C3 - Community Care Cooperative

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Diversity and Inclusion

We, the Community Care Cooperative Board of Directors, hereby declare racism a public health crisis and affirm our commitment to diversity, equity and racial justice. We commit to implementing a proactive response to racial injustice, including charging management to create a Committee that will provide organizational leadership.

  • Create a diversity, equity, and racial justice statement
  • Create a diversity, equity, and racial justice Committee Charter, Mission Statement, and 2021 performance metrics and share these results with transparency and accountability
  • Commit to understanding and overcoming our racial biases and practice cultural humility
  • Hire, retain, and develop a racially and culturally diverse workforce at all levels of the organization inclusive of leadership and staff, and contract with racially diverse vendors
  • Promote policies and practices that improve the health of racial and ethnic minorities in communities we serve
  • Advocate for racially diverse representation in Board governance
  • Develop equitable policies and practices to achieve the goals of this resolution
  • Include strategic initiatives in our Balanced Scorecard that advance our work towards racial justice

Our employee-led Diversity, Equity, and Racial Justice (DERJ) Committee works to acknowledge, recognize, and address how white supremacy and systemic racism have adversely impacted people and communities of color. We seek to: 

  • Promote an organization that recognizes the inherent worth of all individuals and foster a culture where Black, Indigenous, and People of Color are equally recognized and valued, and civility and social justice are honored
  • Commit to racial equity and social justice by fostering inclusiveness, valuing diversity and racial representation, facilitating healing, and promoting avenues to equitable systems by addressing disparities in the workplace, the healthcare system, and within the wider communities served
  • Learn best practices and sound theories to overcome racism, sharing models, skills, tools, approaches, programs, and practices

Current Initiatives of the Diversity, Equity, and Racial Justice Committee

We strive for true change in all we do, including hosting a DERJ Symposium, employee trainings, affinity groups, vendor relations, and a health equity fellowship program for recent graduates.

DERJ Operation Framework

This frame provides the theory of change, which gives us confidence that the proposed activities will yield the desired impact and propel us closer to a more diverse, inclusive, and racially just state.

Human Resources
Reorient Human Resource policies and practices to provide for and assure proportional representation of the population C3 services.

Racial Justice
Support the racial justice movement within the communities we serve and the industry.

Inclusion
Dismantle all forms of racism against Black, Indigenous, and People of Color within C3.

Health Equity
Close health disparity gaps to a variance of less than 5% for each measure.

Medicaid Health Equity Strategic Plan 2023 Summary

The Community Care Cooperative (C3) defines health equity as “the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.”1 Our health equity program is dedicated to addressing the systemic racial and social oppression that contributes to poor health outcomes among people of color, members of the LGBTQ+ community, people with disabilities, and other socially disadvantaged populations. In pursuit of this, we will adopt a comprehensive approach that combines clinical and social health tools to deliver the promise of health, as defined by the World Health Organization:

“…. a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” 2 

While clinical tools are an essential component of healthcare, they are not enough to address the complex, multifaceted drivers of poor health outcomes that disproportionately impact socially disadvantaged populations.3 That is why our health equity program adopts a social-ecological paradigm that acknowledges and addresses the social, economic, and environmental drivers of health and, in doing so, creates a state in which everyone has a fair and just opportunity to attain their highest level of health. 4 5 This paradigm is consistent with the Institute for Healthcare Improvement’s Framework for Improving Health Equity and MassHealth’s Health Equity Framework.

The Social-Ecological Model is a valuable framework for advancing health equity as it considers the multiple levels of influence on health outcomes. This model recognizes that individual behaviors and choices are shaped by the broader social and environmental context in which they occur, including through interpersonal relationships, community norms and values, organizational policies and practices, and larger social, economic, and political systems. By understanding and addressing these various levels of influence, the Social-Ecological Model offers a more comprehensive and holistic approach to promoting health equity.

Over the next four years, our Health Equity Program will address the three prevailing health challenges confronting our ACO. An analysis of our clinical and insurance claims data identified Emergency Department (ED) visits among members with Mental Illness (MI), hypertension, and diabetes as the significant health concerns within our member population. When disaggregated by Race, Ethnicity, and Language (REL), the data revealed a disproportionate representation of Hispanic members among those with MI visiting the ED. Additionally, our Black members showed disproportionately poor outcomes for hypertension while members without self-reported race data had poor outcomes for diabetes. 

Due to the unavailability of reliable Disability and Sexual Orientation and Gender Identity (D/SOGI) data, we could not disaggregate data by these demographics. Therefore, our primary focus for the next four years will center on addressing inequities related to race and ethnicity. We plan to address D/SOGI disparities after three years of intensive data collection. 

Our strategic goals for the next four years are as follows: 

  • Goal 1: By the end of 2024, we will increase the percentage of ACO attributed Black members 18-64 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<140/90 mm Hg) during the measurement year by 2% and by an additional 2% every year until 2027. 
  • Goal 2: By the end of 2024, we will reduce the percentage of ACO attributed members 18–64 years of age with diabetes, who did not provide a valid self-reported race response and whose hemoglobin A1c (HbA1c) level was poorly controlled (>9.0%) by 2% and by an additional 2% every year until 2027. 
  • Goal 3: By the end of 2027, we will increase the percentage of emergency department (ED) visits for members 6 to 64 years of age with a principal diagnosis of mental illness or intentional self-harm, who had a follow-up visit for mental illness within 7 days of the ED visit by 10%. (This goal will be part of our QHEIP Performance Improvement Plan, which is still in development.) 

We offer various avenues for community members to provide input to our health equity efforts. Primarily, we engage our members through focus group discussions and key informant interviews to gain insights into their experiences with our healthcare services. Additionally, we seek input from our community members through their active participation in governance committees, including the Patient and Family Advisory Committee (PFAC) and the Health Equity Committee. Through these multiple levels of engagement with our members, we ensure that our efforts are shaped by a rich tapestry of diverse community perspectives.