Titus Regional Medical Center is the main health care destination for five rural counties in northeast Texas. With that responsibility comes an unshakeable commitment to health equity for all the patients it serves. In this conversation, Terry Scoggin, CEO of Titus Regional Medical Center, discusses how the organization has designed a system of care to ensure that every patient has equitable access, and how the AHA's Health Equity Roadmap has provided valuable resources to support Titus’s mission of transforming the health of its communities.

Tom Haederle

When you are the health care destination for five rural counties in northeast Texas, your operational strategies have a lot of impact on patient lives. For Titus Regional Medical Center, 174-bed independent hospital, the driving operational strategy, or principle, is an unshakable commitment to health equity in all its forms.

Tom Haederle

Welcome to Advancing Health, the podcast of the American Hospital Association. I'm Tom Haederle with AHA Communications. Health equity is a journey. Each hospital or health system pursues this goal in its own way, according to the needs of the communities it serves. In today's podcast, a sort of audio case study hosted by Jackie Hunter, vice president of health equity strategies with the AHA’s Institute for Diversity and Health Equity, we learn how the Institute's Health Equity Roadmap, currently used by 720 hospitals nationwide, has helped Titus Regional design a system of individualized care that relies on data to deliver impressive results.

Tom Haederle

Here's Jackie.

Jackie Hunter

So I would like to welcome today Terry Scoggin, the chief executive officer of Titus Regional Medical Center, a joint commission accredited 174-bed independent rural hospital system serving the northeast Texas area. Welcome, Terry.

Terry Scoggin

Thank you so much for having me. So glad to be a part of this program and talking about rural health care and health equity in rural communities as well.

Jackie Hunter

So let's get started. How does health equity fit into your organization's strategic priorities?

Terry Scoggin

It's the foundation of what we do. On a daily basis, health equity impacts everything there is about health care. In a rural community, especially in northeast Texas, we're 60 miles from the Arkansas border, the Oklahoma border and the Louisiana border on I-30. We're 45 to 50 miles from a health system equivalent in every direction. So our county is 32,000 people.

Terry Scoggin

We're surrounded by four counties that don't have a hospital. So we have about 82,000 people. We are the independent health system for those five counties. And in northeast Texas, health equity is one of the driving factors in health. So when you see all the analysis and you talk to people, 80% of a person's health is determined by those health equity factors, whether it be in Texas, the non-medical drivers of health, or across the rest of the nation when they call it social determinants of health.

Terry Scoggin

Those are the driving factors in health. So health equity is so much deeper than just diversity, equity, inclusion. But it really gets into what are the individualized needs of that patient and how do you affect it. So from our strategy perspective that's how we build our strategy. Trying to understand the needs of our community, of our physicians, of our team members, and all of those things for the individualized care of each one of them.

Jackie Hunter

So it sounds like you are doing some great work in that space. And, you know, thanks for sharing that information with us. So I know you're very familiar with our Health Equity Roadmap. What has been your experience with the Roadmap thus far? And in particular, how does it align with your current organization’s strategic plan that you mentioned?

Terry Scoggin

So from a Roadmap perspective, we've had the opportunity the last few years to go through the process, have our data submitted, then review our results. We've been lucky enough to participate with the American Hospital Association and the different regional parts of AHA to really analyze health equity and listen to podcasts and websites and all those different resources that AHA makes available. Podcasts like this one.

Terry Scoggin

And we learned so much about health equity, but we've used that Roadmap to kind of really do the drivers of health. And I encourage anybody who's going to look at that Roadmap, those drivers are the ones that I've really found valuable to us. So when you look at the levers and the summary of levers of transformation that the Roadmap has, I think you're going to find some great foundations for strategies, for milestones, for action items that you, as a health entity, can take into, that are going to have a dramatic impact on your daily work.

Jackie Hunter

Jackie Hunter

This electronic tool serves not only as diagnostic, but also to assess the current state, of health equity as a baseline for continuous improvement, helping organizations like yourself become more equitable and inclusive. The journey towards health equity doesn't end with assessment, as you already referenced. After completing the HETA, members receive a comprehensive profile and links to assess the transformation action planners, which sometimes we call TAPs.

Jackie Hunter

Additionally, all members participating in the Health Equity Roadmap are invited to join the journey, a virtual community designed to support ongoing efforts in health equity transformation. So we really appreciate your involvement within the HETA, as well as being a champion for this work. How did you leverage the data collected through the HETA, and corresponding results to inform your actions?

Terry Scoggin

As far as using the data, it was amazing just to see how the data was put together in the HETA analysis. It's not what I was expecting. We talk about expectations and we talk about the data. I was expecting it to be something about more like a community health needs assessment. And I want to talk to our peers and other people who are taking this assessment.

Terry Scoggin

It's not what it is. It's not a CHNA. This is a way of really breaking down how are you looking at diversity, equity, inclusion across your health system, across your community, and really looking into deep into your foundation? I was very surprised by the data and how it was put in a way that we could use it, whether it be policies, whether it be committee structures.

Terry Scoggin

And then, especially in our strategic, you asked earlier about that strategic priorities. It's critical when we look at the mission and the vision of our community, vital independent rural health system, that we understand the health equity impact on each one of those milestones that we put in place.

Jackie Hunter

That's great. And I know, you know, earlier during my introduction, I talked about you all being a joint accredited, you know, with The Joint Commission. I'd like to chat a little bit about that. So what impact do you hope this will have on your accreditation and compliance with The Joint Commission, as well as the Center for Medicare and Medicaid Services?

Terry Scoggin

Terry Scoggin

We were looking at health equity so wrong. Health equity is not just race or it's just not diversity and inclusion. Health equity is so much more. And going through this Roadmap and going through this assessment, we are able to look at so many different areas of it, and what it really made us focus on is data. And there's a lot of things

Terry Scoggin

in there you start asking yourself, let's get into the data. I had the opportunity with the AHA to go through a cohort a couple of years ago as well, and we were able to access some tools, and we use one of those tools that really gets into the socioeconomic and really the health equity matrix and indexes for your community. And that's, we started pulling data.

Terry Scoggin

I'm a CPA by background, I love numbers. I'm probably not the guy you want to invite to dinner and have to the cocktail party. But I love data. And when we really what was encouraged through this analysis is we started pulling data and it wasn't just pulling ethnicity and race and stuff. We were looking at all the different segments in our community, insured and uninsured, race, ethnicity, religion, uninsured.

Terry Scoggin

We're working. We don't have insurance, but we have commercial insurance, Medicare, Medicaid, all those different aspects that you break down when you start looking at it. We're 47% Hispanic in our county, 43% white, 9% African American. Really breaking in what does it look like in the census areas of our county? The life expectancy in the north part of our city was almost 12 years higher than the south part of our community.

Terry Scoggin

That is right next to one of our manufacturing plants. Those are the types of things when you start looking at health equity and you really break down the segments in your community, there's so many segments. And one of the levers that it talks about in here, and I think I hear all the time from AHA, is talking about individualized care.

Terry Scoggin

If you are not treating each patient from an individualized needs point of view, you're missing it. You're not providing the care that they need. It's not just we treat everybody this way. That's wrong. The health equity lens that we're trying to put on it really focused on in this assessment, is really trying to say, what are the individual needs of that segment and more importantly, what's the individualized needs of that patient and their family and how can we meet it?

Terry Scoggin

So from a Joint Commission standpoint, when they came last January, they said, okay, what are you doing with health equity? And I said, okay, here we go. How much time do you have? Here's all these slides that we worked on. We've broken down this our social vulnerability index. This is our uninsured rates. This is how it is for our prenatal group.

Terry Scoggin

Here's what is for geriatric population. We were able to show all the segments of our population that they looked at. And then they looked at my board members and said, okay, what do y'all know about this stuff? And we, part of our board package every month, I have a section of the board meeting that's focused on health equity, something educational, or some facts about health equity.

Terry Scoggin

It may be something we got from AHA. It might be some data we want to look at. That's the difference. And so when my board members started saying the same thing that I was saying, and then they looked in our board reports, they were like, okay, we get it now. I will tell you this, I was impressed by Joint Commission, and I would encourage my peers and colleagues across the health care industry to be prepared.

Terry Scoggin

I think Joint Commission has it right. If we're going to make a difference in the lives of people across the United States, we have to focus on health equity. And I think the things that a Joint Commission are asking and the data they're asking for, and they're wanting to see it in your board reports, they’re wanting to see it in your strategic initiatives

Terry Scoggin

as you talked about earlier, I think they've got it right, and I'm excited for what CMS is doing and what Joint Commission's doing related to health equity.

Jackie Hunter

What are some early lessons on how the Health Equity Roadmap has influenced and transformed the culture within your organization?

Terry Scoggin

From a culture standpoint, I think the Health Equity Roadmap has allowed us to see the data, to see the information. Once you see this, you can't unsee it. And that's a difference that I've had over the last four or five years. And I appreciate AHA for the opportunity they've given me to participate in these things and try and ,once you see it, you can't unsee it.

Terry Scoggin

Once you see the inequities in health care or the inequities caused by our own actions and our own policies, you don't unsee it. And when you look at this data in a rural community, it's different because that's not a number. That's not a percentage. I know who that person is. I know who that segment is. I know where they go to church.

Terry Scoggin

I know where they live. I understand that they don't have the exercise things in that part of the community. So the difference is really from our standpoint where it's influenced in our organization is we've seen the data and once you've seen it, you cannot unsee it. And I think we're challenging ourselves, whatever it is, if it's a committee, if it's a group task force, who's on it?

Terry Scoggin

Do we have enough men and women? Do we have enough of the age groups? Do we have enough of the different race and ethnicity? Have we considered our gay-lesbian community? Have we considered our uninsured community? All the different things. I think that's one of the things I've loved about this is it's opened our eyes and we're asking questions and we're having conversations.

Terry Scoggin

Rural is one of the inequities in health care, and being in rural is a health inequity. And I think those are the things we've got to talk about. Whether it's at the Texas Hospital Association or the American Hospital Association, you know, we asked ourselves, do we have the right mix on this committee? I think the AHA does a great job of trying to balance all the different measures of health equity, and they put a committee or a group together.

Terry Scoggin

And it's exciting to listen to some of these, you know, some of the ambassadors of health equity, when we come to some of these meetings. I think we have to continue to do it, whether it be our small organizations, our regional, our state. We have to focus to ensure that we're not creating an environment that is detrimental to health equity.

Jackie Hunter

That's great. No. Wow. That was powerful. And you know, with that, how do you expect this cultural shift to be sustainable?

Terry Scoggin

That's the hard part. How do you keep it sustainable? That's where it's going to be very difficult. But you know, where I think it is, and this is the discussions we've had in Texas over the last few months with the Texas Organization of Rural & Community Hospitals, TORCH, and also the Texas Hospital Association. This is where we need to talk to our legislatures.

Terry Scoggin

This is where we need to talk when we're lobbying for additional funds. You know, we struggle from a health care perspective, especially with the payers. The payers, for the most part, are for-profit companies, and they have lobby groups that are talking about all the bad things that are going on in health care. We've got to turn it on its side and say, okay, what are you doing about the uninsured population?

Terry Scoggin

What are you doing about this segment? How are you addressing health equity? These are the things when you talk to your legislatures, when you talk to the people in the Senate and the Congress and the state legislatures, that's the stuff that's going to make a difference. And I think there's funds out there. We just need to put money in the right place.

Terry Scoggin

And I think if we start focusing more dollars on initiatives related to health equity, we will be able to mitigate a lot of unnecessary health spend. And I know that's not a popular statement, but I believe it. The money's there. It's just going to wrong places. So using these health equity data that you talked about, I think we can use those numbers and statistics to really once you see it, you're not going to unsee this.

Jackie Hunter

You know Terry, this was great. It was great chatting with you. You know, definitely have me fired up and really appreciate the hard work. And thanks for continuing to be a champion for us in this work. And, you know, thank you for sharing your insights and experiences with us today. And hopefully this will also help our rural counterparts, navigate through the HETA, and just want to again, thank you so much for your time and continue to do the great work in your rural setting.

Jackie Hunter

Thank you Terry.

Terry Scoggin

Thank you.

Tom Haederle

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