Applying Health Ecosystem Leadership to Systemic Inequity

At TLD Group, we believe that we've arrived at a pivotal moment in time, one that we hope will inspire America to engage in a conversation around how we as individuals and organizations and as a nation can and must do better. Centuries of inequality and racism have culminated into acutely horrific consequences for Black Americans in 2020.

The systemic nature and complexity of taking on this challenge makes it impossible for any one organization or sector to solve independently. This is where a health ecosystem collaborative mindset is important for our industry to ultimately create greater impact and move the needle. Solutions that emphasize how the various sectors such as hospitals and health systems, pharmaceutical companies, payers, policymakers, local governments, and community organizations, operate interdependently are the only ones with the potential to deliver on meaningful systemic change and equality for all.

On a recent episode of our Health Ecosystem Leadership Podcast TLD Group Founder and CEO Tracy Duberman, PhD sat down with Ron Phillips, Senior Vice President of Human Resources - Retail & Enterprise Modernization for CVS Health, to discuss systemic inequity within the current health system and apply the competencies of health ecosystem leadership.

Abbreviated excerpts from this conversation can be found below

1. We are seeing people in the streets protesting over police brutality. We have over 42 million people unemployed out there right now, and the numbers are probably much higher, and we have a global pandemic. What should healthcare leaders be focusing on now given these tremendous challenges?

I think about what physical distancing has done for us. It's in place for many of us, and I think it's critical now more than ever to check in on your team. Something as simple as "How are you doing today," can go a long way. I know that it means a lot to me and when people have reached out to me, and I can see the impact when I reach out to others just to check in and say, "How are you doing? How are things going?" And I can see the relief and almost seeing people have the opportunity to exhale.

People are dealing with a whole host of things. Some people may want to delve into a conversation about what they're working through. Some may be dealing with some heavy issues, but may not want to talk. And some may be just fine. That simple question makes space for them to engage how and when and if they want to.

I'll also add that self-care is critically important. As leaders, we're also people and we're personal caregivers, we're parents and siblings, we're community members, etc. And we're quick to make sure that we're taking care of everyone else, as we should, but we can't do that unless we take care of ourselves. Here again, and I think this metaphor works better now than ever, put the mask on yourself first and then you can begin to take care of others.

2. What role do you think healthcare leaders can or should play in raising awareness of inequities and building political will to address them?

I think, first and foremost, you got to make sure that you understand yourself what those inequities are, the history behind those inequities, what are the barriers to breaking through them. I think this can be done through any of the masses of content that's available out there.

I think the first step is to kind of inform and understand what are those inequities and almost look through the lens of those folks that are on the other side of those inequities. I just think a lot of people are learning informally through listening sessions and things of that nature. Our workforce is a products of the community, and so I think there's a wealth of information among your own teams. Really get insight into answering the question first, what are those inequities?

My caution though is to not put the burden of educating you or your organizations on the very people who are impacted by these inequities. Many, especially in black community, have expressed that they are exhausted. They're tired of years of not being heard, and now being constantly and consistently asked to explain what they've been saying repeatedly for years but to no avail. And so you've got to come at those conversations in the right way.

I also think that when you have those listening sessions, you've got to make sure you put in the work to understand and learn ahead of time and leverage these opportunities for those who want to express themselves and to be heard, and then leave those sessions with a renewed commitment to what you will do to address systemic racism and inequality. I think that those are some of the initial things that leaders can do in raising awareness.

3. From the perspective of envisioning a new, more positive and equitable future, what might a racially equitable and just future for healthcare look like? How do you envision that?

I love this question because I get to talk a little bit about CVS, right, because this is what our mission is all about. We talk about, we are here to help people on their path to better health, and so I just want to break that down. To help people on their path to better health. Not affluent people, not just certain kinds of people. We are here to help all people on their path to better health.

And so that means bringing to bear all of the assets that make up, say companies like CVS Health, right? To break down barriers to access; barriers to affordable, quality healthcare, whether it's being where people need us the most. You think about our 10,000 stores, so that opens up a lot of access to healthcare. We continue to provide free health screenings through Project Health, expanding our capabilities through our new HealthHUB model. You haven't been in our HealthHUB, please visit one. I think it'll blow you away.

But also we're doing more than that. I think about, you've got to figure out all of those other pieces that impact affordable access to healthcare. And so things like we're investing in affordable housing because we it's clear to us that in some cases your zip code has as much an impact on your health as your genetic code. We're committed to making sure that we leverage the power of our scale, our scope and our local footprint to bring a broad spectrum of services to when and where people need folks the most.

4. How does one go about getting the right people to the table to make systemic change in healthcare?

I would say start within your own networks, start with your friends, your family. Regardless of your specific role in your organization, I think we all contribute to the organization's ability to serve those who need us. If you belong to professional organizations, asking the question of what they can do to address inequality and injustice. Be the one to ask that question, be the one to force that dialogue, instead of just moving the agenda.

I also think that social media gets a bad rep, but we are so connected through social channels now more than ever before. And so how hard would it be to convene a group on LinkedIn, that network to have a cross company or even multi-industry discussion about systemic inequality? The question, and this is from the old civil rights movement of the 60's, they ask the question over again, "If not you, then who? If not now, then when?" And so I would say now is the time for everyone to be engaging folks, to bring them to the table.

We think of leader in a traditional sense of direct reports in that leadership or some type of hierarchical structure. But the reality is we lead in our church, synagogue, mosque. We lead within in our families, with our kids, our children. We lead in our community. There are so many different opportunities. Hey, the first thing you lead is yourself, right? There's so many ways to lead. I think everyone's a leader and I think good leadership comes with significant responsibilities.

5. In your opinion, why haven't we made more progress in addressing inequities in our healthcare system? Is it because of these boundaries and obstacles, and are they real or are they issues that we can with effort overcome?

Oh, I think they're very real. I also don't think we have enough time to go through all the obstacles and barriers, but I think about the effect of interpersonal, institutional and systemic biases and policy, practices, structural inequities and the sorting of people. We sort people into resource rich or resource poor neighborhoods, K-12 schools largely on the basis of race and socioeconomic status. I was watching something the other day that said we are even more segregated today than they were prior to Brown vs the Board of Education in 1954. That is amazing to me, but it says something about the structural nature of racism.

Those structural inequities rise to large and preventable differences in health metrics such as life expectancy, with research indicating that one zip code is more important to health as well as genetic code.

Healthcare reform, I've heard that for the past 30 years, right? I think [reform] has been so incremental because there are powerful forces that want healthcare to remain the way it is. And so it's been very difficult to break down some of those barriers and some of those obstacles. I think about the consequences of removing provisions from national healthcare policy. You see that in the politics today. Those healthcare policies protect people with pre-existing conditions. It blows my mind that we're actually having that conversation in 2020 about eliminating those provisions, but that just shows what you're up against. Around 27% of non-elderly adults have pre-existing conditions. Racial and ethnic minorities are disproportionately represented in that group. And we are seeing, especially over the last few years, the weakening of protections for patients. Those are the things that just immediately come to mind.

But I do feel a sense of hope and optimist because what's happened over the last two or three months is different than I've seen, and it started with people really move beyond the noise that's out there to ask fundamental questions around systemic racism. And I think, here again, now is the time for folks to continue to demand change...