Effectively engaging with and serving vulnerable populations is made even more difficult during the COVID-19 pandemic, when trust in healthcare systems has been eroded.

By Chris LaVictoire Mahai, President, Aveus, and EVP, Medecision


In February, I had the opportunity to host a webinar to discuss how to identify risks and effectively engage with underserved and vulnerable populations. This is a challenging task in “normal” times—but during a global pandemic, the challenges, risks and opportunities are even greater.

With this in mind, I invited Dr. Jan Berger and Jesse Thomas to discuss how we need to think about serving complex and vulnerable populations. Dr. Berger is a healthcare executive with 30 years of experience in the private, public and government sectors. She is the founder and CEO of Health Intelligence Partners, a global healthcare consultancy, and chair of the Medecision Advisory Board. Thomas is the CEO of Healthy Blue, the Medicaid health plan at BlueCross BlueShield of North Carolina and a fellow member of the Medecision Advisory Board. Also joining us was Dr. Terri Steinberg, Medecision’s group senior vice president of analytics and population health and chief medical officer.

Each of these healthcare leaders has a vast amount of experience in caring for and engaging underserved and vulnerable populations—and I am thrilled that they agreed to explore this topic with me for our roundtable discussion.

1) Personalize engagement with the “N of 1” rule. 

Evidence-based care is widely promoted as the best way to form decisions and create care plans—and it’s often associated with better patient outcomes. However, evidence-based care doesn’t take into account personalized trials with individual patients and their specific needs. The same concept is true for engaging with individuals or populations. “N of 1” is meant to refer to the idea of personalized engagement, as compared with population engagement.

“I manage a health plan that focuses on the vulnerable and underserved,” Thomas said. “Their daily lives involve just making sure the kids are safe, there is food on the table, and there is a secure and safe place to live.”

People want to know that they are cared about on an individual and personal level, Thomas added. “Just because a person lives in a vulnerable or underserved community doesn’t mean they don’t have events to celebrate, things to rejoice in or things that are important to them,” he said. “We can’t define people by their socioeconomic status—we have to define people by their heart, character, will to achieve, desire to overcome, and their endurance through the best and worst of times.”

2) Operate with a consistent CARETM model.

People in minority communities have every reason to be distrustful of the healthcare system, as they have been exploited over many decades. For instance, from 1932 to 1972, researchers from the Tuskegee Syphilis Study studied 600 Black men in rural Alabama—but the men weren’t told what was being researched or given any treatment. In 1951, a physician from Johns Hopkins took cancer cells from a Black woman named Henrietta Lacks without her consent—and those cells have been used in worldwide medical research.

These are just a couple of examples where minorities have been made to feel used or exploited. In addition, research indicates that people of color are less likely to get attention, empathy or the medical services they need from their doctors. But healthcare providers and medical professionals can drive trust with patients by operating with a consistent CARE™ model, which was developed by Dr. Berger as a tool to guide interpersonal interactions. Dr. Berger’s CARE model looks like this:

C: Communications — How you address people and communicate with them is important.

A: Attitude and Assessment — Healthcare was a power model for a very long time, and providers and payers often felt more “powerful” than the patient. Check your attitude and whether you’re coming across as superior, Dr. Berger suggested. Assessment is also important: How can providers make sure their goals and the patient’s goals are aligned?

R: Respect and Responsibility — Respect speaks for itself, but it’s vitally important. It’s also important to remember that we all have a responsibility in providing the best care possible.

E: Engagement — How do we not only build a relationship, but also maintain it?

3) Never underestimate the value of cultural competency.

America has often been described as a “melting pot,” in which different cultures have contributed their own unique “flavors.” But it’s critically important for healthcare professionals to be culturally competent.

Cultural competence is defined as “the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural and linguistic needs.”

Mistakes are bound to happen when we’re working with people of different cultural backgrounds—but learning from those mistakes is paramount, Dr. Berger said.

“I’ve worked around the world, and I’ve made a lot of cultural mistakes in initial interactions with people,” she said. “In some cultures, you don’t use a person’s first name unless they offer it to you. In some cultures, you greet someone with a handshake, and in some it’s a hug. My experiences have taught me the value of respecting and understanding cultural differences.”

Integrating care plans and health care delivery around the whole person in a way that is culturally sensitive demonstrates that you care about the individual, and that goes a long way in engaging the person and improving their health outcomes, said Thomas.

4) Build trust by being compassionate.

Trust is a many-splendored thing, and compassion and competency are the key elements of building trust. Trust is earned by building relationships with other people.

“People trust others when they know the other person has their back and puts them first,” Dr. Berger said. “And, for vulnerable populations, that trust can be hard-earned. Building trust can be difficult due to historical factors, operational factors and so much more. Then, you add in the COVID-19 pandemic and political unrest and it’s almost like piling on.”

Dr. Berger said these factors are what makes relationships so important—both with communities and individuals. Human-to-human connection that is thoughtful and intentional bridges divides and helps to rebuild trust, added Thomas.

5) Implement care intelligence platforms to provide consistent and helpful guidance. 

Our society has unfortunately created a world of “haves” and “have-nots” in terms of the digital divide, Dr. Steinberg said. She shared an anecdote about registering her 95-year-old mother for her COVID vaccine dose in New York.

“My entire family spent days working to get her signed up,” Dr. Steinberg said. “It became very clear to me that we benefited greatly from the ability to use the computer, having an internet connection, and having time in our days to repeatedly log on the website.”

She went on to share how it’s incumbent on each of us in the technology world to make sure that we don’t build systems that leave a fraction of—or even a majority of—societal members behind. We frequently talk about automating the way the consumer interacts with healthcare. For example, let’s think about banking. In the 1970s, the implementation of the ATM changed the world. But the real change wasn’t that somebody could go up to a machine instead of a bank teller—it was that people had access to their accounts whenever they wanted or needed it.

“When we think about innovating healthcare, the real innovation will be to create systems that are built around human interaction,” Dr. Steinberg said. “Our technology should be smart and data-driven, but conversations—whether on a phone, video platform or text message—should have human-to-human connection.”

“We can’t just be thrilled and over-the-moon with ourselves about what we’re accomplishing with technology,” Thomas added. “We have to strike the right balance between high-tech and high-touch and do it in a way that is very meaningful.”


Want to hear the full conversation? Get access to the on-demand webinar on Trust and How to Better Serve Underserved Populations or listen to our speakers via the podcast. And check out this blog post on defining, measuring, and elevating trust.

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