What You Need to Know
- North Carolina has used new data on patient race and ethnicity to shape primary care bonus spending.
- Walter Isaacson wondered what COVID-19 is doing to children and young adults.
- Dr. Cheryl Pegus, a Walmart executive, says clinical care accounts for only about 20% of the determinants of health.
Walmart Inc. has joined with CVS, Walgreens and other retailers to help get Americans vaccinated against COVID-19.
A company like Walmart is in a great position to help the country deal with health equity issues, Dr. Cheryl Pegus, a cardiologist who serves as Walmart’s executive vice president of health and wellness, told health insurance company executives Tuesday.
“You think of Walmart,” Pegus said, during a session at the America’s Health Insurance Plans (AHIP) annual meeting, which started Tuesday, online, and is set to end Thursday. “We’ve got about 1.5 million associates. About 150 million people come through our doors every week; 4,000 of our stores are in HRSA [Health Resources & Services Administration] designated medically underserved areas.”
Most of the employees live in the medically underserved communities where the stores are located, Pegus said.
Studies have shown that the kind of clinical care a doctor provides determines only about 20% of an individual’s level of health, and that much of the rest of health depends on factors such as access to fresh food, vitamins and telecommunication services, she added.
Pegus said Walmart can combine its own pharmacists, food delivery people and care coordinators with community health workers, and help organize and support health improvement efforts.
Making sure that people with health problems have smart phones and internet access can also help, both by bringing goods and services to those people, and by giving telehealth providers a glimpse of those people’s lives, Pegus said.
“A lot of clinicians finally got to see how their patients live, and what that world looks like and what may be needed,” she said.
For the COVID-19 effort, Pegus said, Walmart started by looking hard at store market data by ZIP code, to see what communities might need.
The company also held many teleconference meetings store personnel could use to communicate with one another, as well as with local sources of expertise, such as aldermen in Chicago.
When the aldermen from the South Side of Chicago said their constituents had no way to get to the vaccination centers, Walmart arranged to send mobile vaccination units to the area, Pegus said.
She talked about other community-tailored vaccination efforts, such as mass immunization events scheduled to fit with teachers’ schedules, and events designed to have extra pharmacists present to meet the needs of people with disabilities.
North Carolina Data
Another speaker, Dr. Mandy Cohen, secretary of the North Carolina Department of Health and Human Services, said her state lacked good, detailed vaccination data needed to improve health system fairness when she came into office.
“[We] have to collect data systematically on race and ethnicity if we’re actually going to map our time and our resources differently,” Cohen said. “When we launched a new system, we had the technology to make it a forcing function, that we collect race and ethnicity data at every step. You couldn’t log a vaccination in North Carolina unless you logged race or ethnicity data.”
Because of that approach, North Carolina lacks race and ethnicity data for only about 1% of the people vaccinated. However, in other states, officials lack race and ethnicity data for 44% of the people vaccinated, she said.
She said one criticism of the approach is that some patients would refuse to give race and ethnicity information.
“Almost no one did that,” Cohen said.
Cohen said North Carolina then used the data to give primary care practices scores indicating how frequently they treated patients from the highest-risk Census tracts.