing health equity and racial justice, as well as eliminating discrimination
• Community: working to serve the whole community as an engaged, responsive, and informed partner
• Power: sharing and effectively using resources and influence
• Trust: building, earning, and sustaining trusting relationships with key stakeholders and populations

READ MORE: Fewer Than 2% of Hospitals Excelling at Health Equity, Value

In addition to outlining foundational principles, Raising the Bar pointed out key roles healthcare organizations need to play in order to deliver on their promises for health equity.

Foremost is the provider role with which organizations are likely most familiar. Raising the Bar said organizations need to focus on their strategies to deliver whole-person, patient-centered care that prioritizes health equity by eliminating health disparities.

That means creating innovative strategies to facilitate patient access to care, creating and sustaining an environment that prioritizes cultural competency and personal safety, and providing holistic and high-quality care that considers the social determinants of health.

Second, organizations must understand their roles as employers. Most health systems are the biggest employers in their communities, providing jobs to clinicians, administrators, service staff, and other folks that keep hospital operations running.

Decisions about clinician workforce diversity, equal representation, healthy and safe working environments, and DEI efforts will be crucial in this area, Raising the Bar said.

READ MORE: 5 Steps to Building the Link Between Public Health and Health Equity

Next, organizations should look at themselves as partners, something that has come to the forefront as community health partnership has shown promise for improving health outcomes. Involving community members in organization governance, building relationships with trusted leaders and community organizations, and respecting the expertise of those community partners will be key.

Finally, organizations must understand their roles as advocates with a lot of influence. Pushing for payment reforms that emphasize health equity, engaging the public in the importance of dismantling institutional racism, lobbying for health equity in public policy, and investing in the community should all be paramount for organizations pledging health equity.

Raising The Bar represents one effort at creating a playbook by which organizations can craft their health equity priorities. Health disparities existed long before COVID-19, but the pandemic served as a catalyst to push many organizations to promise action.

There hasn’t been an established roadmap for achieving health equity, most experts have acknowledged. But as more organizations begin to broach the issue, Raising the Bar has the potential to convene those experiences into a set of best practices.

“Long-standing structural and systemic challenges within healthcare are well-known, but the pandemic underscored the imperative to confront root causes of health inequities,” said Karen DeSalvo, MD, Raising the Bar Stewardship Council co-convener, co-founder NASDOH.

“Raising the Bar solicited input from all sectors and everyone who shares concerns about the current healthcare system, and they all see the need for bold action, but direction on concrete steps to take has been lacking,” DeSalvo added. “Now there is a clear framework to guide the work.”

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Findings support personalized public health interventions to help close gaps.

Research supported by the National Institutes of Health shows that cardiovascular-related deaths have declined over the past two decades, but disparities remain. [NIH News 7.18.2022]

Researchers found that inequities are mostly driven by differences in race and ethnicity, geographic location, and access to care, among other factors. The findings were published in Circulation, and the research was partially funded by the National Heart, Lung, and Blood Institute (NHLBI), part of NIH.

In one paper(link is external), researchers analyzed data from the Centers for Disease Control and Prevention and found that, after adjusting for age, rates of cardiovascular disease-linked deaths dropped among Black and white adults between 1999 and 2019, as did heart disease-related disparities between the two groups. However, Black adults continue to experience higher death rates than white adults, especially in rural or segregated areas, according to the researchers.   

“The persistent disparities observed in our study likely reflect the fact that Black adults disproportionately experience social, economic, and environmental barriers to optimal health due to systemic inequities and structural racism,” said Rishi K. Wadhera, M.D., a section head of Health Policy and Equity at the Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center and an assistant professor of medicine at Harvard Medical School, Boston.   

Download full article here> 

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As the highly transmissible BA.5 subvariant spreads nationwide and the federal government is encouraging booster shots for eligible adults, some experts are questioning whether it's time to update the definition of "fully vaccinated."

COVID-19 cases have increased 16 percent over the past two weeks, while hospitalizations have jumped 19 percent, according to data tracked by The New York Times. The increases come as BA.5 accounts for an estimated 65 percent of U.S. cases, according to the CDC. [Becker's Hospital Review 7.14.2022]

The Biden administration outlined its strategy to combat this rise in cases and hospitalizations July 12, urging all eligible people to get their first booster dose if they have not done so yet. Federal officials are also considering plans to make second COVID-19 boosters available to all adults, pending sign-off from the FDA and CDC, several administration officials told The Washington Post on the condition of anonymity.

While research shows BA.5 can evade immunity from vaccination and past infection, vaccines are still effective at protecting against severe disease, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said during a July 12 White House briefing.

Some experts have been critical of the White House's decision to encourage booster shots without changing the definition of fully vaccinated.

"The only new action from the White House BA.5 briefing was an admonishment to 'Get your booster!,'" former U.S. Surgeon General Jerome Adams, MD, tweeted July 14. He went on to criticize the administration for not expanding second booster eligibility or changing the definition of "fully vaccinated," which he said currently "implies you don't need a booster."

Based on the CDC's definition, individuals are considered fully vaccinated against COVID-19 if they've received their primary series, which entails two doses of Pfizer or Moderna's vaccine or one dose of Johnson & Johnson's. The CDC says people who receive recommended booster doses are "up to date" on their vaccines and best-protected, but the agency has not formally included boosters in its definition of being fully vaccinated. 

Eric Topol, MD, founder and director of the Scripps Research Translational Institute in San Diego, has also called for the CDC to change its definition of fully vaccinated to encourage boosters, according to The Hill.

"What country has a lower booster rate than Iran, Rwanda, Sri Lanka, Azerbaijan, Tajikistan and 61 others?" he tweeted July 11. "The United States."

Health experts' calls for a definition change are not new; many experts pushed for the change last winter amid the original omicron surge. In January, CDC Director Rochelle Walensky, MD, said the agency had no plans to require a booster shot for people to be considered fully vaccinated against COVID-19. It's unclear whether the agency's stance may change amid the current surge. 

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Members of the FDA's Patient Engagement Advisory Committee shared their concerns about augmented reality and virtual reality health care devices at the second day of a PEAC meeting on the topic held Wednesday (July 13), asking how reliable information about the technologies would reach patients and caregivers and what role FDA might play.[Inside Telehealth 7.14.2022]

Sign up and receive this full article here> https://insidehealthpolicy.com/inside-telehealth-daily-news/fda-advisers-how-do-patients-get-virtual-reality-device-risk-efficacy. 

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As the highly transmissible COVID-19 omicron subvariant BA.5 now accounts for 65 percent of cases in the U.S., concerns are rising over the potential for a new surge. However, experts predict it will not be as devastating as past surges.

"BA.5 is doing what omicron does but with a marginally more effective immune evasion," Meaghan Kall, an epidemiologist at the U.K. Health Security Agency Kall, told The Atlantic on July 12. "I don’t believe that it represents a massive paradigm shift."

COVID-19 hospitalizations in the U.S. have risen 18 percent over the past two weeks, with a daily average of 38,517 people hospitalized as of July 12, according to HHS data tracked by The New York Times. Cases have also increased by 19 percent, with 129,858 new cases as of July 12, Times data shows.

"People shouldn’t be surprised if they get infected, and they shouldn’t be surprised if it’s pretty unpleasant," Stephen Goldstein, PhD, a virologist at the University of Utah, told The Atlantic.

Richard Besser, a former acting director of the CDC, told The Hill on July 13 the "sheer volume" of infections would likely lead to a rise in hospitalizations but that he did not think it would be "anywhere near the numbers we saw with the previous omicron surges."  

Dr. Goldstein also told The Atlantic he takes "some level of comfort" in the fact that other countries have used vaccines to keep the severity of BA.5 waves low.

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To curb the COVID-19 devastation on communities of color, vaccine plans must prioritize equity | Do we need to revisit this? 

To curb the COVID-19 devastation on communities of color, vaccine plans must prioritize equity The COVID-19 pandemic has disproportionately impacted communities of color with rates of illness and death that far exceed their representation in the population. The pandemic also has exposed and worsened pre-existing inequities in access and opportunities, which unfortunately includes access to COVID-19 testing, treatments and, now, vaccinations. Since the initial rollout of COVID-19 vaccines in the United States in December 2020, more adults have become eligible for the vaccine over time. By May 1, 2021, all adults 18 years of age and older were eligible to receive the COVID-19 vaccine. However, vaccination disparities have continued to increase despite the expansion of eligibility. 

Full document- download here> 

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Now through July 15, CCH will be offering a $100 Visa gift card to anyone age 6 months and older who gets a vaccine or booster shot at a participating Cook County Health hospital or health center. Appointments are required. Gift cards are available while supplies last.

Make an appointment at vaccine.cookcountyil.gov.

You can also make an appointment by calling the CCH COVID Hotline at 833-308-1988 between the hours of 7:00am and 6:00pm Monday through Friday.

Provident Hospital’s Sengstacke Health Center has vaccine for adults and children. Appointments for that location must be made by calling the hotline at 833-308-1988.

The time is now to make sure your whole family is up to date on their COVID-19 vaccines!

The FDA and CDC recently approved the Pfizer and Moderna COVID-19 vaccines for children 6 months through 4 years. Vaccines for young children are available at all CCH health centers.

Booster shots are now also recommended for all people age 5 and older.

Getting vaccinated helps to protect your child against serious illness, and to prevent your child from spreading COVID-19 to more vulnerable family or friends.

Data show that the vaccines are safe and effective for young children. In fact, they often have fewer side effects from the vaccine than adults.

Families are encouraged to talk to their pediatrician about vaccination and to get vaccinated at their doctor’s office.

Children under age 18 must be accompanied by a parent or guardian to get vaccinated.

Beginning on July 16, People who are not currently CCH patients will be able to visit one of five community COVID-19 vaccine and testing sites: Stroger Hospital, Provident Hospital, Arlington Heights Health Center, North Riverside Health Center or Blue Island Health Center. Current CCH patients will still be able to get COVID-19 tests, vaccines and booster shots at their doctor’s office.

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Immunocompromised individuals made up 12.2% of all COVID-related hospitalizations, despite accounting for only about 3% of the U.S. population, a CDC report showed. [MedPage Today 7.8.2022]

— Once hospitalized, no mortality difference between vaxxed and unvaxxed immunocompromised patients

And once hospitalized, there was no difference in the risk for death between vaccinated and unvaccinated immunocompromised patients, reported Jason Robert Singson, MPH, of the California Emerging Infections Program in Oakland, and colleagues in the Morbidity and Mortality Weekly Report.

Among vaccinated adults, those who were immunocompromised had higher odds of intensive care unit (ICU) admission (adjusted odds ratio [aOR] 1.40, 95% CI 1.01-1.92) and in-hospital death (aOR 1.87, 95% CI 1.28-2.75) compared with non-immunocompromised patients.

Full article here> 

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The FBI today issued a “white” joint cybersecurity advisory warning of ransomware threats against the U.S. health care and public sectors. The bureau said the threat stems from the North Korean state-sponsored “Maui” ransomware platform, which has been in use by cyber actors since at least May 2021. The FBI, jointly with the Cybersecurity and Infrastructure Security Agency and the Department of the Treasury, released resources, tactics, techniques and procedures, along with indicators of compromised systems, with the recommendation that organizations apply mitigation strategies and not pay ransom demands. [American Hospital Association 7.6.2022] 

Download full notice here> 

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New Prescribing Authority Could Improve Access for Some Patients at High Risk for Severe COVID-19 

FDA US Food & Drug Administration

New Prescribing Authority Could Improve Access for Some Patients at High Risk for Severe COVID-19 Today, the U.S. Food and Drug Administration revised the Emergency Use Authorization (EUA) for Paxlovid (nirmatrelvir and ritonavir), to authorize state-licensed pharmacists to prescribe Paxlovid to eligible patients, with certain limitations to ensure appropriate patient assessment and prescribing of Paxlovid.  "The FDA recognizes the important role pharmacists have played and continue to play in combatting this pandemic," said Patrizia Cavazzoni, M.D., director for the FDA's Center for Drug Evaluation and Research. "Since Paxlovid must be taken within five days after symptoms begin, authorizing state-licensed pharmacists to prescribe Paxlovid could expand access to timely treatment for some patients who are eligible to receive this drug for the treatment of COVID-19."  When testing positive for COVID-19, patients should first consider seeking care from their regular health care provider or locating a Test-to-Treat site in their area. While this action allows state-licensed pharmacists to prescribe Paxlovid with certain limitations as described below, community pharmacies not already participating as a Test-to-Treat site can decide if or how they will offer this service to patients.   Patients who have tested positive for COVID-19 and are seeking to determine their eligibility for receiving Paxlovid at locations where prescribing by state-licensed pharmacists is available should bring the following information to ensure that the state-licensed pharmacist has sufficient information to determine their eligibility to receive Paxlovid: Electronic or printed health records less than 12 months old, including the most recent reports of laboratory blood work for the state-licensed pharmacist to review for kidney or liver problems. State-licensed pharmacists could also receive this information through a consult with the patient's health care provider. A list of all medications they are taking, including over-the-counter medications so the state-licensed pharmacist can screen for drugs with potentially serious interactions with Paxlovid.  Under the limitations outlined in the authorization, the state-licensed pharmacist should refer patients for clinical evaluation with a physician, advanced practice registered nurse, or physician assistant licensed or authorized under state law to prescribe drugs, if any of the following apply: Sufficient information is not available to assess renal and hepatic function. Sufficient information is not available to assess for a potential drug interaction. Modification of other medications is needed due to a potential drug interaction. Paxlovid is not an appropriate therapeutic option based on the current Fact Sheet for Healthcare Providers or due to potential drug interactions for which recommended monitoring would not be feasible.   Paxlovid is authorized for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kilograms or about 88 pounds) with positive results of direct SARS-CoV-2 viral testing, who are at high risk for progression to severe COVID-19, including hospitalization or death. Patients in the authorized population who report a positive home test result from a rapid antigen diagnostic test, or a positive PCR test, to their provider are eligible for Paxlovid under the EUA. Confirmation of a positive home rapid antigen diagnostic test with additional direct SARS-CoV-2 viral testing, such as a PCR, is not required. Antibody tests are not considered to be direct SARS-CoV-2 viral tests. ###