Breaking Down Barriers to Better Health Care

In this episode of the Community Check-In, Christy Simoncelli, Director of Health Equity at Excellus BlueCross BlueShield, delves into the crucial topic of health equity, exploring its meaning and emphasizing why it should matter to everyone. Christy passionately discusses the systemic, socioeconomic, demographic and geographic barriers that hinder communities from achieving optimal health, along with actionable steps to address these inequities.

Episode Transcript

(00:03):
Welcome to excel Us Blue Cross BlueShields Community check In. Each week we
cover a specific topic featuring excel UsBlue Cross Blue Shield experts. You'll get
to know our team as we discussthe latest in healthcare, health education,
and community health. Find us atexcel USBCBS dot com and follow on Instagram

(00:26):
and Facebook. I'm Joelamonico and welcometo this week's community check in. Healthcare
should meet the needs of everyone,no matter who you are, where you
live, who you love. Todaywe have Christy Simon Selly, with US
Director of Health Equity at excel UsBlue Cross Blue Shield to talk with us
about health equity. What is it, who's impacted the most, and how

(00:50):
can we address health equity as acommunity. Christy, Welcome to the Community
check In. It's good to haveyou. Thanks for having me. Christy
has spent almost twenty years working incommunity health engagement and research, passionate about
understanding and reducing the underlying causes ofchronic disease and illness in our community,
and of course having access to qualityhealth care is a big part of that.

(01:12):
So I want to start by defininga term because I think many of
us who are not where you arewithin this field, identify what health equity
is far too narrowly, So fromyour perspective, help broaden our perspective as
to what we mean when we talkabout health equity. Yeah, sure,

(01:32):
that's a common question, Joe.So everyone really deserves to be cared for
and to live a healthy life,and so when we talk about this,
you know, we want everyone tohave that level playing field. Too often
our communities face systemic challenges socioeconomic,demographic issues, sometimes even geographic barriers that

(01:53):
can prevent people from achieving that optimalhealth. And so really, from our
perspective, health equity is about makingsure everyone has the opportunity to achieve their
full health potential, where no oneis disadvantaged from achieving their best health because
of who they are or where theylive. That seems to be a very
broad definition, which is good.I think when this topic comes up,

(02:17):
it's one that people shy away from. And we will get back to that
part of the conversation a little lateron. It seems to be a conversation
that we want to pigeonhole into somethingvery narrow, But the entire doctor patient
relationship can really fall under this category, and that's even one just small slice
of the pie. Yeah. Absolutely. I often say in community settings that

(02:39):
the things that happen in that patient, doctor exchange, or just a small
percent of what actually impacts us ata larger capacity. And so we think
about things like where you live andyou work, what does that look like
you're economic or impact sorry, theeconomic or income level can really impact act

(03:00):
your health. Things like race andage and education levels, your employment status,
you know, all those things,sexual orientation, gender identity. These
are all of the things that we'relooking at as impacting someone's healthcare. And
so in some cases, you know, these factors are barriers to optimal health
and to health equity, meaning thatthey can result in some people being more

(03:23):
susceptible to poor health outcomes. Sothis is a good entry point for us
to expand on that. Let's getand blow this up a little bit.
Real life examples are always very helpfulfor us to be able to wrap our
heads around what we're actually dealing with. You've mentioned a few types of instances
or populations that can experience health inequities. I wonder if we can deep dive

(03:46):
a little bit on this and talkabout sort of the day to day how
it impacts the community as a whole. Yeah, so we think about things
we talk about like where you workand what that looks like. If your
employer doesn't cover you know, yourscreenings or health care appointments and you have
to take time off, you're youknow, you're leaving money on the table,
and some folks don't have that flexibilityor luxury to do so. If
you don't have transportation to get toappointments, or if you have to follow

(04:11):
up, maybe you have it oneday, but you don't have it the
next, you know, that couldbe a barrier. Some people don't feel
that they're being heard when they seea physician because of their race or ethnicity.
Maybe their language doesn't align with thephysician that is that they're seeing,
or the provider that they're seeing.Sexual orientation or gender identity issues might not
feel safe to share, so thatthose things become barriers. We think about

(04:33):
cost of services again, taking thattime from work. Maybe you don't have
childcare and so that's a concern.You have to take care of elderly parents.
Those sorts of barriers that come upin a life, and sometimes you
know, just discomfort due to previoustraumas or negative experiences from health experiences in
the past. There is you know, trust issues for sure in terms of

(04:55):
the healthcare system for many communities.Certainly historical abuses from my already communities comes
up a lot. And again thingsthat where you live, we think about
unsafe housing conditions. Perhaps you know, if there's exposures in your neighborhood or
you don't have a sidewalk to walkon, it makes you know you're just
day to day life a little bitmore challenging and less safe, so you're
not necessarily able to be active andget your steps in all those sorts of

(05:18):
things that we think of as healthrelated type activities. But ultimately a lot
of this really just comes down tocommunications. Being able to be seen as
we are and talk in a languagethat is understood and have that trust with
the patient and the provider or huge, huge, poor parts of this.
It would almost seem like this isa layered issue that many who are facing

(05:42):
health inequities are not facing one ortwo, they can potentially be facing half
a dozen or more. Just tojust in those examples that you gave,
you can see that play out incommunities throughout our region that you would expect
to find multiple that will exist thatwill knock people further and further away from

(06:03):
getting the care that is essential.Yeah, I mean if you think about
it. Actually, we're working ona training on this topic and I literally
just put an onion on one ofthe slides, so this is you're just
fed right into it. But Imean, if you think about it,
if you have had have bad experiencesin the past and you don't feel that
trust and connection, you start tobecome alienated from the system, and then

(06:25):
it becomes an issue. I knowof someone in my life who I've recently
encountered who has had a very longtime since a previous physical or healthcare appointment
and now feels kind of disenfranchised fromthe system, And how do we get
someone like that back into care andget what she needs? So health equity,
what does it mean? Why shouldit matter to you? Is the
topic on this community check in.Christy Simon Selly is the director of health

(06:48):
Equity at Excellis Blue Cross Blue Shield. You mentioned mistrust of the health care
system. That's one of those foundationalcauses of health disparity, and I think
many in many cases that is whatan outsider might think as one of the
big things. So a two partquestion. Number one, let's talk about
some of those foundational causes. Andnumber two is mistrust of the healthcare system,

(07:12):
one of the largest barriers that inyour profession, part of your team
might be working to help people overcome. Yeah, I mean, mistrust is
long standing and it's ubiquitous, andI think there's some really good examples we
could look at to sort of againusing real life examples to explain some of

(07:33):
this mistrust really in the healthcare systemis rooted in history. You know,
there were unethical studies performed on blackAmericans in the past. People didn't have
consent or knowledge as to what wasgoing on. And an example of this
is the Tuskegee syphilis study. Thisstudy went on for over forty years.
Participants were not informed when a curewas developed, which was something as simple

(07:57):
as penicillin, you know, somethingthat we can easily access. So these
generational injustices gave rise to these racialand ethnic disparities that come up in these
communities. You know, a studythat we look at in the work that
we're doing, the Kaiser Family Foundationconducted a study that found that people of
color are more likely to face socialand economic challenges that can negatively impact their

(08:20):
health care. The study noted thatblack adults are more likely than white adults
to report unfair treatment while seeking carefor the same treatment for the same condition
because of the race or ethnicity.And when you dig a little deeper and
you start to look at some ofthese subtopics, the same study shows black
women having the highest rates of infantand maternal mortality. Black women face higher

(08:41):
rates of maternal health, morbidity,and mortality across all sectors of people,
and that's regardless of race, income, or education levels. So there's these
implicit biases built into our health caresystem, and this is another piece of
what our team is trying to unravel. These can be factors that lead to
the equities and care and it's barrierslike this that we need to uncover and

(09:03):
address to create that health equity thatwe're looking to see. You talk about
the onion you used as an examplewith your team, and you're right when
you start to peel it away,and just with what you're talking about there,
you peel it back and you findsomething new. And you peel that
back and you find something new.It almost seems like it's an infinity loop

(09:24):
that you're just you're never getting tothe center of the onion, but you're
doing what you can to deal withthe layers. Is it really the question
of we're going to try to dealwith the symptoms for as long as we
need to before we find a core, you know, that's a really excellent
question. I've been, as Isaid, as you said, you're open.

(09:48):
I've been working in this space areally long time, and after enough
time of working on the symptoms,you get to the point where you need
to get to the core, youknow. And so this is how we
know this information really matters to ourcommunity. They need to feel seen.
They need to understand that there's moregoing on than meets the eye. There's
more than just you know, seeingthe doctor and eating your vegetables. We

(10:11):
often underestimate our risk for disease,you know, and we start to normalize
the concept. But there's more aplate. We feel like we can really
start to take a more holistic approachto healthcare and get people engaged in different
ways. People start to see thatthey're not alone and that there are others
like them who have similar experiences thatmay feel they may may hopefully feel more

(10:31):
empowered to do something about it andto advocate for themselves in healthcare systems and
settings, and also to advocate fortheir family members who might also have,
you know, other barriers language orother things that might come up. And
also if we've become more of theaware of the impacts of health disparities,
getting to the core of it,we might feel more empowered to share what

(10:52):
we've learned with other people in ourcommunities. I've always been an advocate of
empowering community, creating that social justiceand change that can help spread the information
around this. So it's really importantto address health inequities to raise awareness around
it because when we are delayed thecare we need, we have poorer outcomes,
our quality of life suffers. Andtruthfully, the more that we're aware

(11:16):
of this of this issue, themore likely the key stakeholders in the healthcare
system will include marginalized populations in thesolutions to ultimately help build a better healthcare
system that better represents all of usand our needs. So really trying to
partner with folks at that level tosort of get to that core and solve
these issues. Now, despite allof that, though, this topic can

(11:37):
be uncomfortable, it can be polarizing, it can be for the most part,
completely avoided. The conversations just don'thappen. So, going along with
what we've just been talking about,why do we need to have uncomfortable conversations?
Why should we be looking to findways to have these uncomfortable conversations to

(11:58):
bring other stakeholders into the conversation becausethose other stakeholders that are not talking about
it need to be involved in thesolution. Yeah. I think that's a
great point. I think some ofthe time it's easy to sort of bury
your head in the sand and think, well, these are not things I
need to worry about. But thisimpacts all of us, right, and
so you know, the more peoplewe have invested in this, and the

(12:20):
more we can start to move theneedle, the better we'll all do.
You know, whether you come atthis from an approach of this is the
right thing to do to take careof people, or it saves money,
you know, it costs more moneyto take care of people who are sicker
and have poorer health outcomes, whoare discovered farther down the path. No
matter what way you come at this, this is the right thing to do.

(12:41):
So we're doing quite a bit inthis space to sort of start to
address this. We have. Healthequity is our topic this week on the
Community check in. What does itmean? Why should it matter to you?
That's what we're going to get intothe heart of in the second half
of our show too, with ChristySimon. Selly, who's the director of
Health Equity at excel Us Blue CrossBlue Shields, been living in this space

(13:01):
for twenty years and trying to peelthe onion back in the community to start
having ways that we can address healthinequities. Just in the small time that
we have been talking, it wouldseem to the outsider that this is a
gigantic nut to crack, or agigantic orange to peel, maybe I should

(13:22):
say, or an onion to peel. And you have to ask yourself,
where's the endpoint? Where do youstart peeling things back again? Another two
part question. Have some improvements beenmade in your twenty years of experience and
what else should we be doing dayto day, year over year to address
health inequities in our community. Yes, so I will say there has been

(13:46):
progress made. One of the brightlights of COVID, I will say,
for someone in my seat who's beenaware of this for a long time,
was there was a light shone onthese gaps and these and equities. We
saw huge differences in the way peoplewere diagnosed and outcomes of COVID by race

(14:07):
and ethnicity that really hadn't been seenbefore. Sadly, I've seen this for
every single disease type I've ever studied, and so having just that awareness is
huge. You know, everyone's talkingabout this now, everyone's got this on
their radar, Our crediting bodies areputting this forward. It's really coming full
circle. And so for me,that is progress and that kind of weaves

(14:28):
into some of the work that we'redoing at excel as Blue Cross and Shield
and how we're trying to solve theseproblems. So one of the biggest things,
as I mentioned, having that awareness, So for US education raising awareness
of the impacts of health disparities arehuge. You know, many stakeholders of
the healthcare system are starting to dothis within their own organizations in the community,

(14:50):
and I know for us that excelUS addressing health equity is a key
initiative in our organization. We're educatingour internal teams, we're putting infrastructure in
place to help uncover disparities and ourmembers, and then putting plans in place
to address them. We're also startingto have those conversations broadly with our community
partners, who are a critical partof being able to remove barriers to healthcare

(15:11):
and our most marginalized communities. We'realso working on collecting more accurate information on
our members. So, for example, if we know what someone's race,
their gender, ethnicity, or economicbackground is, it can help us uncover
more about them. It can helpus undercover disparities within certain populations to start

(15:33):
to try to help and address thosebarriers. And so when we understand more
about our member's life and experience,we can provide better, more tailored,
and more holistic care for those members. That's exactly what I wanted to get
into next is data collection. I'mnot a numbers person, but I am
sort of interested in the fact thatthere are some parts of the population whose

(15:54):
data on health outcomes and how theyrespond to care, what treatments might be
right, access to testing and diagnosticshas just been completely overlooked or been very
underutilized and undersampled. Why is itso important to start collecting and want to
have more data collected on different groupswithin the community to have better overall patient

(16:18):
data available. Yeah, I mean, that's a great question. You know.
The primary reason from our perspective isso that we can start to understand
the disparities and care and help toclose those gaps. So if we have
data, for example, on acertain health condition, and we can see
who's not doing well with a drugfor example, or who is, or
who's not getting a screening done orwho is, and we can then stratify

(16:40):
that by race, by ethnicity,by gender, and all those different things,
we get a clearer picture of wheresome of the problems are. You
know. I have a really greatexample of a very interesting study that I
was kind of tangentially involved with ina previous role. There was a study
done at the University of Buffalo atthe urge of an African American breast cancer

(17:02):
survivor. She had had many womenin her family experienced breast cancer. She
underwent genetic testing and found that therewas no gene for her, that this
wasn't genetic, and she just didn'tbuy it. She didn't buy it,
and so we connected her with agenetic epidemiologist. So someone who studies that
stuff genes and the pieces of itand how it affects disease, and they

(17:25):
underwent this monumental effort to start tocollect data from women who had multiple people
in their family who were African Americanwith breast cancer. They had criteria,
they found these women, and thenthey were able to uncover an area in
a genome that had been previously undiscoveredbecause no one had looked because we didn't
have the race and ethnicity data.So once we got samples and we could

(17:49):
say these are from these people,this is this population is counted, all
of a sudden, you can findthings that she didn't have before. So
really understand standing that there might bean increased risk of breast cancer and certain
African American women and knowing a raceof a person could really help us offer
resources to say, get mammograms earlierin life, or to you know,

(18:11):
spread the word about breast cancer indifferent ways. It also empowers African American
women to advocate for better care fromthemselves when they know they could be at
risk for different diseases. And thatgoes right into talking about those barriers that
are there. We talked earlier inthe show about mistrust, lack of access
because of those two things, justas two examples, that would lead to

(18:32):
less information being gathered from certain populations. So getting over some of those barriers,
you have to do that maybe first, so that you can collect that
better data at least get people intoto share to be part of this.
Yeah. Absolutely, you know,not everybody has had a positive experience,
which we've kind of alluded to beforein terms of the healthcare system. You

(18:53):
know, they might be hesitant toshare their personal information as many of us
are, you know in this dayand age. Can't blame them. People
may have concerns around how their datawill be used and who will have access.
So I can only speak to ourapproach. It excels in that it
is always a choice as to whethersomeone wants to share their information with us
or not. We will only usethis information to access those barriers and disparities

(19:18):
to optimal care and then attempt tosolve those problems. So we're not just
doing it to identify, We're doingit to actually solve. And so the
information someone shares with us will becap safe, It will not be used
for any other issue, It willnot be used for premiums or health coverage
information and it won't be used tostratify anything that would be targeted towards you

(19:41):
in any way other than to helpsolve your health care problems. So if
you're one of our members and you'restill unsure as to whether that feels like
the thing you want to do,you could always call us the numbers on
the back of your member card andour folks can help you share more and
we'll share more information about that withyou. Christy Simon Selly is director of
Health Equity it excel Us Blue CrossBlue Shield. Than this episode of Community
check In, we've been discussing healthequity, what it means and why it

(20:03):
should matter to you. Excel UsBlue Cross Blue Shield very active in bringing
care, bringing information directly to thosecommunities that are most in need of it.
So beyond getting better patient data,which is of course part of the
whole thing, tell us what elseboots on the ground you and your team
at excel Us are doing to helpaddress And we can't talk about all of
it, but certainly but helping toaddress some of these healthcare inequities and health

(20:29):
inequities that exist in communities all throughoutour region. Yeah, at the root
of it. Our mission is tohelp people in our communities live healthier,
more secure lives through access to highquality, affordable healthcare. So we're engaging
our community based organization partners in newways to address health barriers. We're developing
a series of personas or member profilesfor internal use based on member research that

(20:53):
represent the wide range of diverse memberswe serve. The purpose of those personas
is to keep the member at thecenter of our work and help our teams
empathize with our members. When weunderstand the lived experience of our members,
the challenges and circumstances they face intheir lives, we can start to think
about ways to tailor our communications,our products, and our services to better
address their needs. We have newhealth Equity and Innovation awards that are going

(21:17):
out to some health CBO partners aroundhealth and equities. We offer trainings for
our medical providers that cover in depthinformation on the significance of understanding how different
cultures perceive healthcare and how it relatesto impact on services and treatment, potential
barriers, and why cultural sensitivity isimportant in healthcare. We also provide resources

(21:38):
to employees to understand their expand theirunderstanding of health equity as well as diversity
and inclusion through opportunities for training andinternal discussion. We also encourage employees to
get out into the communities where theylive by providing paid time off to volunteer,
which is a great benefit. Wow, that's an awful lot going on,
and I bet that doesn't even reallyscratch the surface as to what's really

(22:00):
going on. So before we runout of time for this episode, I
want to make sure that we talkabout the resources that are available and some
of those things that you would liketo leave us with, so when this
conversation wraps up, others can continueit on their own and with the resources
that are available. Sure, formembers, you can always call one of
our care managers if you feel you'reexperiencing any of these barriers to health.

(22:26):
The number on your back of yourmembership card is the best number to use.
Another resource available if you're experiencing anysocial challenges is to call two to
one one or visit two to oneone dot org for free confidential support that's
available twenty four to seven. Youcan always access two one one. You
can receive expert help with food,housing, transportation, mental health support,
substance use support, disorder services andother things. And you can also learn

(22:49):
more about our approach to addressing healthequity on our website at excels BCBS dot
com slash health equity. As wetalked earlier in the show, this is
a layered approach. This is nota one size fits all approach. There
are many barriers that some in ourcommunity may be facing, one more important
than the other. Some need tobe addressed first before others can be.

(23:11):
In our final sixty seconds, Christy, I mean, so much has happened
in your twenty years. Uncomfortable conversationsare starting to be had in some ways.
What encouragement maybe do you have inour final minute that we'll say,
Look, we're getting more people involvedand at the end of the day,
getting more voices into the conversation isa great step towards letting others into knowing

(23:40):
what the person next to them maybe going through that they can't even see.
Yeah, I mean we spent thesummer traveling our thirty nine county area
and asking questions of our community members, and every meeting I went to there
was such exchange of learning and sharingand people learning about resources they didn't previously
know. We need each other inthis effort. You know, it takes

(24:00):
a village, as they say,And so the more we can get to
the heart of it, the heartof that onion, and the more awkward
conversations we can have, the lessthey'll be left to have. So I
think we're in good shape or makingthe progress we need to get to get
to the heart of it. Makeit the year of awkward conversations. Yes,
that's what I suggest. Health equity, what it means to you,
why it should matter to you.There's many more conversations to have, but

(24:22):
we've been honored to have Christy SimonSelly with US, Director of Health Equity
at excel Us Blue Cross Blue Shield. Thank you for all of your work,
your time, and continued success asyou continue to have uncomfortable conversations.
All right, thank you. Thanksfor joining us on Community check In,
a presentation of excel Us Blue CrossBlue Shield and iHeartRadio. Podcasts of Community

(24:44):
check In are available on the iHeartRadioapp or wherever you find your favorite audio
content. For more ways to staysafe, healthy, and educated, visit
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