By Genoa Barrow | OBSERVER Senior Staff Writer

The Sacramento OBSERVER recently spoke with Dr. Pooja Mittal, who leads HealthNet’s efforts to close care gaps, improve health outcomes and address health equity for the health plan’s more than 2 million Medi-Cal members across the state.

Q. What has been the focus of this effort?

A. This work that we’ve done around health equity has been happening over many, many years. We’re actually the only health plan that’s ever received in the NCQA (National Committee for Quality Assurance) multicultural health distinction, which was established in 2011. We have an entire health education team that tailors all education for our members, based on their culture and background. And that team also does a lot of training for our providers around implicit bias, around resilience, around ways that they can support each of their patients looking at sort of all of that intersectionality, whether they’re interacting with somebody who’s experiencing homelessness, or interacting with somebody who is disabled, or whatever the case may be. So they look at equities across the board.

Q. People on Medi-Cal, people of color particularly, aren’t always treated well while being treated by health care providers. Is this being addressed?

A. We built out a very strong implicit bias training for our providers over the last year and a half and we’ve been giving that training pretty widely. That’s the first step. It’s not the solution by any means, but it’s a place to start. The other work that we’re engaging in, is around also evaluating when people have bad experiences. Internally we track when people have bad experiences and when they report them to us, we follow those. If and when we see a pattern, we make sure that we address that directly with that provider or with that organization or with that clinic, and we offer training, support, education, and then, follow along to make sure that those people’s experiences improved.

We’re also really focused on supporting organizations that are out in the community collecting that data and finding for us where the issues are, and trying to see how we can support them. 

Q. HealthNet’s recent report on health disparities points out the success of a Southern California doula program. What impact has that had on Black mothers?

A. A big part of the reason that we engaged in that work is because we know that Black women don’t receive the same treatment when they go into the hospital as other women. We wanted to make sure that we were supporting them with an advocate, with somebody who could go in and help mitigate some of that and improve people’s outcomes.

Q. Black women have been saying all along that they don’t receive equal care. What has finally made other people sit up and pay attention to that?

A. There’s always been a culture of blame on the patient for many, many years. It’s not “because of the system.” It must be “because somebody is not taking good care of themselves,” or “they’re smoking,” or “they’re drinking more,” or “they’re not in prenatal care.” It took a long time for there to be a shift in the overall scientific understanding that actually systemic racism is at the core, the root cause of the outcomes that we’re seeing.

That shift happened for a couple of reasons. One, I think the data supports that. For a long time, people were focusing on socioeconomic data … and not really looking at it. I have data from L.A. County that shows that Black women with a graduate degree have the same rate of preterm birth and morbidity as White women with a high school degree. It’s right in front of you in black and white. You can’t miss it. Education, or the lack of education, doesn’t support these outcomes. 

Q. And what has been done with that data?

A.  We’ve seen California Surgeon General Dr. Nadine Burke Harris talk a lot about ACEs (adverse childhood experiences) and trauma. There’s also a physiologic and anatomic explanation about why we’re seeing these outcomes. That really has to do with cumulative stress. It took time for the science to catch up and say, “These women are experiencing more stress on a daily basis and generationally, they’ve experienced more stress than other groups.” That cumulative stress causes stress in the body, it causes stress on the cells and just manifests itself as disease, whether that be higher rates of high blood pressure, colon cancer, (or) higher rates of pregnancy outcomes that are not as good. Finally the science and the data have caught up with what many of us have been thinking for a long time. We really need to shift the focus to the system, and to the structure that’s making these outcomes continue to happen.

Q. You mentioned Dr. Burke Harris. How has having a Black woman in that position, with that background, helped in your work around health equity?

A. It’s really inspiring to have somebody who can lead from this huge position, to show people that that’s possible. I think it was very intentional. Her representation matters. We as a plan have done a lot around implementing ACEs work and trauma-informed care work and are excited to be able to push that conversation forward.