Firm 1

Vice President who reported to Chief Medical Officer (CMO).

Lead was responsible for strategic guidance on policy and had a high-profile position that often involved public speaking.

Collaborative activity was reported to a leadership workgroup involving medical, data, and disease management leadership.

None, but recent reorganization brought disparities more clearly within the medical leadership of the organization.

Firm 2

Senior staffer who reported to Chief Executive Officer (CEO).

Supported by staff with firm-wide responsibilities for work related to Collaborative interests such as data collection, medical management, and communications.

As part of routine daily communication to CEO.  Broader communications on the Collaborative appeared to occur as needed through firm-wide structures established to support the overall "enterprise initiative" in this area.

Firm Task Force on Racial and Ethnic Disparities was co-chaired by the CEO and Collaborative lead.  External Advisory Board (preceded Collaborative's formation).

Firm 3

Vice President who reported to Executive Vice President and Chief Marketing Officer.

Lead coordinated closely with staff across firm.

Reported to the Taskforce monthly.

Cross-Cultural Care and Services Taskforce co-chaired by Collaborative lead and a physician, and charged with examining what is needed across the organization to reduce disparities.

Firm 4

Lead reported to the CMO and headed the clinical quality management area.

Lead worked with  staff on geocoding analyses and developing interventions.

Lead reported to a person who was on the executive team for the organization that included key leaders and was the focus for day-to-day management.

None known.

Firm 5

Medical Director who reported to the CMO; served as interface between clinical and administrative side.

Lead coordinated closely with staff across firm.

CMO approved decisions relating to the Collaborative; selected other executives involved as appropriate. Senior executive leadership was briefed in hour-long time slots periodically as is the Quality Management Council and Clinical Quality Committee.

Disparities/class committee created under Quality Management Council.  CEO charged senior managers to come up with a comprehensive plan on disparities reduction that could be presented to the Board of Directors by the end of 2006. (A report to be Board was approved in September 2006.)

Firm 6

Internal staff consultant responsible for external and internal work on quality improvement, reported to the VP for clinical quality programs and informally to medical and network leadership.

Task-specific teams met to work on specific areas (e.g., geocoding and HEDIS) and reported to the executive lead team.

Reported to the Medical Director team charged with overseeing the Collaborative. Information also shared with the executive lead team that meets 2-4 times per year and includes five key executives involved in medical affairs, quality, customer service, human resources, and information services.

One focus of firm's nonprofit foundation was reducing disparities.

Firm 7

Clinical Director reported to the firm's lead for care management and for community efforts.

Lead's position provided linkages to quality leadership and the focus for the broader social commitment of the organization.

Lead reported to two senior executives who report directly to the CEO.

Disparities workgroup of senior leaders from throughout the organization meets regularly.  (Preceded the Collaborative.) 

Firm 8

Senior Vice President who reported to the CEO.

Day-to-day responsibility delegated to the medical director of a large affiliated plan.

Lead was briefed periodically about the Collaborative.  Lead, in turn, reported to the CEO and other executives.  Lead also reported to the Board on cultural competency, which they viewed as part of the Collaborative.

Firm had several support mechanisms in place, including a cultural competency institute.

Firm 9

Field Medical Director who reported to the top two medical leaders in the company.

Lead's position was responsible for coordinating care management across the organization.

Routine reporting to both medical directors and said to be shared among top leadership.

None, but strong research arm (now disbanded) has historically created capacity for analyzing geocoded data and disparities.