Walgreens was in the midst of answering that question in its efforts to combat COVID-19. The statistics had made it clear that people of color and those living in socially vulnerable communities were getting sick and dying from the virus at a faster rate than white people. With pharmacies embedded in local communities, Walgreens had a unique opportunity to reach the people who needed assistance most. A number of initiatives would be launched over the following months, from booking vaccination appointments on behalf of patients, to hosting neighborhood vaccine clinics, to mobile bus tours that could increase vaccination rates across the nation.
But the question of addressing larger healthcare inequities, made more evident and pressing by COVID-19, remained unanswered. Walgreens team members across disciplines asked themselves what more could be done to start closing care gaps in the communities that need it most. It was evident that more could be done to educate patients and strengthen the relationships between them and their pharmacists to deliver better health outcomes.
Thus was born the Chicago Health Equity Incubator, a pilot program developed by Walgreens team members to address health disparities through pharmacist provided patient and community-centered healthcare resources. Meet some of the people involved in the pilot, the learnings thus far, and the dreams for its future.
Forming a task force that empowers patients
COVID-19 and racial justice protests forced temporary pharmacy closures in the summer of 2020, intensifying the need to act on a program that would begin to address racial disparities in community health. Fortunately, Walgreens health task forces had already dedicated time to establishing connections with pharmacies in underserved neighborhoods and developing programs to proactively assist patients, including a pilot in Texas where pharmacists provided pediatric asthma consultations, which directly led to increased adherence.
According to Dana Erf Fortman, director, pharmacy services and health equity, “Health equity is something Walgreens has been focused on for years. We have stores in vulnerable communities and our regional and field leadership have always engaged with these communities. What’s different about having a specialized health equity team is that we can recognize the value and the impact of all these disparate activities and unify them under a more cohesive strategy. That way, we can have the largest impact on our patients and our communities.”
A cross-functional team was formed, made up of individuals across pharmacy operations, data analytics and Chicago-area pharmacies. It would allow for lines of connection straight from patients in vulnerable communities to providers who could interpret feedback into actionable change. The next step was to identify health issues that pharmacists could intervene on that affect the population in question.
Using data to drive strategy
The team narrowed in on key focus areas by working in tandem with local and regional governmental offices who have health-related data pertinent to the mission. Regional healthcare director Scott Diveney worked with representatives in Chicago and the West Great Lakes region to index data that would reveal where opportunities lay. He honed in on a particular pharmacy located at 86th Street and Cottage Grove in the Chatham neighborhood as one located in a high socially vulnerable area with patients who have pediatric asthma, diabetes and other conditions identified more frequently in people of color.
Tanya Singh, a healthcare analyst who was heavily involved in the Texas pediatric asthma pilot, lent her talents building testing models to determine how the incubator would track and measure success.
Using predictive analytic models developed by Singh and her colleagues on the health analytics research and reporting team, they developed screening and intervention methods to address the following need areas:
- Diabetes outreach: Pharmacists prioritize high-touch consultations for those living with diabetes to personalize solutions, address any barriers to taking medications and make recommendations for health screenings and immunizations.
- Pediatric asthma outreach and education: Given the high prevalence of pediatric asthma in Chicago, pharmacists conduct outreach to parents and guardians of children with asthma to provide education on the importance and proper use of asthma medications, review side effects, discuss asthma triggers and provide action plans in collaboration with health care providers as needed.
- Affordable access to medications: In addition to conducting outreach to patients who have not picked up filled prescriptions, resources were allocated to support free same-day prescription delivery to those experiencing barriers to medication access.
“The model assigns a risk score of being admitted to an emergency room if they are not regularly filling their prescriptions. So those high-risk patients are prioritized for intervention. Similarly, for diabetes, we give stores a patient list for those who are due for a refill and it notifies the pharmacist to call the patient and offer any counseling they might need for their diabetes. They know to ask if the patient hasn’t gotten their flu shot or other examinations lately that can help them manage their disease.”
Turning feedback into an actionable future
The incubator officially launched in August 2020 at the 86th and Cottage grove location. This pharmacy was set up for success, according to Diveney, because they were able to have a pharmacy technician dedicate hours to patient outreach and education. Within three months, tangible results began to mount. There was a 60% improvement in prescriptions being picked up after dedicating the time to educate patients and offer free same-day delivery. The pilot would expand to 15 more stores on Chicago’s South and West Sides, and over time, more than 10,400 diabetes consultations and over 2500 pediatric asthma consultations to patients’ guardians would be conducted. As the team worked together to gather data and assess learnings, the most valuable—and sometimes, the hardest data to measure—came from Latasha Guy, a local pharmacy manager.
A Walgreens pharmacist for 19 years, Guy helped develop the information about proactive questions and outreach that would be sent to pharmacists through an online patient portal. She also worked alongside Diveney to gather and share feedback directly from the stores involved. When asking for feedback from pharmacists in the pilot, she was surprised at how transformational dedicating a few minutes to talking with a patient could be.
“Being able to develop that conversation and know, for example, that culturally they had never been taught the difference between preventative asthma medication versus medication to treat an attack, it was very surprising. These conversations had to start at the basic level of health literacy, but I would hear that trust building with the patient. I would hear the patient call back, ask for their pharmacist by name, and maybe say, ‘I ate this for lunch, how will it affect my blood sugar?’ It’s about taking those baby steps to reach that level of communication.”
A year and a half after the launch, the analytics team has conducted surveys and engaged with field team members and are evaluating learnings to determine what’s next. Among the plans are developing a more comprehensive health equity index for use in communities, and exploring ways to continue continuity of care if, for example, a patient moves or has a change in insurance. Says Fortman, “We’d like to expand these services and learnings to additional markets, as well as continue to leverage the Chicago Health Equity Incubator as a true incubator in terms of allowing us to continue testing and learning and advancing our impact within the health equity space.”
Overwhelmingly, the team is proud to be involved in the incubator and hopeful for its future. Fortman led the creation of the central support office’s health equity team to focus on strategy development, unification, expansion planning, and facilitation to expand upon the efforts led by the cross-functional team who conceptualized the pilot.
Says Guy, “I’ve been in the field a long time. I went to school in those communities. I worked in these communities. So I understand the barriers these patients have and I have firsthand knowledge of living it, breathing it, feeling it. I joined the team for health equity and to make sure these programs will make an impactful difference in these patients’ lives.”
True to its incubator status, it’s one that’s evolving as time goes on. But the impact is already being felt.