The need to address disparities in cancer screening rates is an oft-discussed issue in healthcare. Strategies on how to address the issue are less straightforward, leaving many leaders searching for answers in the successes of other health systems.
One such success story comes from York, Pa.-based WellSpan Health, where cancer screening rates recently improved through the National Committee for Quality Assurance’s health equity accreditation program.
Over the course of one year, breast cancer screening rates improved by 6.31% and colon cancer screening rates improved by 8.73% among people of color in WellSpan’s community.
WellSpan’s Chief Quality Officer Michael Seim, MD, spoke with Becker’s about pursuing the health equity accreditation and what it means for the health system going forward.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What motivated WellSpan to pursue NCQA’s Health Equity Accreditation and how does it align with the system’s broader mission?
Dr. Michale Seim: Our mission at WellSpan really focuses on exceptional care for all, and the key word for me in that statement is “all.” We’re located in south-central Pennsylvania. We have a large community of Amish and conservative Mennonite patients in our market. We also have dense urban areas, rural and suburban areas. We touch a lot of different geographic areas, which impacts overall access to and engagement in healthcare.
It was really important to us to think about a health equity framework that would help us understand how we can ensure that all of our populations are able to achieve their healthiest life. Looking at those different areas, we realized that within our communities, where you lived potentially impacted the number of years of life you lived. Our overall system goal was to decrease variation in life expectancy based on different ZIP codes.
NCQA’s framework gave us the opportunity to think about how we communicate with patients, how we have access to patients and how patients are able to really utilize our health system, to then focus on our main priorities as an organization moving forward, simplifying and personalizing healthcare.
The NCQA standards gave us the opportunity to personalize our communication methods to make sure that we’re meeting not only all the government regulatory requirements around language and culture, but also that we’re thinking about how we communicate, both personally and in a bigger group, with our patients.
Q: What were some of the most critical opportunities for improvement and how did you prioritize addressing them?
MS: We are a data-driven organization, and wanted to use that data to highlight the disparities in how people access our health system and how we’re able to provide the services to them to allow them to have their healthiest life.
The data showed us that each of our communities is impacted slightly differently, so we had to take a personalized approach. Within our Amish and conservative Mennonite communities, we really had to build personal relationships with the bishops. Within some of our more dense urban areas, we worked with nonprofits and trusted community programs to make sure that we were reaching patients.
Our goal is — regardless of race, language or ethnicity — to optimize and increase health for all people. We prioritized engaging with people to become a trusted health partner. We decided to focus on breast and colorectal cancer screening, as well as hypertensive management, diabetes, and maternal morbidity and mortality, to build our program.
Q: What internal partnerships or collaborations were key to WellSpan’s success?
MS: I’m very fortunate to lead an amazing quality and safety group, and our community health team. These groups worked together to build a program that engaged our community partners, our internal data and analytics teams, and our care delivery teams.
We’ve just now added our innovations team and have done some really amazing work around how we communicate with patients within their native language. We have been using generative AI to communicate in patients’ native languages in order to help them complete screening.
Q: Zooming in on the significant improvements in breast and colon cancer screening rates for people of color — what specific initiatives contributed to this success?
MS: We started with looking at our performance within different portions of our population against NCQA’s Healthcare Effectiveness Data and Information Set for breast and colorectal cancer.
Our overall goal initially was to be above the 75th percentile for all patient populations for breast and colorectal cancer screening. We’ve done that successfully now, so we’ve raised it to above the 90th percentile.
We did that through different partnerships within our community through outreach and listening sessions to understand each service area’s needs and unique screening barriers with cultural humility.
We then started doing targeted outreach for people who were behind in screening. When we performed a cost-benefit analysis on outreaching to patients in different languages, we found that the return on investment was significant compared to the costs associated with a delay in diagnosis for any breast or colorectal cancer.
We also streamlined care by training our providers and frontline workers to send a patient home with a fecal immunochemical test or schedule a mammogram on the same day the patient came to the clinic. We also invested in mobile mammography to provide screening to community members with transportation issues or other barriers to access.
Q: How does WellSpan plan to sustain and build on these efforts in the future?
MS: Our goal is to eliminate disparities in life expectancy. It’s, quite honestly, a 50-year goal.
Every initiative we have, whether it’s around genetics or violence prevention and trauma, we’re really looking at how to preserve years of life — that’s the principle behind all of our equity and our optimization work. Regardless of where patients live in our community, or their personal obstacles to achieving their best health, we’re going to do everything we can so that all people live the same amount of time.
It’s heartbreaking to me that based on where you live, you live 15 to 20 years less. As a healthcare organization, we have to honestly look at why people are dying decades before others within our community. We need to ask ourselves, where do we need to be a convener? Where do we need to be an advocate? And where do we need to have ownership of our work?
Q: What lessons would you share with other organizations considering this accreditation?
MS: I have three things that I routinely say. No. 1, start. A lot of people are looking at data or trying to attain demographics, those are all wonderful, but we have to start really focusing on outcomes and using data to drive performance.
No. 2, meet with your governance and leadership to make sure that your vision aligns with theirs. Make sure they fully support your North Star, which at WellSpan is for every single person in our community to have the same opportunity to live the same amount of time.
No. 3, people have to have some type of structure. We worked with NCQA to understand what areas we needed to focus on. It was about ensuring we had the structure to then embed health equity into the health system, so that it’s part of our daily work and our DNA. Every single team member knows that we are committed to every patient living their best possible and longest life.
Because health equity is not necessarily just about race and language or other things, it’s about your community. It’s about giving everyone an equal chance to live their optimal life, in my opinion.
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