Since the national call to address health inequities hit a fever pitch last year, we've been eagerly monitoring whether this momentum would translate to fundamental change—or just remain surface level. For us, the biggest indicator is in how money changes hands. Would the confluence of Covid-19 inequities and protests against police brutality be enough to alter how the industry does business?
Apparently, not yet. There's still a limited shift to value-based payment, insufficient cross-industry financial incentives for advancing equity, and a lack of penalties for poor performance. These are the very changes to our business models that would require us to make progress toward equity. In the absence of top-down change from policymakers, the onus rests on the shoulders of health care leaders to use whatever leverage they have to push the industry toward this structural change. But that monumental task is going to require significant alignment with stakeholders who we're not used to viewing as partners.
We need to partner to create structural change—but are we looking in the right places?
The health care leaders we work with will be the first to tell you that they don't have the competencies to tackle a problem like equity on their own. But they've also been relatively limited in who they've traditionally partnered with to advance health equity. Primarily, leaders look to community-based organizations (CBOs), who bring essential capabilities like building community trust and delivering social services. But leaders still seem reticent to look within our own industry for partnerships—especially when it comes to direct competitors.
That's a major missed opportunity. It might feel uncomfortable, but these types of partnerships can amplify our impact. In addition to the potential to shift incentive structures across the industry, the comparative advantages of one sector can fill gaps in another. Even the best CBOs can't fill these gaps—they don't have the scale, reach, or resources that exist within our own industry. Cross-industry partnerships are the only way we can navigate traditional inefficiencies while shifting to business models that incentivize this work.
We can push each other to do better, but only if we approach partners in the right way. And while the focus of this piece is cross-industry partnerships, each of these tactics can help bolster your working relationships with CBOs, too.
Three ways to forge successful partnerships across the industry (even with competitors)
- Get your own house in order first
To build credibility in the community and ready yourself to be a good cross-industry partner, organizations must establish a health equity "infrastructure" that is durable (e.g., can withstand departures from motivated individuals). This includes:
- Putting real dollars on the line to advance equity. This can involve external grants, but it should also include where you're allocating internal funding. By looking at your budgetary decisions, partners should be able to tell whether you're embedding equity efforts into every part of your organization, rather than relying on one-off passion projects.
- Setting internal accountability for meeting health equity goals. We've noticed more and more organizations creating individual incentives to advance equity that span the entire organization—including the C-suite. For example, LA Care has made DEI training an enterprise-wide goal for all employees. 10% of all annual bonuses depend on 100% participation in the training.
- Creating a robust, transparent database to ground efforts. This requires establishing both quantitative and qualitative metrics to measure progress. Once you understand where your efforts may be falling short, you can better identify the ways your partners can help.
- Select the right partners who align with your goals and can help you fill gaps
Look for partners who have the same vision of what long-term success looks like. Ideally, that vision is backed up by similar incentives and business models. If not, partners must be willing to work towards evolving their business models to align on shared goals and incentives—even with previous competitors. Partners must agree to:
- Select a distinct number of equity goals that are specific, measurable, and actionable. Remember that the value of health equity efforts isn't just measured in financial ROI, and your goals should reflect that. At the outset, be prepared to regularly measure the success of your partnerships. If these collaborations aren't achieving their goals, you might need to adjust or sunset.
- Commit to transparency about wins and losses. This will be difficult. No one wants to share vulnerabilities with organizations that could capitalize on them, but it is necessary to ensure accountability. Transparency builds trust and comradery between stakeholders, but beyond that, it allows us to fix the real problem because we're not hiding it behind a curtain.
- Determine how you and your partners can hold each other accountable for progress
It can be difficult to commit to the vulnerability and transparency that advancing equity requires. But we have to own our mistakes, admit when we need help, and listen to feedback if we want others to do the same. We at Advisory Board hope to model this by acknowledging that this piece only scratches the surface on how cross-industry stakeholders can partner to hold each other accountable for change. As you make progress in this space, don't hesitate to reach out and tell us what you've tried. Email Darby Sullivan at firstname.lastname@example.org.