Improving health outcomes among at-risk populations

Employers that prioritize equity can benefit from better employee engagement, increased creativity, and improved problem-solving abilities. The workforce is full of diverse perspectives, unique talents, and often untapped potential. Equity also bolsters employee morale and loyalty.

So, if your goal is to improve health equity among your health plan members, there are few better places to look for innovation or inspiration than under the United Against Racism platform of our parent organization, Mass General Brigham. In fact, health equity is a top five priority for the entire Mass General Brigham system—including throughout each of its many hospitals and the communities they serve.

Our mission is to dismantle the barriers, systems, and actions inside and outside our walls to provide excellent medical care and equity for all,” said Dr. Elsie Tavares, MD, MPH, Chief Community Health and Health Equity Officer at Mass General Brigham and a leading expert in community health equity and health disparities.

July 2024 Social (18)“We’ve made a huge commitment to influence the areas of health inequities—with as much rigor as we put towards research, medical innovation, and clinical services. And if we don’t have a robust way of measuring our inequities, then we don’t have a robust way of designing a precise solution for our problems.”

“Three years ago, we began quality improvement programs focused on patient data and improving accuracy about our patients and what we know about them, including race, ethnicity, language preference, disability, preference for accommodating disabilities, and more.”

“Looking ahead, health equity will be achieved when every patient we care for, and every member of the communities we serve, have fair and just opportunities to attain their highest level of health.” 

Helpful health-equity definitions

Health equity: The chance for people of every race, gender, ethnicity, disability status, sexual orientation, language, or religion, etc., to reach their full health potential.

Healthcare disparities: A difference in level or access to treatments or in rates of disease occurrence and disabilities between population groups.

Areas of focus to improve health equity

July 2024 Social (17)Substance use disorder: Mass General Brigham’s Bridge Clinics are transitional outpatient addiction clinics for patients in need of rapid access to substance use disorder care. The expansion of this care model has led to dramatic improvements in access: a 41% increase for Black patients; a 114% increase for Hispanic patients; and an 86% increase for patients with limited English proficiency.


Hypertension control: Mass General Brigham’s teams are reducing disparities in hypertension outcomes by expanding access to treatment. This past year we enrolled 1,088 patients in our hypertension management program and distributed more than 1,100 blood pressure devices throughout local communities.


Maternal health: Our Birth Partners program matches patients with birth doulas to provide nonmedical support and guidance with the goal of reducing maternal health disparities. In 2024, we will also test a new postpartum care model designed to improve cardiometabolic and mental health outcomes through a new initiative known as DrEaMH (Driving Equity and Maternal Health outcomes, pronounced “dream”).   


Equity in cancer: Stark disparities exist in cancer screening and outcomes by race, ethnicity, and language. To address this disparity, teams across Mass General Brigham will develop programming to reduce disparities in cancer screening rates through supporting system navigation and mitigating social barriers, such as transportation to care.


Social Determinants of Health screening and response: Social Determinants of Health are non-medical conditions that affect overall health. They include the conditions in which people are born, work, live, and age, as well as the wider set of forces and systems shaping the conditions of daily life. These include access to transportation, food, housing, medication, and education. Screening has been expanded to target primary care clinics to reach more patients.


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