One On One With The Chartis Group's Ken Graboys

Graboys: There are three principal trends that are shaping health care delivery. These are trends that were in their nascency before COVID, but where the pandemic has acted as an accelerant to the point where they are now true disruptors.

The first is industrial convergence in the health care space. The sheer scale and centrality of health care in our lives, coupled with huge advances in technology, digital connectivity, and data deployment, has led to a confluence of non-traditional industry segments entering health care delivery. Whether it's retail, consumer goods, personal tech, e-commerce, or other areas you would not traditionally associate with the typical health care delivery equation, they are now becoming a meaningful part of it.

People are now able to go to Walmart to receive care, use their watch to run an electrocardiogram or a smartphone to monitor chronic health conditions. Hospitals are now delivering care in the home, while Amazon is now delivering virtual care on your tablet.

In this more complex, multi-faceted health care delivery landscape, the questions for providers now become more critical: What is our role and where can we provide the greatest value? Who are we competing with? Who do we partner with and how? How does this change our clinical model? How does it change our operating model?

The second trend is an infusion of private capital entering the health care delivery space at an unprecedented, almost unrecognizable magnitude and velocity. Health care as traditionally measured makes up almost one-quarter of the U.S. economy—and when you factor in other elements of our lives that impact our health—the soft measurement of health care—standard health care activity comprises much more than that.

There is significant opportunity, given how fragmented and challenged the health care environment is, for capital to come in and begin to relieve those friction points. We're seeing waves of venture capital, private equity, institutional and corporate investment come in at levels that were heretofore unimagined. Such investment has huge potential to advance health care technology, approaches to care, access, and cost of care. But it also has the potential—in fact the likelihood by its very definition—to create winners and losers in the health care delivery space. Capital drives consolidation, creates industry technology and data standards, and the like – all of which can lead to a dynamic of who's in, who's out, who's made the right investments and who did not. Will traditional organizations be able to create new revenue streams or will they be left short. The result, wherever there is investment there is the opportunity for returns and losses and sometimes that can be fruitful, and sometimes it can be less than constructive.

The third trend, so to speak, is the profoundly pressing need to address the disparities in health care delivery that are endemic in our communities. Full stop.

Again, all of these elements existed pre COVID, but the pandemic's effects served as a refracting device through which each trend was further illuminated, amplified and accelerated to the point of disruption.

Consulting: How is Chartis evolving its consulting model and general operations for the post-pandemic landscape?

Graboys: There are a few things that are evolving and changing in how we practice our consulting work. First, while the nature of our work and our consulting models will continue to be built around the notion of co-development with our clients, I expect client co-creation and collaboration to become even more pronounced.

The second is the evolution of our consulting delivery model itself. The default model will likely be less oriented toward full-time on-site work models. We will be more strategic and timely in our determination of working on-site versus remotely to deliver the greatest impact cost-effectively for our clients while also providing a more balanced work experience for our consultants.

Thirdly, I see a more active focus on change management for our clients. If anything, the pandemic response and subsequent vaccine campaigns and rollouts have demonstrated that simply having the right answer is not enough to implement meaningful, enduring action and change. It is equally important to integrate and associate that answer with the right change management strategy, communications, education, creation of supporting incentives, and supporting organizational structures. There is a tremendous amount of gray space between a solution that has been developed and what ultimately occurs.

We've seen that throughout the last year and a half and our clients are very cognizant of the fact that, without a focused approach, success is less likely. Unless health care change management adoption and communication occurs with the inclusion of physicians, employees, patients, families and communities, they aren't going to have the impact that they desire. So we have really focused on building our change management strategic communications capabilities and building that into the work that we do.

Consulting: Without question, huge disparities exist in health care delivery and access, and have even been exacerbated by the pandemic. What do you see as the root cause of the inequities and, are there potential remedies to reduce or eliminate it?

Graboys: I think that the challenge has been that there really is no single root cause. In many ways your health status and my health status are a byproduct of so many things. A lot of it has to do with the environments in which we live in and the opportunities we've been afforded (or not afforded) and the supports that exist in our communities. I don't know if there is a single root cause or a single solution for that matter. But given that, I think a key has to be meaningfully weaving together the elements of our traditional health care delivery landscape with those elements that materially affect one's health status that are not typically considered part of that landscape. Bringing together our caregivers, our hospitals, our health centers with those things we would call the social determining factors.

In addition to direct care delivery, we must also address food insecurity, housing insecurity, job security, public transportation and its impact on access, employment environments and schools. Where you begin to see communities move the needle, is where they bring together those community elements with traditional health care elements—combining them through technology, through connectivity, through community health workers and integrated programs. Chartis is in the process of working with a few very challenged communities in urban areas of the U.S. helping them do just that. And it is amazing the impact that can be achieved.

Consulting: What do you see as the driving force for change and adoption going forward, governmental/regulatory influence or free market forces?

There really has to be a coordinated, meaningful partnership between those two forces. On the public health side, federal, state, and local government provide much of the financing and the regulatory guardrails supporting the provision of care. These forces have to work hand in glove with the private capital side we discussed earlier. Why? Because the cost of change is just so great—the cost of achieving the advances necessary to ultimately deliver greater care and provide greater access for all—advances in connectivity, digital health, AI, community-based care, is so material that it must be borne by private investment as well as public funding.

Consulting: As you mark Chartis' 20 anniversary this week, what do you see as the company's course over the next 10-20 years as it seeks to contribute and prosper during this tremendous moment of change in health care?

My background originally was in public health as was Chartis' other co-founder Ethan Arnold, so centrality of mission was foundational for Chartis. We founded the firm with the mission to materially improve health care. We did this under the premise that, if our mission was directly aligned with that of our clients' mission, we will better serve our clients and community. Our mission has been the prism through which we manage the firm.  We believed that by not being driven by traditional business objectives first and foremost—such as growth or industry domination—that it would lead to better and more meaningful outcomes for our clients as well as better and more deeply aligned relationships with those clients. And that it would provide for a more fulfilling work experience and professional environment for our people.

Over the past 20 years we have grown from two guys who started Chartis above a pizza shop in Chicago to over 500 colleagues in offices across the country.  We have been fortunate and privileged to have worked with the most insightful and dedicated clients across the nation. The last year has been devastating—more than 600,000 COVID deaths.  Yet, through it all, the health care system across the U.S. took care of 330 million people. The system and its caregivers brought much more light to the world than I think we can appreciate.

As we look to the next 20 years, it is clear that our clients' appetite to write the next chapter—to build the next generation of advances on behalf of the communities they serve—an appetite grounded in decades of experience and recently forged by the furnace of the pandemic—has never been greater. Their energy and potential to achieve those advances has never been higher. For us, it is a privilege to work with them to co-develop that next generation of solutions every day.