Achieving health equity is complicated, and it isn’t something that healthcare organizations can do entirely on their own. Instead, it requires dynamic collaboration—an ecosystem in which payers, providers, community organizations, policy and advocacy groups, and other entities work together to effect change.
The ecosystem of health equity requires a collaborative approach, a focus on prevention and upstream interventions for social determinants of health, the ability to leverage data to improve population health, and a sustainable funding model.
Defining the Health Equity Ecosystem
Collaborating with the health equity ecosystem requires key players to think deliberately about the care continuum, says Krista Stepney, Principal and Vice President of Operations for the Chartis Just Health Collective. This requires thinking beyond traditional healthcare organizations.
“The ecosystem should include every entity that has some type of connectivity to care delivery, the patient experience, and health outcomes,” says Stepney. “We must broaden our strategies beyond the traditional care delivery system.”
Payers play an increasingly important role in the ecosystem, says Mohammed Nomani, Associate Principal with the Chartis Payer Advisory Practice.
“In the past, payers have been very transaction focused. The provider provides care, submits the claim, and the payer pays it,” Nomani says. “Now, there’s greater awareness that better alignment with their provider partners can promote holistic care. Payers are starting to invest in community relationships and are even paying for new services with the intention of keeping members healthy and, in turn, lowering the cost of care. It’s about addressing people’s social, emotional, and spiritual needs to keep them healthy, balanced, and more fulfilled.”
The health equity ecosystem also includes community stakeholders, such as community-based organizations, faith-based leaders, political leaders, and other partners, says Mark Bourdenko, Strategy Principal with Chartis.
Finally, the ecosystem involves patients themselves, says Stepney. “Healthcare organizations need to consult the communities they serve,” she says. “Organizations need to meet communities where they are and center the voice of those who have been marginalized, leaning into their lived experience to inform the organization’s interventions. Healthcare organizations need to engage the people who will ultimately be impacted the most by their decisions.”
Identifying the Role of Healthcare Organizations
What role do healthcare organizations play in the ecosystem?
It depends on the organization and its internal capacity, says Nathan Hall, Strategy Principal with Chartis. While optimizing the clinical encounter is critical, healthcare organizations may be able to pursue additional opportunities within the ecosystem as well, he adds. For example, some organizations might be able to convene entities within the ecosystem, secure funding, or serve in a variety of other roles.
“In addition to the roles they play as care providers and employers, hospitals have immense purchasing power, political power, and community brand,” says Hall. “They have a unique and privileged position to seek funding, support, and legislation that advances health equity. Their position within the local healthcare ecosystem, combined with their existing resources, can put them in a position to effectively bring together other members of that ecosystem.”
Hall says each entity within the ecosystem needs to ask itself these questions: What are my strengths and weaknesses? What do I bring to the table? How can I contribute the most?
“Find where you have your own unique edge, and push that really hard, so everyone in the ecosystem can maximize their contributions,” says Hall.
In addition, don’t be afraid to push the boundaries of traditional roles, says Nomani. “For example, health plans and hospitals could be more involved beyond the clinical aspect of care,” he says. “How can they partner with other types of organizations that will enable that patient to stay healthy over the long-term?”
For example, Medicaid managed care organizations (MCOs) can work with health systems to identify high-need Medicaid enrollees and community-based organizations serving under-resourced populations to provide and pay for evidence-based non-medical services, such as nutrition, housing, transportation, education, employment support, and interpersonal and toxic stress management.
Various states are using the Medicaid 1115 waivers as a vehicle to improve access to social supports for populations with high and complex needs, streamline payment to CBOs, and integrate access and financing of social supports into the mainstream delivery of healthcare.
Promoting a Collaborative, Data-Driven Approach
Promoting health equity alongside partners within the ecosystem requires an unprecedented level of collaboration, says Stepney. “This should be the crux of how we do this work. It should be less about increasing market share and more about access and equity. These conversations need to happen more often,” she adds.
It also requires a robust data strategy. “You need to look at where disparities or inequities exist today for different patient populations,” says Stepney.
Organizations must also look closely at their health needs assessments, says Bourdenko. “What programs are already in place to address these needs? How can you transform? Once there’s some internal consensus around that, it’s about design leaders who will be accountable for bringing other partners along,” he says.
Having a focused approach helps organizations define clear solutions, says Bourdenko. It also means there will be a more realistic number of key performance indicators (KPIs) to track and partners to coordinate—both of which can lead to more successful outcomes. “Tackling clinical and social determinants through an ecosystem gives you a lot of latitude, but if you stretch too thin and go too far, you may not achieve the desired outcomes,” he adds.
Setting Sights on Financially Achievable Collaborations
“The funding landscape for community health has changed dramatically over the last 12 months,” says Bourdenko. “Tens of billions of dollars in new funding for community health and health equity are now in play, via new Medicaid 1115 waivers and other sources.”
While these funding opportunities can propel efforts to address health-related social needs and improve outcomes, the key is bridging stakeholders from across the ecosystem around shared objectives and aligned economic incentives. Organizations often start this process by convening to develop a common vision for under-resourced communities or patient segments, identifying key metrics or outcomes of interest, and developing funding pathways for effective, value-based care models.
“Healthcare organizations nationally are pursuing transformative partnerships to address longstanding disparities in areas such as behavioral health, chronic disease, and maternal and infant health,” says Bourdenko. “These collaborations rest on effective care and delivery models, aligned economic models, and community trust.”
It’s clear that dramatically advancing health equity will require involvement of multiple entities across the ecosystem. As more entities take a collaborative approach, leveraging their unique strengths and capabilities, all communities will realize more equitable health.