It's no secret that the US health system is in desperate need of repair. Structural inequities such as housing and food insecurity, air and water pollution, and access to educational and economic opportunities — known to the medical community as social determinants have been linked to disparate health outcomes for years. However, never in recent history have we so acutely and rapidly felt their affects as we have during the COVID-19 pandemic. United around the common purpose to improve overall population health, industry leaders must harness their collective power and influence to champion changes that will benefit the health of our nation.  

It is clear that in order to drive improved population health providers, payers, pharmaceutical, public health, etc. – must align and transform. The challenge is “how”?

Making Systemic Change Work

When a problem is systemic the issue has roots in the overall system, rather than a specific, individual, or isolated factor. Changing one part of the affected system in isolation will not resolve the problem, instead systemic problems require changes to the structure, organization or policies that govern the overall system.

Just as it takes a village to raise a child, it will take an ecosystem to change the health system. The US health system is made up of numerous players — pharmaceutical companies, healthcare providers, insurance companies, technology companies, to name a few — each with an important role to play. Evolving the system of today into one that delivers improved population health will require significant transformation in all sectors of the field, and perhaps even more challenging is the need for these transformations to be designed and implemented in a synchronized fashion.

No single enterprise can address these challenges on its own, organizations from across the sectors must work together to design collaborative solutions to today's most pressing challenges. When successful, collaborations result in a level of synergy that no one organization can achieve on its own.  The power of successful collaborations is that the whole becomes stronger than the sum of its parts. Industry research reveals that organizations which participate in cross-sector partnerships are able to form a more holistic view of their customers and lower readmission rates by more accurately influencing health and wellness outside of acute care. In considering what an effective collaboration to increase quality and care may look like we invite you to explore the following example:

CASE STUDY: Pueblo, Colorado Coalition & ReThink Health

ReThink Health, a thinktank organization that works to change the focus of today’s health systems toward the health and well-being of local communities, centers their work around coalescing unlikely partners to galvanize collaborative efforts in communities across the country. ReThink has been touted as one of the most innovative organizations in healthcare given its original approach to enhancing population health from the ground up and offers tools and resources to help communities champion these change efforts.

One such example is the effort that took place in Pueblo, CO.  In a community where more than 40% of the residents are in poverty and unemployed, Pueblo county had some of the worst health outcomes in the state. In 2010, a group of health leaders from the community took action to provide better care, better health, and lower per capita costs. Working together with ReThink Health, an analysis of the governance, structure, and strategy of the care system revealed missed opportunities in process alignment across the local health system, a rift between potential allies who could contribute to a shared solution, as well as a brittle primary care infrastructure that led to delays in care.

To achieve their goals, the coalition brought key stakeholders together, engaged in extensive data collection across the care system, and developed a strategy to meet their goals. As a result, the coalition implemented measures to coordinate care, increase post-discharge planning, increase adherence to treatment, recruit safety net primary care providers, support healthier behaviors, reinvest savings, and share savings with providers. These efforts have resulted in a number of improvements in care delivery and health outcomes.

The Role of Health Ecosystem Leadership

Creating, sustaining, and achieving systemic change efforts is in large part a function of leadership. Addressing today’s most pressing challenges requires leaders with the capacity to lead collaboratively both within their organization and across organizational boundaries and sectors. The complexity of implementing cross-sector initiatives requires leaders who are capable of tackling systemic and structural change with an Ecosystem Mindset.

A qualitative review of expertise from over 30 executive leaders across the health ecosystem demonstrates that leaders who exhibit the ability to envision a new future, align diverse stakeholders, manage obstacles, and continuously act and learn are most prepared to galvanize support for, and manage effective collaborations. 

1. Envisioning the Future.
   Leaders have the platform and influence to ignite the kind of dialogue that leads to meaningful change.  We need to take the time to listen, discover, organize, and absorb from others across sectors to create a shared understanding of what better future for the US health system can look like. Only from here – with a shared vision – can we align efforts and outcomes.
2. Align Stakeholders.
   To advocate for systemic change, we need to orchestrate a coherent system of actions taken simultaneously by actively seeking connections with stakeholders across sectors, taking concrete steps to enable trust, and demonstrating respect for diverse expertise and perspectives. For too long, we have focused on perspectives in silos. As organizations bring stakeholders from other sectors into the conversation, leaders must allow these stakeholders to build on their original vision and incorporate their inputs and interests to develop a shared solution. 
3. Manage Boundaries and Obstacles.
   To overcome inevitable obstacles, it’s important that leaders focus on opportunity, and remind themselves why the partnership was developed in the first place. Centered around a common mission, health ecosystem leaders can constructively navigate conflict and difficult conversations among stakeholders, resolve points of tension, clarify roles, and re-align on ways to interface effectively.
4. Act and Learn.
   Health ecosystem leaders define change plans and take reasonable steps despite uncertainty. By  identifying what is working and what is not, adapting plans and advancing a shared vision for a better future for healthcare they continuously move the needle on large scale change efforts. This requires leaders to create a new narrative for what is meant by us through cultivating a broader sense of belonging. And in the world of leadership, this starts with recognition of how current organizational practices may contribute to systemic challenges and how to make meaningful and impactful shifts in how work is approached to create win-wine scenarios across sectors.  

The road to improved population health is paved with partnerships within, between, and among the various sectors that impact health and wellness. Releasing constraints that exist between competing sectors, both internal and external, to allow partners to innovate will allow for new models that support the broad goal of high quality, cost effective care. Moving toward a payment model where all partners are incentivized to work towards the best outcomes for the patient is a way to catalyze this process. In turn, external changes can be supported at the organization-level with effective ecosystem leadership and a culture supportive of collaboration.

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