Michael Grace has been a healthcare executive for over 28 years, working at some of the nation’s premier health systems. He served as a COO at Kaiser Permanente ‘s East Bay service area in California, where he was responsible for 2.4 billion dollars in new hospital construction and a 3.8-billion-dollar operating budget. He was the COO for Banner Health, where he created 26 distinct institutes (Centers of Excellence) at the University Medical Center, where service lines focused on Cardiology, Neurology, Orthopedics, OMFS, ENT, Bariatrics, Pulmonology, Endocrinology, Women’s health, and many other diagnoses. He also worked at the University of Chicago Medicine, Detroit Medical Center, and Northwestern Memorial Hospital.
Grace is also a civil rights activist, serving as the former president of the Michigan Chapter of the Southern Christian Leadership Conference, the only organization in living history that was co-founded by Reverend Martin Luther King Jr.
Grace is the founder and CEO of MAG Global Holdings Inc and its three subsidiaries, a digital healthcare company, which is bridging the gap between cutting-edge technology and health care. He recently spoke to the noted journalist and cultural critic Bankole Thompson, who is the dean and editor-in-chief of The PuLSE Institute, a national anti-poverty think tank headquartered in Detroit with a distinguished National Advisory Panel made up of some of the most important civil rights leaders and anti-poverty campaigners of the last 50 years. The two spoke about the adverse impact of health disparities in the Black community.
In the interview Grace examined the state of care in places like Detroit, Chicago and other underserved Black communities that need immediate attention and he also reflected on his work with former First Lady Michelle Obama.
The PuLSE Institute: The coronavirus pandemic has exposed the racial disparities in healthcare. As a health care administrator, what do you think needs to be done to address the health inequities in the Black community?
MICHAEL GRACE: First, I would like to thank The Pulse Institute for allowing me to speak on these issues relating to healthcare and poverty. The fight against poverty, disparities and inequities is a never ending battle. To answer your question, racial disparities in healthcare has been ongoing for several decades prior to the coronavirus pandemic. COVID-19 just allowed for the world to see, again, how minority groups are disproportionately affected by COVID-19 and other conditions.
Racial disparities between Blacks and Whites have always ran deep. We have a higher rate of diabetes, hypertension, and heart disease than other groups, or what is described as marginalized groups. Our children have a 500% higher death rate from asthma compared with White children. Inequalities continue to contribute to gaps in insurance coverage, uneven access to service and quite frankly, this contributes to poorer health for us as Black people.
When former President Barack Obama cleared hurdles and obstacles to get the Affordable Care Act passed, a lot of us minority healthcare executives thought that the ACA would finally make an impact in drastically reducing minority disparities as it relates to access to care.
The uninsured rate among African Americans declined after the law passed, over 2.8 million gained insurance immediately. Unfortunately, the continued cost of many types of coverage options means that access to affordable care is still a challenge for us. So many of our brothers and sisters remain part of what we call the underinsured which leads to leads to higher deductibles or out of pocket cost.
Despite some coverage gains from the ACA, remaining healthcare challenges exist today that have a disproportionate impact on us as African Americans, when you peel the onion back layer after layer you see another barrier. For example, lack of Medicaid expansion in key states, healthcare providers’ shortages especially in rural areas, just makes it difficult for us to provide care needs in a comprehensive manner no matter where you live. Bankole, in a lot of our communities, Medicaid has been the lifeline for access to care, for low income people, young pregnant girls, the elderly and people with some type of disability.
We make up over 20% percent of the enrollees , because as it relates to disparities and poverty, we continue to be poorer. But one group you do not hear a lot about are what we call the coverage gap African Americans, meaning you earn too much to qualify for rational Medicaid, yet not enough to be eligible for premium tax credits under market place plans. As I referenced earlier, pealing back the onion, each layer has a barrier to get around unless you can afford it.
Let me say, every year medical journals, healthcare organizations, health insurers, different institutes publish social determinants of health, healthcare disparities in Black America and so on. It is important to have these various opinions and analyses with the colorful graphs, but the question remains, what are we really doing to address these inequities?
We have not faced this head on as we did to mandate vaccinations for the coronavirus, some states create task force, but the needle never moves. As healthcare leaders we need to join together with our communities.in order to create change one neighborhood at a time. Today, we have more tools in our arsenal than in past years, the digital age has transformed the way you go to the doctor and the way you receive your medications.
We are now at the forefront of change with telemedicine tools, remote patient monitoring devices, and hospital-at-home programs and our ability to take care of those patients who are chronic care managed using this technology. Remote monitoring allows us to see a patient’s vitals from their home or anywhere they maybe and we can set different alerts to alarm of changes in conditions. We need our state and local leaders to allocate funds to get these devices in the homes of all of our vulnerable patients. Because care delivery is changing, so what are you prepared to do is the question I have for those who are in power to make a difference. I know I am.
PuLSE: The health disparities that exist in the Black community lends itself to longstanding economic inequalities including endemic poverty. Do you think there is a broader appreciation in the healthcare administration community across the country about this fact, and the need to confront the challenges of inequality? I think it is a known fact, but little action to address the issues.
GRACE: When I worked for Oakland California based Kaiser Permanente, as part of their research regarding economic inequalities the community action poverty simulation was created. The goal was to promote a greater understanding of poverty in breaking down stereotypes and allowing participants to experience poverty and step into the real life situations of others. Role playing of different life situations in the lives of low income families and their struggles open their eyes to poverty and the barriers to health care access among other things. Kaiser continues to donate millions of dollars each year to address economic inequities most of which goes to grass root organizations in the states where they have hospitals.
Health disparities continue to plague our communities and our way of life. Adult obesity rates for African Americans are higher than those for Whites in just about every state, year after year little has been done to address the issue. The same applies to breast and prostate cancer. This is not just a health care issue, it cuts deeper. Food deserts play a significant role. Time and time again we see our inner city neighborhoods saturated with stores that sell alcohol, but no fresh vegetables and fruits or fresh cut meat products.
We have and continue to have community gardens which are great, but we need large companies like the Cincinnati-based Kroger’s to step up. They own the majority grocery stores in the country and should be partnering with highly regarded and nationally respected organizations like The PuLSE Institute to make a difference in the fight against poverty.
The reality that I am laying out may not be news in some parts of the country where there are communities that are engaged with significant population of minorities, but that is not enough. The fact remains that low socioeconomic groups fall into unfortunate category’s and face illnesses earlier and more severely, and suffer higher rates of impairments and death.
Economic disparities affect a person where they live, learn, work, play and worship. High levels of stress or stress can add to the already serious health consequences we face on a daily basis. We need to continue to train our healthcare workers about the prevalence of disparities which exist in health and healthcare.
We can use digital health interventions in homes, schools, neighborhood, workplaces and rural general stores. We need more of our religious organizations to promote and encourage healthy choices by individuals, and finally the larger goal and the elephant in the room is to dismantle racial bias not just in healthcare and in health, but wherever it exist in our society.
PuLSE: What in your view are the key social determinants to drive a healthy Black community, especially in cities like Detroit which has a high concentration of poverty?
GRACE: Social determinants of health have tremendous impact on our health regardless of age, race or ethnicity. There are several factors that make up these determinants such as housing, food, education, transportation, violence, social support, employment and behaviors.
Each one of these represent struggles many of our communities face, and each is a barrier to good health. We need to address each one to address the social determinants of health. Social economic factors like education, job status, financial support, public safety and whether one has a dependable vehicle to get to a doctor’s appointment, or is there a friend one can call, are all issues that compound the problem of care. And the question of whether our community safe is the major factor that drives a lot of the factors. Finally, health behaviors such as tobacco use, diet and exercise, alcohol use and sexual activity, all impact care.
Poverty sets the stage to a lot of the factors I mentioned because it affects infant mortality rates, literacy, hunger, economic stability, mortality and life expectancy.
The word people shy away from often is racism and the role it plays on each of my topics. There are hundreds of studies conducted over time that have been consistent in proving that racism not only impacts social satisfaction, but also the ability of African Americans to be healthy, both mentally and physically.
This ties directly to chronic illnesses and mental health, which I haven’t really addressed. In addition to instigating poor health outcomes among people of color, racism also creates barriers to economic opportunity and uneven access to health care. A recent study stated health care systems perpetuate racism and bias towards African Americans. This has been well documented with examples.
PuLSE: A report just released stated that hospitals in metro Detroit are the most racially segregated. What is your take on the report and what does it say about the region of southeast Michigan?
GRACE: The report was very interesting. It stated that researchers studied more than 2800 hospitals in the U.S. using Medicare claims and a community survey from the 2020 Census Bureau to determine the racial makeup of patients at each hospital versus the community in which they serve.
Metro Detroit’s hospitals scored the worst for racial inclusiveness at 90% percent segregated. One of the reasons given was that cities like Detroit ranked as the most racially segregated metropolitan city in the nation. Of the rankings, Henry Ford Wyandotte, Beaumont Hospital Troy, and McLaren Port Huron ranked among the 50 most racially segregated hospitals, while DMC- Sinai Grace hospital ranked as the 13th most racially inclusive hospital in the U.S., followed by Henry Ford hospital in Detroit at 19 and DMC’s Harper University Hospital ranked 33rd were in the top 50 most inclusive.
This report has shown that over the past 20 years nothing has significantly changed based on where you grow up, live work, worship and obtain health care. One of the largest contributing factors to the report and its information gathering centered on elective procedures as Vikas Sani, president of the Lown Institute said in a press release, “hospitals that do more elective procedures serve Whiter and wealthier patients. ” The article states the same thing I would say, and that is the gap between the racial divide closed ranks during COVID-19, but that needs to happen all the time, every day, every patient and every encounter. The crisis and racial dived is real.
PuLSE: What is the responsibility of leaders of healthcare in Detroit and the region to address the glaring racial disparities?
GRACE: Those of us in key C-suite roles need to use all available resources we are aware of to move the needle and make an impact with health disparities. We have all the data points we need. We know what the conditions are that contribute to the crisis. We know everyone cannot get to a hospital or clinic, and when it’s almost too late for any type of preventative care it’s too late. And that is when you hear ‘if you would have gotten here six month ago, we could have helped you.’
Today, we have artificial intelligence that tells us everything we need to know about our patients, their demographics, different medications they are taking, diagnosis, disease state by demographics or groups, chronic conditions, the last visit to their primary care physician or OBGYN, or other specialty. We can place a heat map over zip codes and point of areas where disparities are prevalent.
If we truly want to impact society and give citizens the same inclusiveness we have seen over the past two years, it is time to answer the call here in Detroit. Lets create a movement to reduce the disparities. Let’s use our places of worship, let’s walk neighborhoods and connect with those people who have been missing from our clinics and show them that we care.
PuLSE: What should Detroit, the nation’s largest African American city focus on in improving the health outcomes of its residents?
GRACE: This is an excellent question and an opportunity to look at the state of healthcare for Black people in Detroit. Recently, I was reading the first ever report on the state of Black health in Chicago, and it brought tears to my eyes. In 2018, the city conducted a community health assessment that worked with community organizations, leaders and nearly 2,000 residents to determine priority public health issues. Healthcare was at the top of the list in most areas along with grocery stores, schools and transportation such as maternal and child health needs to stay at the front of any list as it relates to health and access to care. Prenatal care, mental health, teen pregnancy and access to contraceptives fall inline right behind.
We must continue to focus on social determinants of health and disparities that prevent us from shifting the paradigm in order to effect change. We have talked about this for years, but we are so segmented and apart from each other that it makes it impossible to lessen the negative health impact of our city. It is important to know that zip codes matter and play a role on our ability to make noticeable gains, but with organizations like The PuLSE Institute it can happen.
PuLSE: What is the responsibility of health care executives to the communities in which they serve in building trust but also addressing racism in healthcare?
GRACE: Most people know racism has an insidious effect of the lives of Black people even when it is unintentional. Across every medical intervention, from a simple procedure to a complicated treatment we hear the stories.
As health care executives we have a unique responsibility to educate and continue the conversation about institutional racism, health inequities and antiracism in medicine. We need to ensure the content of the conversation includes emphasis on cultural humility, diversity and inclusion, implicit bias and the impact of racism on medicine and health.
PuLSE: Can you reflect on the work you did with former First Lady Michelle Obama on healthcare?
GRACE: Twenty years ago, was the first time I met former first lady Michelle Obama, we were both working in leadership roles at The University of Chicago Hospitals, where she was responsible for Community Relations and in that role she did a lot of work with children and adolescents on the south side. She was very engaged in the community and always had time to help people no matter where they lived.
One of the First Lady’s key programs was dealing with Childhood Obesity. Her office reached out to me and the SCLC, where I served as president and we joined forces with her and created the Stomp Out Childhood Obesity program which featured students from Cass Tech High School .My friendship with the First Lady and the family has continued throughout the years. Attacking health care disparities has always been one of her goals and it continues today.