The Client Challenge

As a large clinically integrated network (CIN) and accountable care organization (ACO), Southern New England Healthcare Organization (SoNE HEALTH) was looking to better engage with and deliver care to patients across numerous demographics and geographies. To that end, SoNE secured grant funding through the Institute for Healthcare Improvement (IHI) and Blue Cross Blue Shield Massachusetts (BCBSMA) to leverage digital technologies to improve health equity for targeted patient groups.

  • Overcoming barriers for patients who are sicker, experience more health inequities, and often face difficulties navigating the healthcare system.
  • Engaging patients across a wide range of diversity (e.g., geography, age, race, ethnicity, sexual orientation, gender, gender identity, varying ability, and language).
  • Coordinating care across distributed provider organizations and a wide variety of technologies.

Navigating to Next: The Solution

SoNE partnered with Chartis to develop an enterprise digital strategy to promote health equity. The goal was to implement digital infrastructure to improve patient engagement through their care journey, enable access to care through alternative care modalities, and enhance quality through better data collection and reporting stratified by clinical, social, and geographic data points.

Chartis evaluated SoNE’s digital capabilities, integrations, and operational pain points, and assessed the challenges of delivering equitable care across the wide array of patient populations. Chartis then held several visioning and design-thinking workshops with key stakeholders to identify 3 areas of opportunity—all of which integrated health equity components into the digital infrastructure: (1) deploy a proactive patient engagement platform and improve the network referral system; (2) develop 24/7 virtual triage and care-at-home capabilities; and (3) optimize population health management through actionable data reporting.

For each opportunity area, Chartis collaborated with SoNE to determine the projects and digital investment required, and developed a digital transformation roadmap that included sequencing, best practices, risks, and dependencies.

Navigating to Next: Key Components



data stratified by race, ethnicity, age, language, and disability (REALD), sexual orientation and gender identity (SOGI), socioeconomic status, and geography.



the population’s needs using collected data and assemble representative focus groups to shape requirements for digital solutions.



equity requirements in digital tools (e.g., data collection capabilities, accessibility, and customization for cultural sensitivity).



centralization of key activities and governance models before digitization occurs.



in people who support the organization’s health equity goals and in technology that enables greater data collection and enhanced interaction across providers and patients.



cultural humility into the organizational culture and across digital and non-digital patient touchpoints and products.

Client Impact

This digital strategy helped SoNE meet the first of 3 key outcomes: to increase data collection that supports patient stratification by clinical, social, and geographic data points. With this data, SoNE is developing new patient outreach campaigns (e.g., broadcast messaging, custom reminders, and pre-visit communications) that incorporate culturally competent language. In the next year, SoNE will transition these manual outreach efforts to an enterprise customer relationship management (CRM) platform that will automate this process, allowing SoNE to efficiently and proactively reach different patient demographics across multiple languages. These campaigns will also help SoNE meet its second and third desired outcomes: to increase primary care utilization and increase patient engagement designed to close gaps in care.

This digital strategy unifies key stakeholders and sets the foundation for further health equity work:

completed design workshops to develop a consistent, culturally sensitive consumer experience

175 K+

patients better served through a more integrated network

1700 +

providers given the tools they need to better manage medically complex patients

How We Are Making Healthcare Better

Chartis gave us the ability to not only meet our grant requirements but also to foster support across SoNE for our important work in health equity. ”

Renee Broadbent

Next Intelligence

Providers can meaningfully improve health equity through digital transformation by:
  • Integrating a culture of health equity across people, process, and technology.
  • Establishing a strong foundation of data collection and reporting practices. 
  • Using a people-centered approach shaped by culturally representative patient groups to envision the ideal future state.

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