Renee DeSilva: Improving Representation on Corporate Boards

The push to diversify boards of U.S. companies has been a longstanding issue in corporate America. In the wake of George Floyd’s killing, many CEOs of U.S. public companies wrote pieces pledging to fight racism and own up to past shortcomings. Concrete commitments were made, often including pledges to increase the diversity among boards and C-suites. The re-energized national conversation on race, coupled with impatience around our sluggish improvement towards gender equity in the board room, has created a unique historical moment to accelerate progress.

Much of the drive to diversify boards stems from a simple ethical motivation to address lingering racism in every sphere of society. As a Black woman, I see this desire to improve as genuine and inspiring. Yet, in addition to the moral justification for diversifying boards, there is a strong business case to be made as well.

For one, corporate leaders understand the U.S. is becoming a minority-majority society: White people will make up less than 50% of the population by 2045. Women and communities of color account for an increasing share of economic purchasing power and members of these groups expect the companies they do business with to embrace inclusive policies. From a reputational perspective, companies do not want to be seen as laggards in regard to diversity—whether in governance, executive leadership, or any other domain.

Moreover, recent moves by government and industry are making board diversity a necessity. A California law requires that companies headquartered in the state have diverse boards: for example, a board with nine or more members must have at least three directors from under-represented communities. As of 2021, Goldman Sachs will require that any company it takes public have at least two diverse board members. And on December 1, NASDAQ announced it would ask the SEC for permission to require all member companies to have at least one woman and one diverse board member.

Beyond PR considerations and industry or legal requirements, diverse boards frequently function more effectively. Too often, new board members are selected from networks of existing board personnel, sharing similar experiences and perspectives. Lack of diversity—whether it be gender, ethnic, age, skill, or philosophy—can constrain a board’s “cognitive breadth,” resulting in directors that may be unable to compensate for one another’s blind spots.

In contrast, diverse boards bring talent with different lived experience and a wider range of perspectives. High performing, diverse boards can objectively examine a range of opinions and feel psychologically safe in challenging one another. A diverse board’s understanding of nonwhite customers and employees will have depth and nuance. Fewer important issues will be overlooked, discussion will be robust, and decision making will improve.

The numbers show how far we have to go, especially with Black women and Latinas. In 2018, Black women comprised 6.8% of the adult population and 7.8% of all undergraduates, but only 2.7% of directors in Fortune 500 companies. Under-representation of Latina women is even worse. Latinas comprise 7.4% of the adult population, 12% of undergraduates, but less than 1% of all directors.

Issues of gender are inseparable from issues of race. It is well known that Black and Latino people in general are underrepresented at the senior-most levels of U.S. businesses, including boards. Less widely appreciated is that women of color at senior levels of corporate power are under-represented within their own groups. For example, as of 2018, 68% of all Black directors were men, as were 80% of all Latino directors. Companies need to consider gender and race together.

In my capacity as CEO of The Health Management Academy, I regularly speak with leaders of the nation’s largest health systems and private and publicly held healthcare companies. I am encouraged by their honest commitment to greater understanding and to the enhancement of diversity, equity, and inclusion. The dialog around race and gender in 2021 is more authentic, serious, and determined than it has ever been.

So the question remains—how will we meet this moment? What are a few concrete steps that any organization can take to advance representation of Black women and Latinas across C-Suite and board roles? I’ll be back next week with concrete advice on improving #race and #gender equity in the executive ranks.

Renee DeSilva

Leveraging Care Redesign to Reduce Waste and Manage Healthcare Costs

The healthcare system accounts for almost one-fifth of the US GDP. However, studies have estimated a third of spending can be attributed to waste in the system. As the industry faces mounting pressure to provide more affordable, consumer-centric care, stakeholders will have to identify and address existing waste to help manage cost. As providers and industry organizations implement solutions and strategies to improve quality and reduce cost, it will be important for stakeholders to focus on the areas that will drive the greatest ROI.

Addressing waste and truly managing the total cost of care will require a fundamental overhaul of the current care delivery process. Care redesign—the process of reengineering system-level clinical care delivery to improve quality, increase operational efficiency, reduce clinical variation, and manage the total cost of care—can help organizations transform to meet these goals.

Leading Health Systems (LHS) can use several strategies to evolve the healthcare system into one that minimizes waste but comprehensively supports patient and consumer needs, including to:

  • Streamline clinician workflows and backend processes
  • Develop and communicate clear pricing models
  • Establish and ensure adherence to evidence-based care pathways
  • Develop robust care coordination and transitions of care models

Patient Privacy and Opportunities to Commercialize Data Assets

Over the past decade, the Leading Health System (LHS) market has experienced rapid advancements in technology and digitization. Aided by improvements in interoperability, digitized clinical data have created a new and increasingly valuable asset for health systems. LHS are harnessing the power of clinical data with sophisticated analytics, such as AI and machine learning. However, data security and patient privacy remain a top concern, particularly as health system arrangements with big tech increase in prominence.

Consumer behavior has also demonstrated a growing maturation of digital health care and data sharing. A new report from Stanford University identifies an increase in the use of digital health tools by consumers over time, increasing the amount of data available to drive advancements in care delivery.

These trends, as well as the ONC’s recent 21st Century Cures Act Final Rule, have forced LHS to evolve their data compliance strategies, particularly as it pertains to sharing clinical data with third party entities. With the ONC’s push toward greater data sharing and availability, LHS are increasingly evaluating the opportunity to commercialize their clinical data.

Renee DeSilva: Member Lessons on Equity & Inclusion

A few months ago, I shared my personal reflections on race and health. I was encouraged by the warm response and since then, the national conversation on diversity, equity, and inclusion has accelerated. The Academy has strived to create opportunities for our members to share success stories, pitfalls, and common challenges. Most recently, I had the chance to engage with CEOs, key physician leaders, and D&I experts across healthcare.

Here are a few of my takeaways:

The CEO owns the Equity Agenda: Executive teams, and especially CEOs, must be bold and willing to lead from the front. Unsurprisingly, organizations further along the D&I journey are led by an unambiguously committed CEO. Common among these leaders is a ‘bias to action,’ which often starts with self-reflection and education on what it means to be actively anti-racist. Carl Armato, President and CEO of Novant Health modeled this when he took 20 senior white male leaders off-line to attend the White Men’s Caucus (check out White Men as Full Diversity Partners before you react to the name). Carl understands that all senior leaders need to be Chief Equity Officers.

Inclusion matters: Executive engagement and strategy alone won’t drive performance. Darin Latimore, M.D., Deputy Dean & Chief Diversity Officer at the Yale School of Medicine said it best, “If your culture is not inclusive, it will eat the best D&I strategy for lunch.” Successful organizations start by investing in and measuring inclusivity and belonging. They work hard to create space where diverse voices can be heard and they acknowledge that D&I is not just a ‘thing’, but rather a way to do all things.

One size does not fit all: Driving strategy and execution depends on the context of your organization, and sometimes, it may feel like the work conflicts with operational priorities. Lisa Gutierrez, Chief Diversity & Inclusion Officer, IU Health, recalled her work in manufacturing that championed Six Sigma methodology, which has a focus on reducing variation. Diversity and inclusion, on the other hand, is designed to draw out the differences that elevate our impact. Lisa tweaked the strategy to align with Six Sigma’s other themes of effectiveness and efficiency. DE&I efforts require leaders to adapt their roll-out to reflect the nuances of their own organization.

In closing, consider this challenge issued last week by Dana Beckton, Chief Diversity & Inclusion Officer, Sentara Healthcare to our Physician Leadership Program cohort: Before the end of the year, identify one structural process or policy that works against an inclusive culture. Lean in, build some muscle, and commit to changing that practice.

Renee DeSilva: Personal Reflections on Race & Health

On a cold night in January 1997, my phone rang in the middle of the night. On the other end of the line I heard my mother’s voice, distraught and hysterical, as she tried to tell me my 34-year old brother had died at the hands of police. I was a senior in college, 300 miles away from home, and desperately trying to wrap my head around the news. I was heartbroken. 

Across the next few months, I was thrust into a role that my 20 year-old self was not ready for. I led conversations with the police, talked to witnesses on the scene, and represented my family with the media. I will never forget the heartache. As I witness the recent examples that demonstrate a lack of value placed on black and brown lives, my heart continues to break.

I am a black daughter, wife, sister, aunt, and mother. I have never had the luxury of being unaware of what it means to be black or brown in America. I’ve written letters to the police department on behalf of my nephew after frequent racial profiling and taunting. My biggest fear is that my children will not be safe. At 25, 14, and 11 and despite our affluent neighborhood, I know that they are not immune. They can tell you they’ve heard versions of this talk many times.

I also have the privilege of serving as CEO of The Academy, where I reflect on these issues in multiple ways. From the standpoint of an executive, I am often the only person of color and woman in the room. It can feel lonely and isolating at times—I am aware of the subtle and overt ways that this is plays out in corporate America.

As a healthcare leader, I think about the mountain of research across the industry highlighting the inequities in US health care system. The disproportionate impact of COVID-19 exemplifies this, with “African-American deaths being nearly two times greater than would be expected based on their share of the population.”

Where do we go from here? At The Academy, we typically avoid religion or politics. But in this case, these are human issues. As the leader of an organization with a platform of thousands of health system and industry leaders, we must explore ways to create a safe space for dialogue on challenging topics. Moreover, we need to drive the national conversation on equity and inclusion. I am pushing myself to get out of my own comfort zone and lead from the front.

Addressing the Rise in Behavioral Health Needs from COVID-19

Unaddressed behavioral health needs impact a health system’s financial, clinical, and equity strategies. According to Milliman, treating patients with behavioral health diagnoses costs about $875 per member per month more than patients without such diagnoses. In 2017, deaths of despair (i.e. those related to suicide, alcohol, and drugs) reached the highest rate since the CDC began collecting this data in 1999.

The lasting pandemic has only exacerbated this trend, with nearly 50% of U.S. adults currently exhibiting some signs of depression. The greatest burden of symptoms occurs among populations with compounding stressors (e.g., job loss and limited childcare) and the least access to financial and social resources.

With the increase in telehealth utilization across health systems, more patients have access to behavioral health consults through virtual channels. However, current approaches to addressing behavioral health needs are often inadequate and fragmented. Despite the relatively high prevalence of affected patients, significant barriers still restrict access to treatment.

Providers must create a proactive strategy to identify, assess, and manage patients’ behavioral health needs—particularly for at-risk populations and caregivers. A comprehensive behavioral health strategy includes at least three tactics:

  • Integrate behavioral health services into all medical and physical health services. Initial targets often include primary care for ongoing management and the ED for crisis stabilization.
  • Leverage technology (e.g., apps and online communities) to scale in-between visit care. Beyond tele-visits, IT tools can enable ongoing symptom management at scale.
  • Activate community-based partners (e.g., social service organizations) in regional hotspots. Partners can help mitigate symptom escalation among hard-to-reach groups.

Redesigning Chronic Disease Management

Chronic diseases are defined as conditions lasting one year or longer, require ongoing medical attention, and/or limit daily activities. Today, chronic diseases affect millions of Americans and drive over $1 trillion dollars of annual healthcare costs. Beyond direct healthcare expenditures, research indicates the indirect costs of the chronic disease burden from lost economic productivity exceed $3.7 trillion – almost 20% of the US GDP.

While historically challenging, chronic disease management has become even more difficult amid the coronavirus pandemic. Patients are limiting their interactions with the healthcare system and care has shifted to virtual platforms. Providers must implement strategies to proactively engage patients with chronic diseases to manage ongoing care and prevent exacerbation and avoidable cost in the future.

The lasting pandemic creates an opportunity for the development of new care models and innovative solutions that address longstanding challenges that are particularly acute among chronic disease patients, such as medication adherence, care coordination, and inequitable access. Such strategies will set the foundation for long-term transformation that will ultimately drive improved patient outcomes and population health.

Preparing for a Future of Remote Work

While a multitude of forces such as changing workforce demographics, technology adoption, globalization, and automation have increased the prevalence of remote work in recent years, COVID-19 has catalyzed a large-scale shift to a fully remote environment for many organizations. Despite the early experimentation, the US workforce is largely interested in maintaining their newfound flexibility. A majority (72%) of US office workers report wanting to work remotely at least two days a week post-COVID, and almost one-third (32%) would prefer to stay fully remote.

This rapid shift to remote work for office workers globally required organizations to quickly adjust and create new expectations, norms, and processes to maintain operations. Challenges with maintaining culture in a remote or hybrid environment, assessing productivity, recruitment and onboarding, and people development will all be critical for organizations to address in a widely remote future. As remote work becomes the norm, organizations will need to rethink their approach to the workforce and redefine the competencies necessary for success.