At the Chartis Group’s Just Health Collective, a Firm Commitment to Advancing Health Equity

Tell me about the origins of Just Health Collective?

We are a national health equity advisory firm, focused on creating a liberated healthcare system free of bias, discrimination and disparities. We focus on helping organizations transform and operationalize equity, both from an internal perspective, working inside organizations, and also translating that to health equity, strategy, and tactics. We have a model in which we offer strategic advisory services; that’s at the top of the pyramid—to boards and c-suites. The middle of that pyramid is transformation; we offer health equity and cultural assessment, and information, training, support, and education. And the bottom of the pyramid is knowledge transfer. And the bottom of the pyramid is knowledge transfer. To facilitate knowledge transfer, we have a digital platform called Chartis Health Equity Village where people can share curated knowledge in this community and can learn from one another.

Tell me about how your staff members are functioning?

We have a core group of six employees in the Collective, but we have a growth trajectory planned out; we also work with about 20 subcontractors who come into engagements. The bigger piece is that while our team are the subject matter experts, we’re also taking our knowledge and transferring that to our colleagues in the rest of the firm, so that they understand how to apply an equity framework to our quality improvement projects or access projects. So it won’t just be Collective, it will be Chartis as a firm that will be working with this. And that will create a multiplier effect.

You’re starting out by working first with large multihospital systems?

We serve clients across the ecosystem. Hospitals and health systems, health plans, healthcare associations, healthcare technology companies, and public health organizations.

Is one of the challenges in this work getting to a level of concretization of efforts and outcomes?

Health equity can seem a bit amorphous for those who haven’t studied the space; but it can be concrete. And that’s how we assist organizations. We help them understand the existence of disparities—in clinical care, in outcomes of disease conditions. We also help them understand how those disparities can come about, within the healthcare organization, and how they are created through social, political, and environmental determinants of health. So we work with various leaders in organizations to help define how you apply an equity-based framework to your decision-making, to your leadership, and how you begin to operationalize policies, procedures, practices, and programs, that will ultimately yield improved health outcomes and reduce disparities and inequity.

I could imagine you entering an organization through all sorts of channels, via different people with different roles and titles.

Chief strategy officers, health equity officers, diversity officers, medical officers, all bring us in. It doesn’t matter, for our purposes, how we’re brought in. We focus on strategy and vision around this, and make sure it ties into the overall strategy of the organization.

How is your organization going to be paid for your important work?

Some organizations will contract with us to provide one-time educational services; other organizations may want us to facilitate a board retreat on the imperative for health equity, and what the governing board needs to do to advance that. For organizations looking for transformation, we’re usually brought in to do a health equity and belonging assessment, which generally takes about 90 days; and then phase two takes from 18 to 24 months, because we’re working with various stakeholders to help them to collect and understand data and help them to come up with key interventions that will transform their organization.

What are some of the biggest challenges in doing this work?

One of the biggest challenges is simply help people to understand what this work actually means. Oftentimes, we are working with leaders to help them understand their own bias, and to understand things like systemic racism and how it plays out in the healthcare experience. So we do a lot of work that requires introspective learning on the part of leaders. So we have to build a lot of trust in order for them to understand things like how systemic racism still has an impact on healthcare. The second challenge is helping organizations to really understand the type of data they need to be collecting—race, ethnicity, sexual orientation, gender identity, and social needs data. And there’s a real challenge in trying to make the data “clean”: at the point of registration, a staff member could make a guess about a person’s race or ethnicity and could be wrong. It’s very important to collect clean data to understand patient experience, clinical conditions, and process flow. It’s much easier said than done.

We’re still pretty early on in collecting, analyzing and using this data, correct?

We are pretty early on, but there are some organizations around the country who have been doing this for some time, and who have been using it to examine disparities that might be taking place inside their organization.

What should senior healthcare IT leaders be thinking about right now?

I would reiterate that the collection of data should be an organizational strategy that often can be led by healthcare IT and analytics leaders. I would also add that technology leaders also need to be cognizant of bias that can show up in algorithms, in digital platforms, and in the processes behind those platforms. Understanding how technology can be used to leverage, is really critical; without that understanding, technology will not help us get there.

A good discussion has been evolving forward in the industry around the challenges involved in ensuring that artificial intelligence will not end up being used in ways that cement or even worsen health inequity; put another way, a good discussion is taking place around how to ensure that AI is used in ways that will advance health equity, and that algorithms developed for all purposes can be developed through an equity lens.

Yes, that’s absolutely correct. It’s really important for organizations and people to see health equity from a broader perspective. So, being able to apply a framework with which to understand whether or not decisions you’re making are causing harm to marginalized communities—for instance, where you might decide to locate your next clinic: traditionally, we’ve followed where growth is occurring and where we’d have the most lucrative payers. That might be a rational business thinking, but it can often harm marginalized communities that are high utilizers. By applying an equity lens, we should be centering those communities that have been harmed, because on the back end, it will create better outcomes and better control costs, because those populations might be showing up in the ED or having longer lengths of stay. But if we’re really thinking of a population health approach, focused on demographics, we can actually see greater value for those populations.

If population health is pursued through a health equity lens, we can do well as an industry by doing good, correct?

Yes, that’s absolutely correct. And just as there is a moral case for this work, there’s also a business case, with regard to taking better care of marginalized communities, who oftentimes are high utilizers and suffer the worst outcomes.

What do the next couple of years look like in your work?

The next couple of years will be about growth and scale for Chartis Just Health Collective, so that we can broadly impact the industry. And we hope to work in a collaborative partnership with organizations to truly do transformative work. Oftentimes, organizations will focus on tactics, and things that are on the margins, versus really thinking about this as a strategic imperative for business transformation. So as things move ahead, we’ll see payment incentive programs change from CMS and health plans; we’ll see laws and regulations put in place by states and by accreditation bodies. It will very much be how we do business in healthcare. So organizations that can get ahead of the curve and can expand their work in the health equity and belonging space will be most successful in the future.

CMS and CMMI [the Centers for Medicare and Medicaid Services and the Center for Medicare and Medicaid Innovation] are looking to transform Medicare, Medicaid, and ACOs [accountable care organizations, through a health equity lens. Are you encouraged by their efforts?

I’m absolutely encouraged. It’s one of the more exciting developments. Health systems have to operate in a system that’s not always aligned with regard to social determinants of health. So aligning our payment incentives to recognize health equity will be a game-changer. And it’s not just healthcare organizations, but also the social service organizations that collaborate with them. Hospitals and health systems need to collaborate with community-based organizations, local business organizations and corporate organizations; it really requires alignment to address the needs of populations at risk. That’s the transformative work that needs to happen in order to address health equity. And that’s exactly where Chartis Just Health Collective is headed, to help to bring together key stakeholders to bring about changes.