Health Equity

For health care leaders, a fork-in-the-road moment in addressing health inequity

Gabriel Perna | April 14, 2021

For many health care leaders, COVID-19 will be a fork in the road regarding how their organizations act on the equity issues plaguing health care. Either they hold their organizations accountable for advancing equity or they essentially fail their own workforce as well as the patient populations and communities they serve. 

“Are we going to match this moment? Are we going to have the courageous conversations around structural racism and social injustices? Are we going to look at new ways of developing the next generation of leaders, to make sure they are supported and mentored? Are we going to integrate mental health with all of health care? Are we going to show up and sharing power with the communities we serve? Will we embrace the concept that equity begins at home and our own organization’s systems, practices and policies must be inclusive? We need to keep our focus over the long haul,” Patrice Harris, MD, Immediate Past President, American Medical Association. 

Throughout day two of the Virtual Confab 2021leaders examined how the pandemic impacted communities of color, revealed current challenges with vaccine access, and looked towards the future with guarded optimism and an eye towards improving health inequities and addressing social determinants of health. The day was also a chance for leaders to look within themselves and understand how they can be better servant leaders in order to address some of these major issues. 

In Minnesota, Craig Samitt, MD, President and CEO of Blue Cross Blue Shield Minnesota saw firsthand the significant impact that COVID has had on disadvantaged communities. On top of that, the State has been in the middle of social injustice ever since George Floyd was killed in Minneapolis.  

“What I would say really motivated our work was the feeling like enough is enough. For too long, we’ve paid lip service to the impact of social determinants of health or systemic racism on the health of our communities. Just like a lot of other things in health care, we’ve admired that it’s a problem but we’ve done little to fix it,” said Samitt. He said it’s now time to go down the right path.  

For Blue Cross Blue Shield Minnesota, fixing the problem began with an internal assessment that revealed the company was not as diverse as it should have been. Samitt said these reviews were a humbling process for the organization but have set them on a journey to fix equity issues at home by having “brave conversations,” and listening sessions. They have also begun working with tangible actions to solve inequity problems, such as stamping out hunger in Minneapolis. He says solving hunger challenges can have a downstream impact on other health care issues as well. 

The expression that we all use is ‘an ounce of prevention is worth a pound of cure.’ Health care lives in the pound, we need to live in the ounce. So, if we paid greater value for what’s in the ounce than what’s in the pound, if we focused on wellness prevention, community, social determinants of health, and we paid for it differently, our hope is that our community would act differently,” said Samitt 

For an organization with the scale and size of Walmart, vaccine rollout has been a momentous challenge, especially in medically underserved areas. Cheryl Pegus, MD, EVP of Health and Wellness at Walmart, says that 4,000 stores are in HRSA designated medically underserved areas. What’s helped the organization achieve success in vaccine uptake, specifically in communities of color, has been understanding the importance of cultural concordance and health literacy challenges, working with community health workers and engaging in community events, and partnering with like-minded organizations.  

For the next generation of leaders, expect the unexpected. Become comfortable with the fact that you won't always have all the information you need and you're still going to be called on to make decisions.

Nancy Agee, President and CEO, Carilion Clinic

“The success of COVID-19 vaccine rollouts has been probably for the first time in a really long time, every stakeholder in health care saying, ‘We need to work together to make this move quickly and to reach those who are in need and who may have vaccine hesitancy.’ I want to remember this time and I want us all to remember next year and 2-3 years from now and how we can continue to do this. And the next issue for us within health care and for all leaders to address is health equity and how we address structural racism. I’m leaning in on it. I think many people are. I want us to not just use that word. I want us to show how we can get it done together,” said Pegus   

For health care leaders and organizations, they say the time is now to focus on these equity issues with their burning platforms amid the backdrop of the pandemic and social strife. There will be different approaches to tackling the problem, neither of which will be easy, said Alex Drane, Co-Founder and CEO, ARCHANGELS 

I heard someone the other day say ‘it’s not about soft skills and hard skills. It’s about hard skills and harder skills.’ All of the empathy, humanity and compassion and data-driven, operational, and scalable ways to do that are possible. That is what we will need to be doing. And I hope this is the forcing function that gets us to it,” said Drane.  

Health care leaders are looking internally, not just at ways to combat health inequities, but to become better servant leaders and create organizational improvement. Kim Keck, CEO of Blue Cross Blue Shield Association, says after the George Floyd incident, she has had a lot of honest conversations with employees to try and implement a more effective anti-racist workplace.  

“How we lead is really important. One of my expectations of leaders came from a great mentor of mine, which is assume positive intent. We went through many of our conversations reminding our employees in these difficult times that we are going to be guided by our culture in how we lead, starting by assuming positive intent. Let’s have the courage to put issues on the table. Let’s be curious and ask questions, let’s say what we’re doing and do what we say. Let’s trust one another, let’s raise our hand if we need help. Over and over, we reinforced these expectations of leaders to have some of these conversations that we’ve never had before,” said Keck.  

Having these conversations isn’t always easy. Stephanie Tilenius, CEO of Vida Health, said, “I know as a CEO, I had probably some of the most challenging times in the past year in terms of how to think about talking about these topics with our employees and our community.” 

For Nancy Agee, President and CEO, Carilion Clinicwhat’s made it even harder is that the organization serves “urban Appalachia,” where there are rural areas with connectivity and access issues. On top of the pandemic and other issues of inequity, clinicians had to deal with the region’s continuing opioid epidemic and an abundance of patients with multiple chronic and mental health diseases. Needless to say, the organization dealt with a lot of burned-out staff members. The past year has certainly been a lesson in how to lead an organization through crisis.  

“For the next generation of leaders, expect the unexpected. Become comfortable with the fact that you won’t always have all the information you need and you’re still going to be called on to make decisions. Be mindful. It’s not about you, it’s about those that you serve.  And the key is to act,” Agee advised the audience.  

The 2022 Confab will be September 15-16 in Nashville. More details will be available soon. For more on this topic, go to our health equity page.  


Hero image: Parsons

About the Author

Gabriel Perna, Senior Manager, Digital Content

Gabriel Perna is the Senior Manager of Digital Content at Health Evolution. He brings 10+ years of experience in covering the intersection of health care and business. Previously, he was at Chief Executive, Physicians Practice and Healthcare Informatics. You can reach him via email at or on Twitter at @GabrielSPerna