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BTOES Insights Official
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September 21, 2020

BTOES Healthcare Live - SPEAKER SPOTLIGHT : Community Wellness in the Midst of a Pandemic: How to address the social risk factors on a community level

Courtesy of Trinity Health's Mouhanad Hammami, below is a transcript of his speaking session on 'Community Wellness in the Midst of a Pandemic: How to address the social risk factors on a community level' to Build a Thriving Enterprise that took place at BTOES Healthcare Live - A Virtual Conference.

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Session Information:

Community Wellness in the Midst of a Pandemic: How to address the social risk factors on a community level

 Session Transcript:

Very excited about. We have doctor Muhammed, her mummy with us, doctor How Money is a health strategist with more than 20 years experience in public, government and healthcare sectors with a focus on community health and wellness.

He has served as a Trinity Health, senior vice-president for Safety Net Transformation, Community Benefit, Health and well-being where he led the strategy to improve the health and the underlying social determinants of health in community served.

He also served as Chief Health Officer and Director of the Department of Health, Veterans and Community Wellness in Wayne County, Michigan for almost 10 years. He has a medical graduate and holds a master's degree in Health Service Administration from the University of Michigan, in Ann Arbor, doctor .... It's a real pleasure and an honor to have you with us. Very much looking forward to your presentation.

Joseph, good to be here.

So thanks for the opportunity, good to be here virtually. And what I wanted to share with you is a little bit of the lessons learned.

When I was at Trinity and Community Wellness, specifically how we had to deal with it in the midst of the pandemic that we are still going through. So, just to go back to some of the basics of understanding, when we talk about help, than, we mean the complete wellness aspect with the eight dimensions of wellness. Specifically, How the interaction between emotional, social, cultural, and economic wellness all interact together. So, to too many of you, I'm probably preaching to the choir, but usually when you preach to the choir, you get a Sorry, you get a bigger, amen, I guess, or a stronger a, man. We all know that, whatever we provide, in terms of health care accounts, only for 20% of what makes a person well. So, between 20% of health care, including some genetics, the rest is certainly, health behaviors, physical environment, as well as the socioeconomic factors.

Screenshot - 2020-09-18T211337.948And these are what usually people reference as the social determinants of health. We like to call them the social influencers, Because, once something is the chairman, then it's hard to change, but as an influencer, then you can certainly influence the influencer, and, you can certainly act upon it, and, and, and try to minimize its effect on health.

A lot of the examples that are listed under the social influencers, or the social determinants, are housing, education, income level, the place where people live not only the environment, but also the built environment, social support. And recently, as we have witnessed, the discrimination and racism is truly something that impacts how healthy people can be or how negative it can be on their health.

And unfortunately, in the past 20 years or so, the US health care has been, although the social determinants are the social influencers have been at the forefront. They were more the buzzword we continue to fund clinical care up to 95%, and whatever makes people healthy, which are the social influencers, We invest less than 5% even when. When I was at Trinity, we had a one point two billion dollars budget that is our community benefit budget of this. Almost 95% was going to uncompensated care, going to clinical care and safety nets, but to truly invest. And the poor or certain energies was less than 5%, and that model, if we truly want to shift the needle, that model has to change.

And we need to invest more and what makes our communities a healthier place for people to live?

So, and health disparities is something that has been amplified and we've been hearing about it, more and more, I say that the only or one of the few positive things that came out of this pandemic is that people started understanding what inequities are and what health disparities are. So, this is the definition of the National Institute of Health and Health Disparities are, and, and it is how the differences of disease prevalence and the effects of the disease exist among specific population groups. And we know that disparity is going to be based on race.

This is, for example, the age adjusted HIV, or aids diagnoses, and the yellow bar, or the orange bar that you see, that is high in each one of these. clusters are the african american population. And there certainly disparities between Hispanic, White, and African Americans. We also know that disparities are based on income. This is, for example, the health of children based on poverty level. And regardless whether you are at the higher income, or income, or the lowest income, there are disparities between the three income levels, depending on where you fit on the economic scale. But there's also disparities within each one of this income levels based on race as well, so it's kinda like a double jeopardy.

And, again, I'm not telling you something that you probably do, not know, many of the determinants of equity are rooted in, the, what we provide for people. The opportunity for people to advance, whether it's education, whether in this job, whether it is economy, whether it's access to arts, whether its availability, and access to transportation. In addition to access to quality healthcare, which we are not diminishing, that you truly need a good healthcare infrastructure. But in addition to that, you need to avail all these to ensure that people are healthy.

Btog CTASo we take that, and we apply it to a whole community at the community level. And when we talk about community, health and well-being and this, this was the mission of community health and well-being at Trinity. My department is to optimize wellness, and equity, and eliminate disparities. three things that are connected to each other.

But it's truly a more complicated approach to how do we leverage all these together and ensure that communities are prosperous and are conduits for people to practice help. And the approach is twofold. So, it's certainly on the individual level. So our patients, this is when we talk about health systems, the first encounter you have with any member of the community is them walking through the door to your clinic, and they come manifesting with clinical symptoms, but you also need to understand. They came from the community, and they're going back to the community. So, you need to understand what did they bring with them, and what are you sending them back. So this is where you address their needs, not only their clinical needs, or the disease itself.

But you also look at their individual needs, their social needs. And then we need to improve community conditions. Because, again, they are coming, as I mentioned, they are coming from the community, and they are going back to the community. So we need to ensure that the diabetic, for an example, that we are, sending back to the community, has access to, fresh fruits have access to food sources, have access to physical activity, or even have access to a refrigerator to keep the insulin with, with constant electricity. So, all these are things that integrate the social factors into the clinical care to make sure that outcomes are optimal.

So, let's focus a little bit more on disparities and specifically when we talk about the poor and underserved. So, we know that these groups include those that are of racial and ethnic minorities. Specifically African Americans, Hispanics, emigrants people that are low income people that are experiencing homelessness. And another vulnerable population are those that have serious mental illness or substance use disorder, and, specifically, those that are living in group homes, and in residential settings. So, all these are things that we saw in a normal community before the pandemic, but what happened when ... and hit is that we discovered that 1 covert 19, although it can affect everyone. And, in fact, everyone. but the impact of it, it's not distributed equally.

We saw a lot of African that, we know, from previous data, have more underlying conditions, have more social risk factors. And therefore, we saw a higher percentage of infection as well as a higher percentage of death amongst African Americans.

We also saw a lot of the essential workers that are at trips.

And if we look at the demographics of essential workers, then people of color make almost half percent, half of all the social workers that work in the food service or in the agriculture industries. We also see them act, more than 50% and working in basic services, transportation, and all that.

And most of them come from, to start with, come from a under presented or disadvantage. 70% of central workers do not have a college degree And the distribution between those that work and community based services are more women versus men that work and service areas.

So, the essential workers we know are more at risk when it came to covert 19 and exposure then add the homelessness which at any given year, there's about one point four million people living in shelters or in the streets in the United States. And this provides a very big challenge when we talk about a pandemic because one, this is a transient population, that we cannot isolate, we cannot track. We cannot tell whether they're infected or not. So two, these are floating across the system and it's very hard to keep track of this population which makes it even more risky to be infected, but also a transmission infection. So when we go back to what we talk about when we talk about community wellness or community health and well-being then if we want to take a look at it under the lens of this pandemic and what we needed to do, there had to be a new way of shifting our efforts.

We also know that the pandemic has placed an extra burden on an already disadvantaged populations. There were a lot of unemployment, either furloughed or people that were dismissed from their work because of closing a fresh start. Again, we're talking about essentially workers, closing of schools, closing of a lot of places where that meant unemployment was rising with unemployment.

There was lost. And after the ability of health coverage, or if you had health insurance that come through your work, there were a lot of food insecurity due to the the isolation or people unable to provide food. There were some people that moved into shelters or lost their homes. Certainly financial stress at two in the mental stress that added to dealing with a pandemic and dealing with the impact of it on a family basis, but also an individual level. And finally for especially for those that are elderly and there were quarantined or.

Forced due to isolate and the social isolation impact was very evident and in many of the people that we saw.

Also the pandemic has disrupted what we had as a safety net. The resources that were in place in the community. A lot of the funding shifted, so many of those community based organizations and non-profits where we're lacking funding the Safety Net. So these are the clinics such as the free clinics, and all that had to either shift everything towards the covert 19 cases, or they had to close because, again, they opted out of outpatient.

operations. We couldn't ask volunteers to participate in events because we were afraid of the safety of those volunteers. Many of our volunteers would go to homes and check on people and all that. And that was a big no-no, especially in the beginning, that, the first month or so, that large community events, such as health fair, food distribution, all those had to be stopped. And then really engineered and re-organize, to make sure that we are limiting the trans mission of the disease.

So we needed to shift our focus and shift our resources to address the impact of the pandemic. And we focused on these five major themes, so certainly, we wanted to ensure that everybody had access to testing, as well as access to clinical care.

32With that, we also understand that the social needs are now at a higher and more amplified need where they became more crucial as risk factors.

So, although we are addressing someone's the impact of a disease on someone, then we needed to understand what does it mean in terms of transportation, in terms of food, in terms of shelter, in terms of childcare, for example. All those are things that we needed to take into consideration.

the homeless population and how do we outreach to the homeless and how do we provide support. It's certainly something that has to be addressed and we understand that communities are different and we're dealing with different populations. So educating our populations about prevention, about the importance of social distancing, the importance of wearing masks but also the importance of prevention in a culturally competent way. one of the things we noticed in one of our locations in Hartford, Connecticut, for example, as which which was predominantly African american, is one of the messages that was plastered all over billboards, and even on TV.

You might remember the ad council that says, whether you have covered or not stay home.

For some people, that meant that, even if you're sick, you have to stay home and we saw a higher prevalence of people that are very sick and not coming to the hospital or not going to see their doctor, because this is what they understood. If you're sick, you just stay home and you do not.

So, this is where the messages have to be tailored to a level where our population can understand it. And finally, of course, the behavioral health support not only for those that are effected in the community. But also we noticed a lot of healthcare workers, a lot of our frontline, people that essential workers that are burnt out. And they are not only worrying about the people that they're serving, but they're also worrying about going back home. And infecting their family. We heard a lot of stories about people sleeping in their cars after their shift because they didn't want to go back home and, and.

But the family choice.

I'm not gonna go through this whole whole slide. As you can see, Trinity is a national health system. We're 22 states, with almost 95 communities. But what we learned from from this is that no one community is alive. You cannot go and have a standard implementation of one solution. You had to truly understand the needs and every community. And then you had to ensure that what you aren't putting in place, there's something that is needed, and it's going to benefit. So a lot of the lessons that we learned, and some of the examples that I'm going to share are based on the experience that that, yeah.

So, we learned that social care is as important as clinical care. And this is where we established a social care hub in every place where team members connected with patients, But also, it was available for community members either virtually, through our website, or through a physical location where they can call and ask for advice. These local services, such as food, housing, financial assistance, childcare, and also access to medical as well. Another thing that we were looking at is monitoring, almost on a daily basis, The availability of the community based resources.

We know that a lot of our community organizations that are dealing with, like the food pantries, were in dire straits, or they needed more supply. So, this is where we wanted to ensure that we have the capacity to refer someone for services, and a lot of the support went to ensure that those community organizations are OK and they are functioning well.

We also connected our patients too.

Frequently they is the we gave them a resource directory that they can access and and find out what services that are available And what they can meet. This is during the period of the beginning of the pandemic, as you can see and in mid march and it goes to mid May where we had the peak.

And when we started the social care hubs, then you can see in the left-hand corner how fast those services happen or those needs were identified and how they were provided. The same way was also for those that called and inquired for medical need and medical access. So, so the two graphs that you are seeing show that really people are in need of both services, And this was under what we called people under investigation. So these are people that went and had a test, and they either got the result of that test, or they were waiting for the results. So there was a 24 hour period until they got the results that they were positive. Then they went into quarantine. If they were not then we follow on them every week to make sure that nothing has changed.

Screenshot (4)But during that period they were asked whether they needed assistance with food system, shelter and all that and these are some of the data.

Also, the Community Resource Directory, that was a link on a website where people could go and type in their zip code and what they're searching for. And we partnered with Bertha which is a web based community resource directory. And as you can see, the majority of the inquiries that happened during that month between April and May, we're looking for food and housing.

And then health came in, and the third, uh, category.

We also understood that there were barriers to testing, not only barriers, because of the lack of available testing. But with that, there was a missed distribution. or in Inequity, and distribution, or the tests we wanted to ensure that communities have access to testing.

So Community based testing, either through Drive-thru, uh, Events. But even the Drive-thru event has a barrier for those that do not have transportation. So we started having walked and walked through testing sites or we dispatched many of our mobile units, the mobile units usually were just for health education, some basic screening. Now the mobile units became testing sites as well. So this way, we alleviated some of the transportation barriers. We would take a mobile unit and put it in front of homeless shelter, and test the homeless?

And make sure that we are keeping track of that, and we wanted the testing to also address the cultural differences. So, a lot of the services were translated to whatever the predominant language was in that community.

We, as I mentioned, the, the homelessness efforts were very focused on, for example, our atlanta based health system partnered with many of the organizations. They benefited from a strong support from the state where they rented a holiday in the downtown area. They did perform the testing. They partnered with the university and making sure that education is happening. Anyone that needed isolation was taken to the hotel, where basic services were met, and also their medical needs were addressed. And, and in some other places, we provided toiletry stations and branches, or when we know the homeless, that cannot seek shelter, are found. We distributed a lot of the personal protection equipment such as masks and sanitizers and all that.

We also looked at the population that was and in jails and hospitals and when they were discharged, making sure that they are, they have a place to go, or they are connected to a shelter that they can go to where they are protected.

There is no less importance, no greater importance than then making sure that people aren't aware and the communication campaign. So that had to be where do you come in as a trusted partner and that meant engaging a lot of community leaders to provide the education and understand the community and and what message they need, A lot of banking we distributed door hangers in multiple languages. We did a lot of that social media and radio and TV ads and ensuring the importance of masks wearing face covering the the social distancing, the sanitizing and the importance of if you're sick then just make sure that you stay home and your State isolate.

one thing that we are still challenged with is the availability of data. And as many of you probably know, a lot of the data that is collected and very few states when they collect a covert 19 data, whether it's positivity or confirmed cases, or even people that go on ventilator or die, does not specify race, ethnicity, or insurance status. And all that. Sounds, so we are emphasizing the need of having that as a mandate and, and ensuring that we collect that data, because that data is going to be very helpful in identifying where the hotspots and, and most people that are at risk, in our communities.

And with that, we can also have a profile to understand whether there is unintentional bias and treatment, testing, an intervention from the health system that is in the community.

It also would help us to determine where we need to focus our testing and our prevention efforts and all that, and what communication campaign or what messaging needs to be implemented. I am currently helping Wayne County, which is my county in Michigan with their covert response, and we're putting a strategy, specifically, that is targeting community based testing. And the first thing that we're doing is, we're looking at what communities amongst the 43, and they in the county, have the highest prevalence and the highest positivity rate, especially the trend, and trying to understand a little bit why this is happening. So one example is the City of Dearborn chairs, where a high concentration of Arab Americans are, and because of the cultural differences, because of the multi-generational interaction in one household that this population has.

We believe this is why there are higher cases we're seeing in that community rather than in others.

And our approach to this is going to be quite different than if we are targeting, let's say the gross points which are the more affluent population in Wayne County.

Screenshot - 2020-09-18T211337.948Finally, we certainly need to understand the behavioral impact and the stress on community, as well as individuals. So a lot of support needs to be put in two words, hotlines or lines that help individuals and not only, as we said that those that are impacted, but also those that are the health care workers and frontline workers.

We need to ensure that group homes and residential settings where substance use or rehabilitation is happening. And preventive measures. And we need to maintain the essential services in the community, although we are still in some places in Shutdown mode. We need to ensure that these are still happening, and we are providing crisis intervention services in those communities.

So to recap, we we know that covered 19 has amplified things that we already knew that were affecting communities in terms of amplifying the social risk factors and the social influencers of health. And it did affect those that are vulnerable and certain ethnic groups more than others. And it exposed disparities and inequities, in both the morbidity and mortality. Again, within these populations, and in order to ensure that we are pressing, the impact, and mitigating the impact on the community level, than a change in the shift and the refocus, on how we address community wellness, has to be a place in order to minimize that effect, and the impact.

19, and Archimedes.

I'm going to stop here, and I'm sure that Questions.

Doctor Hamam, a great presentation on on the income and social impacts of this pandemic.

So many great insights from, from your reveal.

I'm going to keep monitoring for additional questions here as you're presenting, but one of the things that has emerge has to do with perhaps some of the options that we may have in addressing these inequalities going forward. As you said, if there is a benefit from the pandemic is that it has exposed to a wider audience, what those inequalities are.

Well, what would you say are the main areas of potential improvement when it comes to addressing these inequalities going forward?

Well, certainly, it depends on how we are looking from which side, we're looking at it from health systems, understanding that it is no longer.

The health system role is not only to provide clinical care. So the health systems are still going to be the first where those covert patients aren't going to come in, so putting a tool that is going to screen for the social risk factors, and connecting them with partnerships or whatever The system can provide. Connecting them to some of the services that are in the community, supporting some of the citizen community is going to make that intervention complete. It's, again, as we talked about, it is no longer sufficient to address the disease itself. We need to look at it from a complete and holistic approach, and make sure that we are addressing all that.

Many of the non-profit health systems have a forum for IRS requirements that need to invest in communities. And I think this is where some of this investment is put in a smart plan, more impactful way, and looking at beyond what happens within the hospital walls.

Farewell, William Fuller from Oregon asks about the first states that the pandemic has significantly increased demands against community health budgets and the how has Trinity, and maybe organizations, healthcare organizations in general shifted, or are acquire the funding to address the shortfall and how much more and maybe needed to, to address that.

That is a great question, and unfortunately the answer isn't as simple. Many of the health systems we know have been challenged financially, due to many reasons cut down on elective surgery. There was a period, and they all the outpatient and staying there, were only seeing patients. And all that What we did, and Trinity Trinity was at a little bit of advantage, although we experienced that financial challenge, similar to any other health system at Trinity had a budget for community wellness to stop. So it wasn't only the community benefit, which some of you are familiar with, that term such. As uncompensated care, there were budget annual budgets that we put into programs that we called programs for community empowerment and to improve immediately. What happened when Covert hint is that we went into two things.

one, we downsize, whether you like that or not. But we had to put our priorities straight. But then we shifted everything to specifically address covert. So, we had a project that was in its last year that was called Transforming the Initiatives.

And this was a lot of advocacy, a lot of building community coalition and all that we instructed those eight communities that were provided.

And that that were participating in, that project to put everything at home, and whatever is remaining from that grant, what would they do based on the needs in their communities? and every one came up within one week of a plan to address a covert need many of it.

I can tell you almost 70% went to food emergency they found out that the food pantries, the food system had to be and everything shifted there. Some of them went into the shelter and housing. So, this is where we have to be flexible. And, and how are you using your available funds, but also, you have to look into the future and say.

Are we putting our community benefit dollars into things that are going to leave a better impact? Or are we, I given example, health fairs and normal days, every hospital, I'm sure, and participate, in at least, not 1 or 2 or even five health fairs, and although I will not minimize the importance of a health fair.

32But instead of $10000 for one health fair, time slash that is $50,000. What can you use that $50,000 in something that would provide you more sustainable? And so this is where I'm looking at community resources, and looking at your role as a health system, how can you be smart in your investment?

Then the doctor home. I mean, what, what do in your assessment? What would be the, the best levers, if you will, to pull if we have to allocate those resources?

What does the research show, what does your experience account for when it comes to, perhaps, the most important factors, if we can direct funds to, Again, it depends on what is needed in the community. And this is where the community health needs assessment is, your most powerful tool, whatever you discover if that community health needs assessment is done the right way. I E Looking at everything beyond your hospital, data. Looking at the community, demographics, the community profile, than then, this is where you, a recipe for you need to prioritize. Another thing that I need to also mention, is that you do not exist in a vacuum. This is not a one entities job. The health system isn't into apartments renting. The health system isn't into community gardens. Although some, some do. So, there are people and entities that are out there that are doing a great job, how can you collaborate and support?

And make sure that overall winner is the community. So, so partnership is a very important thing to establish and even bringing other competitors, other health systems.

Because again, so many cliches that we use in this space, power in numbers and efficiency and all that, these have to be practiced in order to make sure that we are very good. And you and your FSR is that well, that there is, there's some global aspects to this, but a lot of the priorities are set locally, depending on the needs of the community.

Now, in the, what about the health care providers, and what is their role in this system? Because there has been quite a bit of discussion about healthcare providers, the Institute for Health Excellence, as an example, share some incredible data about the burnout levels of doctors and nurses before the pandemic.

And we all know that it has, it has has escalated probably exponentially since then. Curious about how, what role do they play in the system as part of, as providers, but also as part of the community.

The, the health care providers are, again, the frontline, they are the connection between community members and everything.

From a health system perspective.

You probably, and, I, we trust our doctor more than we trust anybody else. So, this is where the healthcare provider has to be proactive and addressing some of the social needs. Unfortunately, and up till recently, many of the primary care physicians understood the importance of the social determinants or the social influencers of health, and its interaction with what make people healthy. But many of them option and there was study, I think, by the Institute of Medicine that showed that 80% of primary physicians do understand the need to screen for social risk factors. But they don't do it, because they don't know what.

So that stomach ache that doesn't show any physical etiology, but it is because of hunger. A physician cannot write a prescription for a meal. And even if he or she does, no one is going to reimburse.

So, this is where a system put in place that incentivize financially, but also is, and this is where value based come in place, because by addressing all those, you're improving the outcome and shifting to an APM model, where the value and the outcome is more now than off the volume.

And this is where physicians need to understand that by addressing these needs and catering to those interventions, then this is how they are helping their their patients and making sure that they, the outcome is better very well very well up. And when it comes to the role that health systems play in addressing community wellness during pandemics And the and also contrast to that a little bit of the role of the Government where, what is the balance that we should strike on that?

The government certainly has a big role in ensuring that some of the policies are changing. So specifically let's let's look at behavioral health.

Behavioral health is very challenging even in normal times before the pandemic due to many of the legislation that, that to whether it's billing and reimbursement, whether it's allowing certain things to happen or not. There is also a workforce that is lacking, so, all these are things that the government can step in and improve. Health systems, on the other hand, are also members their anchor institutes within the community, And, and if you're familiar with the anchor strategy, then it is hiring locally, sourcing locally, and investing local.

big systems that are, and it community can provide a lot of economic opportunities on those three levels within a community that can change the hall.

Policy, environmental, and system change is something that health systems can contribute to. So by policy, this is where the government comes in, the health system has the role of advocating. And we have seen, even during the pandemic, a lot of these policies have changed. And a lot of it was a result of those that are the frontline health systems were advocating for a better way on or minimizing or really releasing, removing some of the restrictions on things that were in place, for example. Telemedicine?

We saw a lot of those restrictions lifted on who can do it and how you can get paid for it and all that. And this is what we need a more flexible government when it comes to policies, because this is what is.

Very good, very good. I'm scanning for additional questions. I'm asking for additional questions here and I have one from Received Heart Acre, who is actually who is attending this from Hong Kong, and so it's even a Hong Kong right now, still great that you stayed up late to be a part of the, of the conference. And Steve asks from our community health care perspective, where are we better and worse, prepared across the United States for was likely coming this winter with the spread of cover 90, and what, if anything needs to be done immediately to address that?

That is a very good question. Depending who you ask. There are two schools of thought of what we might encounter this winter. So certainly, having a flu season is going to add, probably more burden to those that are.

Experiencing covered 90, and the symptoms are the same. So, you will have a lot of people that are rushing or clinical care, and this is where understanding who's who is going to happen. Another theory, which is probably the more optimistic Siri theory, is that because of all the precautions that we are taking in place because of the social distancing covering and all that, we might have a much more softer flu season because of the contamination. Regardless what it is, what we are preparing is certainly the ability to test.

So, increase testing capacity to immediately the fine weather this as a covert case or a new case, increase the capacity of hospitals and ICUS and ventilators in case we had another surge, like what we had in April. These are the most two that are very important in preparing and, of course, continue to deliver the message of the importance of prevention and protection and all the practices that we know artifact.

Doctor Hmm.

I will finalize of a question on, as, you know, healthcare. We have healthcare providers, healthcare, transformation leaders, operational excellence, in our audience, and of course, you know, citizens of communities, what can we do in this different capacities, if you will, to support community Wellness, going forward.

I always say, it takes a village. So everybody has a role, whether you're an educator, whether you're in business, whether you're a health care professional, or whether you are a community member.

Again, coming together and putting all the resources towards the benefit of the community is essential. Some of us can, can do it better than others. Some of us have expertise in one field versus the other and this is where putting the brainpower together is going to be very helpful.

Screenshot (4)Starting from an understanding that, um, Not everyone is going to be equal, and how they can access resources. Not all communities have equal opportunities to protect themselves or respond to that. And starting with those that are most vulnerable is something that has to be the first step.

We always talk about equality and equity and we need to start thinking more in an equity term. Quality is giving everybody the same. Equity is giving those that need more more resources and that's what we need.

Farewell very well. I think for this audience the focus off in the law within the organizations on end to end process optimization on that as an example as opposed to a yellow, the more common segmented approach to process optimization. What you have done for us today is to expand the end to end process of social health care. And and I think that that you have broaden the horizons and shown us that the end to end process, if you will for healthcare is is much wider than most people have have probably perceive it to be. And if there is any as you mentioned before if there was any benefit from this pandemic is that probably or we all have become more aware of that. Thank you so much for sharing your expertise, your insights. It's a true honor to have you with us and our global audience certainly appreciates everything that you shared today.

My pleasure. Thank you, Joan.

Thank you.

Ladies and gentlemen, this concludes this segment, and we are going to get ready for the top of the hour to shift into another global impact area. And that has to do with global healthcare supply chains. Supply chains for healthcare have been significantly disrupted and dislocated and there is really a lot of uncertainty about how that's going to look going forward with lots of issues related to the supply chains themselves and geopolitical issues already taking place. So with that, we're going to have an expert on that from the Mayo Clinic. Eric ...

is going to be here with us and he's going to wrap up our conference with a view of the impact of covert 19 on the Global Health Care supply chain and specifically how effective the Mayo Clinic. And so, really look forward to meeting you back up at the top of the hour and enjoying Eric's presentation. So, thank you, Susan.

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About the Author

more (6)-Sep-21-2020-12-03-52-11-PMMouhanad Hammami,
Senior Vice President, Safety Net Transformation, Community Health and Well Being,
Trinity Health.

Dr. Hammami, a senior health executive and chief health stratgist served as the Senior Vice President for Safety Net Transformation, Community Benefit, Health and Well-Being at Trinity Health. In this role he led the strategy to improve health for individuals and improve the underlying social determinants of health in communities served.

He also led work for Trinity Health's community-based delivery models and public health initiatives and partnered closely with state and national experts to integrate health caredelivery with public health activities. Prior to joining Trinity Health, Dr. Hammami served as Chief Health Officer and Director of the Department of Health, Veterans and Community Wellness in Wayne County, Michigan for almost ten years.

A graduate of Aleppo University, Syria, Dr. Hammami completed his post doctoral research in Pediatrics at the Newborn Center of the University of Tennessee in Memphis, and then accepted a faculty appointment at Wayne State University School of Medicine in Detroit, Michigan and a research position at the Detroit Medical Center, Department of Pediatrics. He then received his Master's degree in Health Services Administration from the University of Michigan.

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