Health care is at a promising inflection point as the movement to both advance healthcare equity and move care upstream gains momentum. New regulatory requirements, performance incentives, and accreditation standards are prompting health plans, hospitals, and clinics—especially those serving Medicaid beneficiaries—to focus even more on reducing healthcare inequities and patients’ health-related social needs.
The ultimate impact of this moment, though, comes down to whether healthcare leaders and teams decide to merely aim for the floor or set their sights higher. Some will choose to simply comply with new requirements by reconfiguring or launching a patchwork of programs. But there are other leaders and teams who will rise to this moment, deciding to move beyond mere compliance toward real impact. And they will do so using a cohesive portfolio of strategies that drives equity-focused improvement and transformation across multiple levels—from patient care to institutional policy, and from community conditions to the societal practices that put people in harm’s way.
We work with courageous healthcare teams and communities across nearly 30 states who are reaching for this kind of impact as they navigate complex new roles, requirements, and opportunities. But the same questions always come up. How do we balance trying to create change in our communities and in our institutions? What will be our guide? They need support, but in practice, actual multi-level strategies are scarce.
That’s what inspired us to create the Compass for Health Equity Transformation (“Compass”). It’s a tool that provides a practical and rigorous approach to the design and management of a portfolio of multi-level interventions. It helps leaders assess their current efforts and gaps, define their aims and action plans, and then align health equity strategies across different levels.
How Leaders Are Using the Compass to Drive Change
We’ve already seen this Compass unlock insights and propel teams in Medicaid managed care plans and vanguard health systems to advance health equity. At a high level, they are using the Compass to navigate three major activities:
Compass use #1: Assessing the maturity of health equity efforts across levels of transformation
After establishing a shared understanding of the structural, institutional, and social drivers that shape healthcare inequities experienced by their patients and communities, leaders and teams use the Compass to assess and measure their current health equity efforts and programs. For example, leaders at Health Net, a large Medicaid managed care plan, recently used the Compass as a tool to engage colleagues across multiple internal departments, business units, and regions to catalog equity-related projects and initiatives. To prepare for a new California statewide benefit supporting community health workers (CHWs), they used the Compass to plan an initiative to identify and map CHW employers across the state—work that will not only help Health Net develop its own programs, but also be a resource for the whole state (follow these links for the study report and webinar). In the process, the Compass helped them socialize a structural, multi-level understanding of health equity across the organization.
Other leaders have used an expanded form of the Compass (known as the Upstream Strategy Compass) to go deeper and assess current programs and investments within a specific health equity focus area or strategic priority, like improving maternal health equity or reducing healthcare inequities in cardiovascular outcomes. This upstream version of the Compass adds another dimension to the assessment process, engaging leaders to map initiatives and programs in a priority area not only across levels of transformation but also across levels of prevention (health promotion, primary prevention, secondary prevention, and tertiary prevention).
Health equity leaders at Corewell Health, Michigan’s largest nonprofit healthcare system, used the expanded Compass to engage regional leaders in mapping current clinical as well as community benefits programs that seek to increase maternal health equity. They’ve also used it to identify strategies to support program- and system-level strategies with investments in community and societal work—positioning themselves not only to meet emerging regulatory requirements for health equity and social needs, but also to exceed them by advancing equity for their key priorities: diabetes, maternal health, cardiovascular health, and mental health.
After teams map their current portfolio of health equity strategies, their next step is to measure the maturity of key activities within and across each level of health equity transformation. This is where the Compass serves as a maturity model; leaders assess whether their current actions, tools, and processes within each level of transformation are at an “initial,” “developing,” “defined,” “managed,” or “optimized” level of maturity.
Compass use #2: Defining aims and action plans
Using the Compass as a maturity model enables leaders to take the next step: identifying gaps and prioritizing opportunities for continuous improvement. The results of the assessment step help leaders identify specific opportunities for improvement, including opportunities to improve the effectiveness of equity-focused programs and care models to align with new and contractual requirements and accreditation standards, like those from the National Committee for Quality Assurance or The Joint Commission. But, as a multi-level tool, the Compass then drives the work further. It uniquely enables health equity leaders and teams to identify other institutional opportunities for improvement, such as to drive internal equity-focused systems transformation, help strengthen local ecosystems, and support policy interventions or reforms that improve the structural drivers of health equity.
Before deciding which specific gaps to address or which improvements to prioritize, however, healthcare leaders and teams need to define a set of time-bound equity aims, within and across each level of transformation. This typically takes 1-3 months. As we’ve learned through our work across the country, there are three ways leaders can make this exercise to define equity aims for multi-level transformation easier and more helpful. They can: (1) zoom in on a specific focus area or strategic priority for health equity, such as maternal health, diabetes, or mental health; (2) focus on a geographically-defined community; and (3) include and center the voices of trusted community-based partners, advocacy groups, and people who have lived experience and expertise working to advance equity at all levels.
As an initial set of aims comes into focus for each level of transformation using the Compass, leaders and teams can then revisit their assessment results and prioritize which opportunities for improvement to pursue over the next 6-12 months. These aims and priorities are then documented in their institution’s Action Plan for Health Equity Transformation, which outlines the actions, tools, and resources that institutional equity-focused teams and workgroups will deploy to support continuous improvement. We’re happy to see health systems like Corewell Health use our templates and support to develop and implement clear action plans to pursue their aims for multi-level transformation.
Compass use #3: Aligning health equity strategies for structural, multi-level transformation
With clear aims and priorities for improvement outlined in their action plans, leaders and teams can use the Compass as a tool to align and develop their strategic portfolios for multi-level health equity transformation. We’ve supported organizations to convene internal colleagues and external partners, analyze data on healthcare inequities and unmet social needs for specific priority populations and neighborhoods, and define equity-focused aims. Afterwards, we’ve helped them use the Compass to pull together and align strategies across levels of transformation (programs, system, ecosystem, and societal) and levels of prevention (health promotion, primary prevention, secondary prevention, and tertiary prevention). In doing so, the Compass helps leaders avoid the trap of reductionist “in my lane” versus “not in my lane” debates, and instead invites teams to consider where and how they can lead, partner, or support efforts to drive institutional and community-based strategies for multi-level transformation. With a shift towards a value of investment (VOI) analysis instead of only narrow ROI calculations, healthcare teams can then estimate and measure the economic and social value of their health equity strategies at all levels.
This is also how the Compass helps teams move beyond a reactive “patchwork” approach to managing equity-related programs. Many health systems and Medicaid managed care plans are struggling to keep up with evolving requirements to improve healthcare equity, address patients’ social needs, assess population and community-level needs, and meet community benefits or reinvestment requirements. With the Compass, and informed by their assessments and action plans, leaders and teams like Corewell’s are developing more cohesive multi-level portfolios of equity interventions and investments for each of their strategic priority areas.
Setting Our Collective Sights Higher
We want more leaders to set their sights higher as their institutions work to drive and demonstrate equity-focused outcomes. Small, isolated efforts are understood not to be enough anymore. To move beyond regulatory compliance and make a real impact for health equity, we need to translate a multi-level structural understanding of health equity into a portfolio of strategic action, not a patchwork. And as we look ahead to the next three to five years, that means courageous leaders will need more support and navigation tools like the Compass for Health Equity Transformation to expand their equity programs into broader portfolios—not only to optimize services, value, and healthcare equity within their systems, but also to design and scale bold initiatives to advance health equity and impact in their communities.