Progress at a crossroads

Although support for DEI wanes thin, demand for health equity still waxes large

The conversation about racial justice in America started boiling over about a decade ago.

In 2013, a Black teenager named Trayvon Martin was killed by a neighborhood watch coordinator in Sanford. Then Michael Brown was killed in Ferguson. Then Eric Garner (New York City), Tamir Rice (Cleveland), Philando Castille (St. Paul), Freddie Gray (Baltimore), and Breonna Taylor (Louisville).

By the summer of 2020, those same cities were also roiled by a pandemic that seemed to pour every inequity in our society into a pressure cooker. When George Floyd was killed, on video, before the whole nation–the lid blew off. The energy from Black Lives Matter protests were extended beyond police departments towards the injustices of society at large. America was on the precipice of a reckoning.

To everyone’s surprise, corporate America momentarily became chief reckoner. Companies invested $7.5 billion in employee Diversity, Equity, and Inclusion programming and increased job postings for DEI roles by 123%. At the World Economic Forum, they vowed to use their businesses to reduce health disparities. Nearly 80% of executives claimed to have a health equity strategy in place.

Then the energy shifted.

There may have been other harbingers of impending change but the Supreme Court’s 2023 decision to end Affirmative Action was the watershed moment. Colleges quickly reshaped the composition of progressive spaces on campuses and corporate offices followed suit. Four months ago, the world’s largest HR association announced they would be dropping the “E” from DEI. Today, many prominent Fortune 500 companies have shuttered or shrunk their DEI investments. And over the same brief period, 85 bills in 28 states were introduced to restrict DEI programs across the board.

Few movements have had such a spectacular rise and rapid fall. Yet even as the acronyms got truncated, community demand for a health care system that works for everyone very much remained.

A digital first

In 2022, I convinced Dr. Dawn Godbolt to join Maven as our Director of Health Equity. Dawn is a sociologist whose bubbly personality belies the seriousness of her work: “My grandfather was a sharecropper who was denied access to care because of his race, and subsequently died.” In describing her decision to get a social sciences PhD, she told me, “The idea that you can measure inequality through health disparities just lit this fire inside of me.”

That same year, the National Committee on Quality Assurance (NCQA) announced the first recipients of a new accreditation for health equity, including the leading health plans and hospital systems in the country. In American healthcare industry, earning NCQA accreditation is the gold standard for what excellence looks like. It quickly became the focus of Dawn’s fire.

What came next was two years of work across Maven’s clinical and product teams to meet the NCQA bar. Many of the requirements were embedded in Maven’s product already. Others needed to be added or systematized. For example, while Maven had partnerships with community based organizations, we did not have a Community Advisory Board. Now, we do, and they can give continuous feedback on our product.

“This was not a back burner project. It required executive buy-in from every department at the company. Project teams were formed and budget was put behind them,” Dawn reminded me.

All the effort paid off. This week Maven became the first digital women’s health company to earn NCQA health equity accreditation. More than a badge of honor, it enhanced our ability to improve the lives of the people we serve.

The Disney paradox

As a brand, Disney represents both the nostalgia of simpler days gone by and the messy, aspirational pluralism of modern Americana. And so, in 2023, they became the poster child for the culture wars on DEI.

Disney went head to toe with the Florida government over their commitments to prioritize DEI in hiring and contract consideration, a skirmish some may say they lost. But no one would say Disney actually lost cultural relevance. Just two weeks ago, Moana 2 set a new Thanksgiving box office record of $225 million.

For years, Julie Ann Crommett served as the architect of Disney’s Multicultural Audience Development division. (Before Disney, she did the same at Google and NBCUniversal.) We have Julie Ann’s team to thank for many of Disney’s most impactful (and lucrative) films of the past decade. Think: Black Panther, Coco, Encanto, Soul–movies my children love and devour, and yours probably do too. In fact, they are so beloved that it’s easy to overlook the secret to their success: diverse characters living and thriving in diverse worlds.

“It’s simple math,” Julie Ann says. “If you try to be everything to everybody, you're nothing to nobody. But if you're something really specific, you allow the opportunity for universal connection, because a character that is better etched, a world that is better detailed—that allows for more entry points for more people,” she said.

Central to the DEI backlash was the perception that its champions had overreached; that a “woke” agenda was distracting from core business objectives. But, as Julie points out, Disney’s ability to tell great, accessible stories is in fact their business superpower.

“Disney knows you have to look at the creative pipeline. If you're only having this conversation about diversity at the marketing level, it's too late. It has to happen all the way upstream at the inception of the idea. Otherwise, missteps, missed opportunities, lack of expansion…those happen,” Julie Ann told me. “Audiences can feel when the goods aren’t there.”

To Julie Ann, Disney’s opponents attacked one wing of the company’s DEI work (their recruitment) while completely ignoring the central engine: how their product is made. Mixed up in the debates over language and labels is the substantive work of creating products that ensure those who are disadvantaged are seen and well served.

The same of course could be said of health care. It’s not enough to simply find diverse communities and market new care to them—to actually produce better outcomes, those services must be purpose-built for their needs.

Quality meets equity

When I first met Peggy O’Kane, CEO of the NCQA, she was such a good listener that I didn’t realize I was in the presence of a Beltway titan. She’s been named to Modern Healthcare’s list of most influential people no less than a dozen times. In D.C. and beyond, everyone seems to know her, or at least her life’s work.

We caught up the day after a tumultuous U.S. election. She was uncharacteristically weary but also characteristically tough. Here was a woman who, while working in hospitals as a respiratory therapist in the 1980s, looked around and wondered why nobody was using any data. “When something bad happened, the question was just who do we blame? Not, what system was missing?” she said.

So she did something about it. She forged NCQA as an independent nonprofit that tracks and measures the quality of medical providers, practices, and health plans. “It was nervy of us to say, you're going to take care of your people with diabetes, when they didn't even know who was who,” she tells me. “But we laid a good foundation.”

Today 72% of the U.S. population is enrolled in NCQA-approved health plans. And so during that fateful, heated summer of 2020, Peggy’s staff began to wonder if their structures designed to measure quality could measure equity, too.

“I’m embarrassed to say that for a long time health care thought: okay, here was the quality stuff and here was the health equity stuff—that they weren't connected,” Peggy explained. “And yet, if you look at the major drivers of poor quality and bad outcomes, health equity is right in there. It’s number one or number two.” Thus was born the NCQA Health Equity Accreditation.

Commenting on the current climate for health equity Peggy says, “Many people have lost the plot.” Recently, NCQA has even seen interest from some organizations who would like to pursue the requirements without calling it “health equity.” In this way, the problem isn’t the work—it’s the name.

The lost plot

To understand where the work and the name might’ve gotten tangled, I called up my friend Dr. Ankoor Shah. He is a tremendous thinker and an even better person. A pediatrician by training, Ankoor spearheaded Washington D.C.’s response to COVID-19. When he left in 2021 to become Chief Medical Officer at Accenture, he found himself with an ear to the ground as corporate America wrestled with the implications of racism.

From this vantage point, he observed three “phenotypes” of organizations pursuing health equity strategies. One type put their dollars towards DEI marketing rather than operations. Like Julie Ann, Ankoor insists that these dollars invested at the end of the food chain don't do much. It’s true that consumers might notice their favorite brands aren’t speaking out like they used to. But because there was little substance in these initiatives to begin with, not much has really changed.

In the second type, Ankoor says a health equity mandate came from the top: these organizations were led by executives who just believed it was the right thing to do. These corporations are engaged in substantive work, but they depend on leadership to sustain it—and how they refer to that work may adapt with the opinions of their shareholders, just as Peggy experienced.

This leaves the third type—the ones to watch, Ankoor says. “They’ve realized what all healthcare purchasers or payers are realizing: that because they are on the hook for dollars and outcomes, and disproportionate health outcomes and disproportionate costs are unsustainable, a one-size-fits-all approach doesn't work.”

“They have to think about a personalized or very targeted approach to meet the needs of a certain person in a certain community,” he said. Like Disney, they’ve realized that a tailored approach actually captures more patients. In other words, they see health equity as a solution to the business problem they are solving.

Maven of course aspires to be the third type, and to help our clients be the third type too. And by all indications, the health ecosystem is largely with us. In just one example, more than 20 states have Medicaid managed care strategies with health equity goals and strategies. We’re finding that many of Maven’s own partners are eager to delegate their health equity needs to our expertise.

I will not claim that we’ve got it all figured out. In humbling moments, Dawn is quick to remind me that health equity is an aspiration–something that we are always working towards. The key here, though, is that word “work.” We are committed to doing the work—and we’re finding that the work is far less controversial than the name.

What my team is reading, considering, and building against:

• Julie Ann Crommett has spent her career imagining a better, more inclusive world so that we can imagine it too–and perhaps even manifest it. I highly recommend her TEDx Talk on media representation, which is about her own heritage, her godfather, and how the TV we watch can shape our destiny.

• Every December is a time of speculation about the New Year. For many, the world feels particularly uncertain right now. George Parker’s essay in The Atlantic about our next era of public discourse is reasonable, steeped in history, and well-worth a read.

• Reality is stranger than fiction in Bloomberg’s latest investigation into how select U.S. fertility clinics helped a billionaire fulfill his natalist dreams. It is more fodder for the mounting call for better transparency and standardization in the fertility industry.

• There are many more people who would benefit from fertility services than can access it. But calculating how fertility rates are changing is more challenging than you may think. This piece in the NYT is an excellent primer on why fertility rates are hard to quantify, and perhaps even harder to qualify.

• At Maven, we were shocked by the cold-blooded murder of United Healthcare CEO Brian Thompson, known as “BT” by family, friends, and colleagues. We are also sobered by the responding chorus of pain online about the failings of U.S. health care. We are keeping BT’s loved ones and colleagues in our thoughts, and we are also committed as ever to making health care work for everyone.