What are some of the barriers preventing the U.S. safety-net population from participating in programs that might improve their health, and how can we knock down those barriers?

“We need to challenge the notion of what we [perceive] the safety-net population is. These are people who have the same aims as everyone else: they want to be healthy,” says Anna Roth, the CEO of Contra Costa Regional Medical Center and Health Centers.  “By starting from that point and accepting that notion, then we know we have willing partners.”

Working with this population to improve their engagement isn’t any different from working with other groups, she stresses. “I think I hear that a lot. But I don’t see any evidence of that.”

What Roth does see is people overcoming major inconveniences of getting to the doctor, such as taking three or four busses one way. “This is an extremely resilient group of people who are facing challenges — which many of us could not really even comprehend — to get through the day,” she says.

The way forward? First, Roth reminds us to respect each individual patient. Second, we need to create  “systems that are intuitive — that don’t require navigators, but [that are] actually centered around patients,” she advises. “And I don’t think that’s unique for the safety net.”

From the NEJM Catalyst event Care Redesign: Creating the Future of Care Delivery at Kaiser Permanente Center for Total Health, September 30, 2015.