Ep 112 – Reclaiming Trust: Addressing Cardiovascular Health Disparities in Rural, Underserved Communities through CHW-Led Interventions, with Dr. Jessica Barnes and Chip Purcell

A bright future for the nation depends on the health and prosperity of rural America, and unfortunately, we are at a moment in time where life is not ideal in the rural heartland.  Although most rural Americans are generally satisfied with the overall quality of life and see their communities as safe, we are reaching a crisis when it comes to financial insecurity, trouble accessing affordable, high quality health care, a lack of high-speed internet access, housing problems, and isolation/loneliness. When it comes to health care, even though most rural Americans have health insurance, about one-quarter say they lack adequate health care access, as they have not been able to get the care they needed at some point in the past few years. Consequently, potentially preventable deaths from the five leading causes are consistently higher in rural counties, especially with heart disease.  (Nearly half of deaths from heart disease in rural counties are preventable, compared with 18% in large metropolitan areas.)  All of this has culminated into a mistrust of the traditional, fee-for-service dominated healthcare system and created a “shadow population” of underserved minorities and the socially isolated who are dealing with significant cardiovascular metabolic disease.

The Arkansas Lincoln Project is an important population health program focused on improving cardiovascular health in highly underserved, under-resourced areas of the Arkansas Delta Region where economic and health disparities have life altering consequences for rural residents.  Joining us this week, we have two population health leaders sharing their insights about their work in deploying community-based cardiovascular health interventions led by community health workers. Chip Purcell is the director of cardiology research at the University of Arkansas Medical Sciences and the principal investigator of the Arkansas Lincoln Project.  Joining him is Dr. Jessica Barnes, the co-founder and CEO of 20Lighter, LLC – an award winning cardiometabolic health program, delivering dramatic reductions in inflammation and visceral fat.  Together they are winning the “Race to Value” by fighting cardiovascular metabolic disease in the Arkansas Delta, the worst region in the nation for healthcare quality and population health outcomes.

Episode Bookmarks:

01:30 The challenges of obesity and cardiometabolic disease disparities in Rural America

02:00 Rural Americans facing financial insecurity, poor healthcare access and hospital closures, a lack of high-speed internet access, housing problems, and isolation/loneliness

02:45 “Nearly half of deaths from heart disease in rural counties are preventable, compared with 18% in large metropolitan areas.”

03:30 Introduction to Dr. Jessica Barnes (CEO of 20Lighter, LLC) and Chip Purcell (UAMS Cardiology Research and the principal investigator of the Arkansas Lincoln Project)

05:00 “Rural Americans tend to have higher rates of cigarette smoking, hypertension, and obesity, and report less leisure-time physical activity than their urban counterparts.”

06:20 The US News & World Report ranks Arkansas 50 out 50 states for overall healthcare quality with higher-than-average obesity rates and overall preventable hospital admissions

07:00 “Arkansas is the worst of the worst in health outcomes, and that is where we can make a difference.”

08:00 Mistrust of the healthcare system is pervasive in the Arkansas Delta Region

09:30 The exponential growth curve in building trust through improvement in individualized patient outcomes

10:00 Studying out-of-hospital, premature natural deaths as a proxy for determining population health needs in Eastern Arkansas (how the Lincoln Project began)

12:30 The use of geospatial mapping to identify the highest risk communities to target with cardiovascular health interventions led by community health workers

16:30 The economic challenges of Phillips County, Arkansas and the history of racial discrimination and conflict, including the Elaine Massacre of 1919 (the bloodiest racial conflict in history)

18:00 Implementation of the door-to-door novel intervention model to address cardiovascular health disparities

19:45 Guiding interventions to elicit behavioral change and the challenges of addressing multiple social determinants of health all at once

20:30 “Women are a very fast growing subset of the population that is struggling with cardiovascular disease.”

21:00 Lower income and higher poverty with women in rural areas creates another layer of challenges (e.g.  “inequities in the inequities”)

22:00 “Ultimately our vision is to introduce practical community-centered interventions that improve rural health.”

23:30 “Community Health Workers (CHWs) are the most under-utilized resource we have in healthcare right now.  They should be the face of healthcare to overcome patient mistrust of the system.”

26:00 How the Lincoln Project trains CHWs to navigate the medical and social resources available to improve population health outcomes

28:30 Ensuring patient compliance to support the behavioral changes needed to improve community health

29:30 Referencing recent study showing how Massachusetts General Hospital was able to reduce 30-day readmissions among ACO patients supported by trained community health workers

30:30 “Changing cardiovascular disease outcomes is a longer-term goal but utilization and compliance measures are interim measures of success in the short-term.”

31:30 “Community Health Workers actually come from the local, underserved community and really care about the community members they are helping.”

33:00 How 20Lighter (a unique, comprehensive cardiometabolic telehealth program)engaged African American women in a pilot program aimed at improving risk and burden of cardiovascular disease

38:30 The 20Lighter strategy to dramatically reduce inflammation and visceral fat in hypertensive and diabetic community members

44:00 Utilizing telehealth interventions to support precision medicine programs for rural patients at high cardiovascular risk

45:00 How COVID-19 enhanced the value of telehealth by healthcare consumers and patients

46:30 Tech + Touch = Scalability and Personalization

48:00 How a CHW holistic model of community outreach can help providers better communicate with patients and improve health literacy

49:45 Facilitating health literacy in Phillips County whose community members, on average, have a 4th Grade reading level

52:30 “Fee-for-service created a shadow population — usually underserved minorities and the socially isolated — who are unable or unwilling to involve themselves in healthcare.”

53:45 Why capitation will eventually transform the health of the rural South

54:30 Changing the way people think about wellness by overcoming the failed fads of the weight loss and employee wellness industries