The Chief Medical Officer’s Role in Addressing Health Equity

By Christopher Cheney

A chief medical executive has a key role to play in addressing health equity, the new chief medical executive at Clive, Iowa—based MercyOne says.

Hijinio Carreon, DO, was recently named to the newly created position of chief medical executive at the MercyOne health system. An emergency medicine physician, Carreon previously served as chief medical officer of MercyOne Des Moines Medical Center­.

Carreon recently talked with HealthLeaders about a range of issues, including health equity, physician engagement, and his vision for telehealth after the coronavirus pandemic has passed. The following is a lightly edited transcript of that discussion.

HealthLeaders: What is the role of the chief medical executive in addressing health equity?

Hijinio Carreon: As the chief medical executive, I should promote and ensure responsibility across all disciplines in terms of health equity. I should be in the forefront in addressing health disparities. In this role, I find myself as an essential leader of the hospitals and need to make sure that I create an equitable environment for our diverse population.

COVID-19 has resulted in a lot of changes and identified many weaknesses in our healthcare delivery system—whether those are related to social determinants or how we manage chronic illnesses. From my perspective, it is extremely vital to address health equity. I must ensure that I am implementing effective education programs for our clinicians to address their unconscious biases and to garner patient trust.

My immediate objectives related to health equity and personalized care are a digital strategy to create avenues to improve access to care and ensuring that we continue to move to a value-based care model. We currently utilize health coaches and community health workers to identify the social determinants that exist in our communities. We do not want to just address social determinants but also tie them into the resources that exist within the communities, so that we are addressing the fundamental reasons for why people are not seeking medical care or why people are unable to make an appointment that has been scheduled.

HL: What are the primary elements of personalizing patient care?

Carreon: There has been a lack of personalized care for a long time. Healthcare has struggled to gather patient information necessary to tailor care because of the disparate electronic health records that exist even within some health systems. This creates a great deal of frustration for not only patients but also physicians.

When you break down personalized care, it spans multiple dimensions. There is a partnership between the clinician and the patient. At MercyOne, we want to ensure that we create adequate healthcare access points. We want to ensure that we have effective methods of communicating across the continuum of care.

In my role as chief medical executive, being that chief clinical person over both the ambulatory and inpatient sides means being able to see both sides and not just have physicians focused on the ambulatory side or the inpatient side. I need to oversee the operation from both avenues to ensure that we are fulfilling patient needs across the continuum of care. I want to ensure that patient data is accessible and viewable across the delivery models—whether that is ambulatory, subspecialty services, or the inpatient setting.

HL: What are the primary elements to success in physician engagement?

Carreon: The keys to physician engagement are transparency, alignment of our goals, physician empowerment, teamwork and collaboration, and allowing physicians to lead.

In terms of transparency, at times, the belief is that the physician is the frontline worker and may not have a vested interest in the finances and payer issues that may be occurring in healthcare industries. In reality, physicians developing an understanding of how reimbursement is done, what the current finances are, and where the opportunities exist helps create alignment. With alignment, the goal of the organization’s success should align with the goals of the practicing clinicians. So, if their goals are improvement of patient care and improvement of patient access, they should align with the organization’s goals.

HL: What is your vision for telehealth after the coronavirus pandemic has passed?

Carreon: I have a strong belief in telehealth. In the initial months of COVID-19, about 25% of our patient visits were performed virtually. As we continue to reopen our clinics safely, digital health still maintains a significant objective for us.

When it comes to accessibility, I cannot emphasize enough that telehealth is one of the strategies to improve accessibility, especially in a state like ours where we have a lot of rural communities. There is not a hospital in every town. There is not a clinic in every town. So, we must have different modalities for patients to access us. Versus a trip of several hours, telehealth offers an opportunity for patients to stay in their homes and access care.

If patients need a higher level of care, telehealth can direct patients to the appropriate location to get whatever additional care they may require.

There are concerns about access to broadband as well as insurance and reimbursement issues that may prevent patients from accessing virtual services. We need to make reimbursement transparent for the consumer to ensure that they know what they are going to have to pay out of pocket and what their insurance is going to cover.

From the patient’s perspective, we must create a seamless telehealth experience.

HL: What are the primary measures for the performance of a chief medical executive?

Carreon: Physician and advanced practice provider engagement is extremely important. Quality outcomes—specifically around hospital-acquired conditions and mortality—are extremely important. Then there is improvement in the equity of care in the communities we serve. Health equity must be more than a nice statement that is said—it must be embedded in the belief of the frontline physicians that they believe there is an opportunity to improve equity in care. If people understand the importance and value of keeping our communities healthy, that engenders trust in the patients who we serve.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.