Kathy Colville is Director of Healthy Communities for Cone Health. A $1.8 billion enterprise, it is one of North Carolina’s largest and most comprehensive health networks, serving communities in more than 100 locations, including six hospitals, 95 physician practice sites, and multiple centers of excellence. In this role, Kathy leads Cone Health’s efforts to improve access to care and health outcomes for those most vulnerable to health inequities. I recently spoke with her about some of the challenges she faces as a champion for health systems change.
When I started in 2014, my role was limited; it felt like we needed someone to lead our community health needs assessment (CHNA) and to serve on boards. But as we’ve moved from addressing volume to creating value in health care, my role has shifted. Now, I work at the intersection of health care, public health, and human services.
I’m always thinking about access to care. So meeting with a free clinic or looking at our charity care policy or working with a community partnership is an everyday thing. But there’s also advocacy work where I partner with others within and outside the system. We talk about housing quality. We’ve worked with our city government to get sidewalks built in neighborhoods where our safety net clinics are located. And we’re working on healthy food access. Sometimes we’re just creating connections, and sometimes we’re building things together.
Almost everyone in the health system has a set of outcomes they can measure that show whether they’re making a difference. But in public health, we have so few metrics that are timely and relevant at a geographic level granular enough to be meaningful. This affects our ability to monitor continuous improvement and secure resources.
People agree in principle that we should focus on the social determinants of health (SDOH), but we still need to figure out what interventions have a measurable impact on health and our role in addressing them. So that’s a big question: how do health systems address community health in a way that, rather than forcing them to be something they’re not, collaborates with public health and human services?
Right now, we’re managing two paths. The fee-for-service path rewards us for treating people who are sick. The value-based care path rewards us for keeping people healthy. Our health care systems were built to respond to illness, not to manage and prevent chronic diseases. Health care solved the killers of the past, but the killers of today require different responses. We haven’t figured out how to build that system yet.
I think the structural world of low wages and poverty and racism are formidable challenges, even for the most well-funded grant programs. The idea that it’s now all figured out, and that there are rainbows and unicorns in Cottage Grove isn’t true. But that doesn’t mean things haven’t changed. It’s been a gift to be part of a process that understood that residents are the people who change their community—and then to align resources to foster their leadership. It’s not token resident engagement; it’s a new way of working that we outside service providers have learned as a part of our own evolution.
Lately, I’ve been trying to figure out how the health system can become a better partner by facilitating data sharing and advocating for things like minimum housing standards. As an anchor institution, we have the ability and the responsibility to use our power and privilege to improve residents’ health on their own terms.
These days I know so much more about the gap this work fills in health care providers’ lives. People who have delivered health care in the traditional way for so long just light up when they talk about the potential of community-centered health. It’s demoralizing for many providers to feel like they’re sending their patients into dangerous, unhealthy conditions when they’re discharged. Some healing has to happen through healthy food, homes, and community environments. This just feels like the right thing to do. We’re still focused on repairing hearts, delivering babies, and orthopedic surgeries, but now the stated purpose of Cone Health is to connect health care and wellbeing. We’re a huge organization and change happens slowly, but our leadership is committed to this work and understands that it’s generational.