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This week, we are joined by Coletta Barrett, vice president of mission at Our Lady of the Lake Regional Medical Center. Coletta shares best practices and provides inspiration for how 340B professionals can work toward eliminating health disparities in their hospitals and communities.
340B Insight provides members and supporters of 340B Health with timely updates and discussions about the 340B drug pricing program. The podcast helps listeners stay current with and learn more about 340B to help them serve their patients and communities and remain compliant. We publish new episodes twice a month, with news reports and in-depth interviews with leading health care practitioners, policy and legal experts, public policymakers, and our expert staff.
Audio (00:05):
Welcome to 340B Insight, from 340B Health.
David Glendinning (00:14):
Hello from Washington DC. And welcome back to 340 B Insight, the podcast about the 340B drug pricing program. I'm David Glendinning with 340B Health. Our guest today is Colette Barrett, Vice President of Mission for Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana. The medical center is one of several, that 340B Health will be featuring in an upcoming report on how our member hospitals are pursuing health equity within the communities they serve. We conduct regular research on the equity topic, to share best practices among hospitals and to serve as a source of inspiration for 340B professionals working to tackle healthcare disparities. We were eager to speak to Colette, to hear about some of the compelling and promising work that Our Lady of the Lake is doing in this area. But before we go to that interview, let's take a minute to cover some of the latest news about 340B.
340B Health is out with a new survey report on the effects of drug company restrictions on discounts, for drugs dispensed at community and specialty contract pharmacies. We had conducted a similar survey near the end of 2021, when only eight companies restrictive policies had taken effect. By the time we conducted our March survey, that number had jumped to 14 drug makers. The bottom line in the new report, is that the projected financial losses to 340B hospitals from these drug company actions have more than doubled since the end of 2021. Some hospitals are estimating annual losses that are in the tens of millions of dollars. And these figures do not even account for the expected effects of new contract pharmacy restrictions put in place by Gilead and Johnson & Johnson, which are the 15th and 16th companies to impose them.
Please check out the show notes to read the full report, which 340B Health also has sent to every member of Congress and to key administration officials. Drug companies, community and specialty contract pharmacy restrictions have sparked more opposition from organizations representing patients with chronic diseases, who rely on 340B hospitals for their care. A coalition of patient advocacy groups, representing people living with viral hepatitis and HIV/Aids has issued a joint statement, noting that several of the major drugs affected by restrictions on 340B pricing are crucial for treating and curing patients living with hepatitis C.
The statement calls on AbbVie Gilead, Merck, and the other companies to reconsider the restrictive policies, in light of the impact on these patients read the full statement in the show notes. Now for our feature interview with Colette Barrett. Miles Goldman recently sat down with Colette to hear about health equity initiatives, that Our Lady of the Lake Regional Medical Center has integrated into its patient care mission. Here's that conversation.
Miles Goldman (03:30):
Thank you, David. I'm joined by Colette Barrett from Our Lady of the Lake Regional Medical Center. Colette, welcome to 340B Insight.
Colette Barrett (03:38):
Thank you. Thank you so very much. It's nice to be here.
Miles Goldman (03:42):
And I'm excited to have you joining us to hear about the work Our Lady of the Lake is doing in pursuit of health equity. I do want to hear more about the community Our Lady of the Lake serves.
Colette Barrett (03:54):
Absolutely. We are very fortunate to be a 1005 bed academic medical center located in, what I call the Greater Baton Rouge area. We're actually spread over three campuses. We have a main campus, which is our tertiary level services, trauma center, et cetera. Our children's hospital, which is our newest addition, free standing. And then, we have an 84 bed, it's not necessarily a rural hospital, but in a community parish, a little bit further away from us. And we service the capital area. So we serve uninsured, underinsured, Medicare, Medicaid, managed care. We're a full service provider in this region.
Miles Goldman (04:43):
I want to hear about some of the ways the medical center is using its 340B savings.
Colette Barrett (04:49):
I am so glad that you asked that question because we are very, very fortunate and proud to be a part of the 340B program. We believe that the savings that we enjoy because of 340B, or what we turn back into, caring for those most in need, supportive care for those most in need. We have a clinic in the Mid-City portion of our region who serves mostly the underinsured or uninsured Medicaid population. Our pharmacy there, we were able to, when we took that pharmacy over in 2013, went from 14 to 16 day turnaround time for a medication fill, to less than 12 minutes. And it was very, very, very important for us to know that we were able to meet the needs of our brothers and sisters in these disadvantaged or under resourced areas of our city, and to bring to them the level of services and care that everyone has a right and a desire to have.
Miles Goldman (05:57):
Those are really great results to hear about and really impressive. How do 340B savings connect to Our Lady of the Lake's pursuit of health equity?
Colette Barrett (06:07):
That's a really good question. And health equity can be defined in many, many, many different ways, but one of the ways that we like to look at that around an equity lens is, is it access to care? And is it equal access to care, no matter where in the city that you are located? And so looking at access, we're able to make sure that our clinics are open in those areas. We actually were able to expand and open an emergency room in the Northern part of our parish. When one of the inner city hospitals emergency rooms closed in 2015, we went through a discovery process of what was the impact on the community. And because of the impact on the community, we were able to expand services and open this emergency room attached to our urgent care clinic and primary care clinics up in the Northern part of our parish. That is a way that you use the savings that you have through 340B program to expand services to underserved areas.
Miles Goldman (07:12):
That's really interesting to me that you undertook this study. Can you tell a little bit more about that?
Colette Barrett (07:18):
Yes. We actually worked with our city parish government. We worked with the Louisiana Department of Health. We worked with the other healthcare providers in our community to take a look at, what was the response time on ambulances to a scene, picking someone up and bringing someone to an emergency room. We looked at, what were the impact by diagnosis, realizing that trauma we're going to come to us no matter what, because we are the trauma center for our region. But other diagnoses in looking at the increased time that it took for an ambulance to respond. And what we saw with that, there was a less than one minute increase in response time, across our community with EMS services. If you're having an asthma attack, if you are having a respiratory compromise, if it is an out-of-hospital cardiac arrest, 50 something seconds is a lifetime and makes a difference in someone's health. And so, looking at the data told us that we really did need to take a look at how we support our pre-hospital community by making sure they had another option, an alternative in the Northern part of our parish.
Miles Goldman (08:33):
I'm really glad you mentioned data, Colette. What advice do you have for hospitals on how they can start to collect data and apply to their efforts to address health disparities? That's a topic we hear a lot about.
Colette Barrett (08:48):
Well, I think it's interesting. The first thing that we've struggled with is, is our demographic data accurate? Is it appropriate? And are we gathering it on admission? And so, going to our electronic health records is a place to start with looking at who we serve, who is the population that we serve. The other parts about data, and especially in emergency rooms is understanding what gets in the way of achieving what it is that we've asked them to do. We actually looked at that as part of a health equity lens. We signed the #123forEquity Pledge, that was back in 2016, from the American Hospital Association. And we chose to look at readmission rates, recidivism in the emergency room. And we looked at patients who had visits with us, greater than six within a year. And then we plotted that information and what we found were these were some of the patients that were located in the part of our parish, where there was no emergency room.
So that was part of the data that we used to help say, we need to open this emergency room, in 2017, because people were finding their way to an emergency room in the Southern part of the parish. As a part of that, we began to look at social workers in our emergency room, to look at the reasons why people were familiar to us. We used the term familiar face. And so, what we found was that when our team was using a transactional approach to caring for the patient, meaning, here's your appointment, here's your doctor, here's where you're supposed to be, you didn't make the appointment, you want to let us know what was happened. When we took a transactional approach to that work, we only had about 37% of our patients that kept their connect to care, primary care appointment.
When our social worker lead then said, "We've got to have a different way of doing this." And we flipped our model to what we called relationship based care, where the first reach out was, tell me how you're doing. How is things going? When we turned this to a building a relationship with our patient, and the connection to care was the outcome that happened. It wasn't the reason for it. We saw a fundamental difference in the uptake of people keeping their primary care appointment. That went from the 20s, the high 20s, almost to the high 70s.
Miles Goldman (11:28):
Well, I like how you've taken this data, and then it's led to a direct outcome. We've heard about food insecurity being a major social determinate of health. Is this one of the social determinants of health, Our Lady of the Lake is seeing and working on?
Colette Barrett (11:47):
Yes, thank you for asking that. We are approaching this from multiple different ways. First of all, we are a partner with our mayor's Healthy City Initiative, and one of their foci is food insecurity and social isolation. And so, there are community based programs that we're a part of. One of our faculty in the internal medicine program, Dr Tiffany Ardoin actually is conducting a study, it's called the FISH Study. And it's looking at food insecurity and teaching people how to cook and be exposed to new foods. Because what we found is that, people were not comfortable or, an eggplant, what is that? Broccoli, how do you cook that? And so, we undertook this project with cooking class, with our people, from our clinics that screened as food insecure. They receive a rescue box from our food bank. That's another way that we partnered with a community, a collaborating partner. And with the Baton Rouge Food Bank, we now provide for patients that screen food insecure in our clinics, a rescue box, 25 pound box of food supplement that is considered as healthy as you can get, in a box.
And then, they are connected to the food bank for future follow up, where there may be other food programs, food distribution programs. From that, they were connected to our teaching class program. And in each one of those weekly programs, they receive a food box from one of the partners. And that's where we connect the social organizations in our community that we support through sponsorships or donations, with other needs that we've identified in the community itself to say, "Hey, here's a need here. How can we work together with you all to address that?"
Miles Goldman (13:39):
These issues of health disparities and pursuing health equity, this really became much more on the front page because of the COVID 19 pandemic. And I wanted to hear a little bit more about some of the work you've been doing in that area.
Colette Barrett (13:58):
So in the very, very early days when vaccines outside of healthcare were just coming into being, we were able to make commitments to churches across our community, not just Catholic churches, all faith churches, to come in and do COVID 19 vaccine clinics onsite with them, as a partner. And that really did help a lot in the early days when people were very suspect, because if the church evaluated that it was something that was important and they were willing to partner with you on it, then it told the congregation that this might be a good thing to do. And so, we did multiple church clinics in the early days, and then opened our own vaccine clinics. We partnered with the State of Louisiana and opened up a mega vaccine program out, on the Pennington Biomedical Research Campus, that was program and slotted to give 1,000, 1,200 shots a day.
Miles Goldman (14:56):
How did you go about funding the mobile clinics?
Colette Barrett (15:00):
Yeah, that's a really good question. There are lots of ways that there was funding made available for these. For example, our 340B savings programs helped fund the mobile clinics, where we have mobile units that went out into areas that were harder to get to, or we needed community stakeholders to work with us, to get people to come and get their vaccines. And so, our 340B program help support some of those.
Miles Goldman (15:29):
Did you run into challenges with increasing vaccine uptake?
Colette Barrett (15:33):
There were many, many, many challenges about vaccine uptake and as a society, we're still not exactly where we need to be. And so, like I said earlier, partnering with trusted resources is a way to get some sort of low effect, when it comes to acceptance. In working with our African American churches, we found that utilization of the Moderna vaccine was much more readily acceptable to segments of that population. And so, it was working with our state and working with our pharmacies to make sure that we had Moderna available to us, for these types of screening programs that we were doing. And so, working with all kinds of community partners to get people out and to talk, we mostly wanted people to have the information that they needed, to have the table conversation. The conversation with your family around the breakfast table, around the supper table, and to be able to address concerns and issues from a personal level and from an ability to meet people where they were and walk with them where we would like them to go.
Miles Goldman (16:48):
We've spoken about several, really great promising initiatives with you. Do you see some ways where they're all tying together?
Colette Barrett (16:57):
So with our DEI efforts at the system level, we have a community work group and this is where the data on equity, like our own team members and just wages, et cetera. And looking at operations, it's looking at our spend, in other words, what is our spend as a system with minorities, women, local, small owned veteran businesses? Even though you have a GPO, you still have an opportunity, even within your GPO construct, to purchase local. And so, what does that look like? And then with our investments, are we doing social impact investing? Are we taking investment dollars and are we putting them back into the communities?
And so, from our perspective and our system, we've put those together so that we have a system DEI executive, we have a system DEI manager, and then each one of our ministries in our areas have DEI committees. And then we have an infrastructure for implementation. And so, that's how structure drives outcome and performance. And so, we made the decision as a ministry, to roll that all up into our DEI. That makes it sustainable measurable, and something that we can point to and know who's responsible for what.
Miles Goldman (18:24):
We've heard about the progress Our Lady of the Lake has been making. And there are many other hospitals that have seen some achievements in the last recent years around the pursuit of health equity. Are there steps these hospitals should be taking to keep up the momentum?
Colette Barrett (18:43):
Absolutely. Starting with where you are and what you have. How do you go forward? One of the things that I always encourage, the organizations that I work with is, look and see who's already in the community doing what it is that you subscribe to do or aspire to do. If it's about talent acquisition, who's in the community, skilling people up and getting them ready for meaningful and gainful employment? And so, partnering with that organization to increase their scope and scale is a way to do that. Around workforce development, the institutions that are creating the workforce for the future. Are we partnering with community college, with technical colleges about skills and traits that are much needed in this whole vast arena of healthcare?
How are we partnering with those institutions, to give them stability so that they can increase the pipeline of students that they can bring into the organization to scale them up, train them up, educate them up, so that then they're ready for employment with other healthcare organizations? To me, it's just important to pause and look around and see what the options and potentials are and how we can partner with those organizations to do a bigger, better job, to leave things better than how they were when we found them.
Miles Goldman (20:13):
Well, I couldn't think of a better note to end our conversation on, Colette. Thank you for helping us continue to keep health equity, front and center. I appreciate you taking the time to speak with us.
Colette Barrett (20:25):
You're so very welcome.
David Glendinning (20:27):
Our thanks again to Colette Barrett, for sharing her health systems progress in the pursuit of health equity, both with our listeners and with all those who will be reading 340B Health's upcoming report. Please be on the look after that release to learn more details about Our Lady of the Lake and the other hospitals featured in the report. Such case studies provide important information and inspiration for 340B hospitals that are working to fulfill their missions to all patients in need. In case you miss the news, registration has opened for this year's annual 340B Coalition Summer Conference. We will be convening August 1st through August 3rd, just outside of Washington, DC, in National Harbor, Maryland. Please visit 340Bsummerconference.org to learn more about the conference agenda and to register today. We look forward to seeing you this summer. If you have questions about 340B's role in health equity or any of the topics we cover on this show, or if you have recommendations for some topics we should cover, please email us at podcast@340bhealth.org. We will be back in a couple of weeks. As always, thanks for listening and be well.
Audio (21:43):
Thanks for listening to 340B Insight. Subscribe and rate us on Apple Podcasts, Google Play, Spotify, or wherever you listen to podcasts. For more information, visit our website, at 340bpodcast.org. You can also follow us on twitter @340BHealth, and submit a question or idea to the show by emailing us at podcast@340bhealth.org.