Answering the Call: CommonSpirit Strives to End Health Inequalities

COO Marvin O'Quinn shares how the health system is working to stop social and health inequalities during the COVID-19 pandemic.

Within the core of CommonSpirit Health's mission is to advance social justice for all. Even before Catholic Health Initiatives and Dignity Health merged in 2019 to form the health system, the focus of both organizations has been on community-driven care and advocating for social justice. That mission hasn't changed during the COVID-19 pandemic as it seems to have only strengthened CommonSpirit's resolve to support the patients in its 142 hospitals and 700 care sites across 21 states.

CommonSpirit Health COO Marvin O'Quinn spoke with HealthLeaders about how the health system is living up to its mission during the COVID-19 pandemic by working to end social and health inequalities.

This transcript has been edited for clarity and brevity.

Marvin O'Quinn, COO, CommonSpirit Health (Photo courtesy of CommonSpirit Health)

HealthLeaders: How is CommonSpirit Health fighting to eliminate social and health inequalities?

Marvin O'Quinn: First of all, the core of our mission, and who we are, is to care for the poor, the underserved, the vulnerable, and the voiceless. We're a large healthcare system, but we are based on a sound, spiritual mission orienting our resources towards helping everyone. We put a special emphasis on having our hospitals in poor communities and reaching out to those communities with services that go beyond just traditional acute care.

Each of our organizations throughout the country have strong community outreach programs where we work with local leaders to put together resources and programs that help people in their homes and in their communities, as well as once they get to the hospital. We have implemented, in some of our emergency rooms, a software system that tracks every available resource in a community, so that when a patient comes in and needs something, we're able to make a referral right there.

We're also able to determine whether they actually made it to the referral, and we're able to determine what happened to them after they made it to that referral. We spend hundreds of millions of dollars every year on these services; they're a core part of who we are, and we are increasingly developing them.

We've been involved in programs for what we would call managing the social determinants of health. This is not done with physicians or nurses, it's done with social workers and case managers … to assess [patients'] living conditions: how many medications are they on? Do they have dental issues? Do they even have transportation to get to a physician's office?

Part of our job is to help [patients] get to those resources and then help them when we can. And what that has shown is that people are extraordinarily grateful for anyone who cares and wants to help them, which is rewarding in and of itself, but it also helps them get their health together.

HL: Can you talk about the Equitable Data Collection and Disclosure on COVID-19 Act, and why it's important to you and CommonSpirit Health?

O'Quinn: It's very important because, unfortunately, people who are suffering the most from this disease are the people who have always suffered in this country. That is the poor and the underserved, and particularly minority groups. At our hospital in Southern Cal, the vast majority of those patients are of Latin descent. If you look at what has happened in New York, the vast majority of people who are dying—relative to their proportion in the population—have been people who are black. There are lots of reasons for that; stressors that they have in their everyday lives makes them more vulnerable.

This is a personal statement, but it's patently unfair. It's a result of a society that has built a system that's left a lot of people behind, and those people suffer the most in any type of circumstance. They suffer the most economically, they suffer the most from a health standpoint, they suffer the most from political power in our communities. It's my very strong belief, and our system's belief, that we have to do something about that. The only way to do something about that is to understand what you're dealing with. That starts with the collection of the right kind of data that allows you to pinpoint where vulnerable populations are, and what the potential impact might be, and then you can develop some solutions for that.

Related: CommonSpirit Health Suspends Billing for COVID-19 Tests, Treatment

HL: CommonSpirit Health has chosen to offer services free of charge to anyone who wants to speak with a doctor about COVID-19. Why has the health system chosen to do that, and how have you been able to implement it?

O'Quinn: We don't want cost to be a barrier of getting the right answers for folks in the midst of an unprecedented challenge like this. We thought that the best way to do that was simply to offer the service free. We can worry about reimbursement at some other point in time; this is not the time to worry about that. The job right now is to lead in the community, and help people resolve their fears, or get them to the right medical services if they are in fact infected.

We rolled it out in our virtual program. We quickly invested in and expanded our virtual capabilities. We have close to 8,000 employed physicians, and those physicians happily moved into the virtual environment because people stopped coming to their offices. This was a great opportunity for them to learn and do something new and, given the volume of over 50,000 calls a week, I'd say people like the service as well.

HL: Are there plans to keep this going when the pandemic ends?

O'Quinn: Absolutely. This is something that we've wanted to do for a while. I think a lot is going to change after the pandemic. People will become accustomed to a different life. I believe that people will be comfortable using virtual mechanisms to talk to their physicians, and we hope to keep this in place and to grow it after.

HL: Can you tell me about the partnership between CommonSpirit, county and state officials, and Kaiser Permanente in opening the nation's first surge hospital? How has it helped so far?

O'Quinn: We don't just live in a community and exist there. We are part of that community, and if we're called upon for service … we're going to answer that call. We were asked to help, and the hospitals were seeing that their ICUs were going to be overloaded. Not like New York, but approaching New York, and the state wanted to develop something that would take the load off the hospitals and keep capacity available in these communities.

COVID gets 100% of the conversation, but there are still people who have strokes, heart attacks, babies, and people who are sick with other diseases that need to get into the ICUs in the hospital, and they can't if all of our ICUs are full with COVID patients. The plan was to create a separate entity for [COVID patients] that we can move out of the ICUs, out of the hospitals, into this unit and thereby free up space in all the hospitals in that community.

We worked with Kaiser, and we've worked with Kaiser on a number of projects in the past … and we know the folks from the state, so it was just a natural thing for us to do. We have 31 open beds right now, we have 20 patients in them [as of April 30]. Those patients have transferred from hospitals around the city, ours included: Kaiser, Mount Sinai, and others, and it's meeting its goals.

HL: How long did it take to set up the surge hospital?

O'Quinn: I think about a month. It went pretty fast. We worked a lot of hours to do that and people played their roles well. We had to put in new IT systems, bring in equipment, recruit and hire staff, and pass state inspection.

The hospital is being run essentially by our leadership team. There's a board set up, which is made up of ourselves, along with Kaiser, members from the state, and from the city. And we may eventually put another individual in there to run it, but right now we're running it and people seem to be happy with that. We're pleased with the outcomes.

Related: Leading Through a Pandemic: Q&A With CommonSpirit CEO Lloyd Dean

HL: What strategies has CommonSpirit put into place as we move forward into a post- pandemic world?

O'Quinn: We've put together an internal steering committee to start thinking about what the post-COVID world would look like, and how it impacts what we're doing now, and how we're going to want to do it in the future.

If you step back a minute and [reflect on] what worked and what didn't work, and what surprised you about what we were able to do or unable to do, we can address those issues for a potential second wave of this.

We're also trying to understand what the consumers' mindset is. We know that one of the things that we'll have to do is … put in place the right types of procedures and processes to help guarantee your safety when you come to our institution. All the social distancing things that are in place in the communities will have to be in place in the hospitals going forward.

I know the whole issue of virtual care is going to grow in the future, so it will be less visits to physicians' offices in person and more visits by phone. I think there's also the issue of home care from a perspective of acute care at home, not just home care for patients who've been discharged. We were already looking into that as a way to relieve some of the burden on our hospitals—take certain patients out of the emergency room, treat them, stabilize them, and then send them directly home and then have nurses and physicians take care of them at home in their acute phases. I think that's going to take off afterwards.

HL: Do you have anything else that you would like to add?

O'Quinn: I know that healthcare workers are getting a lot of applause these days for the work they're doing, and I just want to echo the point that it is well deserved. Our frontline workers and even our managers and administrative people are going beyond the call of duty to take care of people. Our staffs are working seven days a week, and they're taking calls on Fridays and Sundays. They've disrupted their entire lives to make sure to meet the challenge of this disease.

I just want to give my thanks to them. I equate a hospital to an ecosystem. All the jobs, they're in relation to each other. It's not just frontline workers, but it's all those people around the frontline workers who are keeping the hospital going, so the frontline workers can, in fact, do their jobs. It's all working exactly as you would want it, and I can't sound surprised because that's what healthcare workers do. They always rise to the occasion, and they are doing that, not just in our hospitals, but across the country.