The Exec: Providence’s Timshel Tarbet Is In The Room Where It Happens

How her C-suite roles intersect to benefit Providence Health Plan and what other plans can learn from her love of Hamilton.

“I love Hamilton! Especially “The Room Where It Happens.”

In her exclusive interview with HealthLeaders, Timshel Tarbet—Providence Health Plan Chief Healthcare Experience & Equity Officer—shared her love of Lin-Manuel Miranda’s transformational musical and that song in particular.

“The Room Where It Happens” recounts Aaron Burr’s decision to run for office after being excluded from key decisions by American architects Alexander Hamilton, Thomas Jefferson, and James Madison.

As for Tarbet, there isn’t a room at PHP she’s been excluded from. Why? The unique intersection of her executive roles, the unique benefits that affords, and Tarbet’s unique ability to deliver ROI.

A unique approach to equity and experience

No one really knows how the parties get to "Yes"
The pieces that are sacrificed in every game of chess
We just assume that it happens
But no else is in the room where it happens — Hamilton

Tarbet’s roles as Chief Equity Officer and Chief Experience Officer are embedded in health plan senior leadership functions.

“That is one of the reasons why I was so excited to come to Providence,” says Tarbet. “In my role, I am part of the Executive Leadership Team. I am in the room where it's happening. As we're setting the strategy, my voice is at that table all the time. It's not that I get invited to present and then leave. That’s what happens with a lot with diversity roles.”

Another difference? “Most times you see either Chief Health Equity Officer or internal DEI officer. But you can't do those things in silos. I'm able to blend the two, to find ways to empower the voices of our internal caregivers and our members and ensure all of those voices are coming through.”

The centrality of her role and its application to internal and external stakeholders isn’t the only thing that’s unique. Tarbet’s hire in June 2023 marked the creation of the equity officer role at PHP. Less than six months later, there was another first: the expansion of Tarbet’s role to include Chief Healthcare Experience Officer.

How claims can benefit from equity-experience intersections

This unique intersection of C-suite roles is delivering unique benefits that other health plans can learn from, particularly those in payvider organizations. Providence Health Plan includes members in Oregon and Washington and is integrated with Providence Health System, which serves patients in those states and five more.

About these intersections, Tarbet notes: “It provides an environment where you start to get a different level of engagement, where you hear and come up with ideas that you never might have thought about otherwise.”

One of those ideas is how bias can make its way into patient claims coding.

"A trainer for our claims teams came to me with some new ways to address health equity and implicit bias—not just in how we're training our internal caregivers but how we're processing our members' claims. This includes things I never would have thought about.”

This is another benefit of her equity-experience roles and how they intersect at PHP.

“If I was only doing internal DEI work and not customer experience, I might not have guessed at the claims portion in addressing health equity, maternal and mental health, getting your flu shot and colonoscopy. The intersection allows for different types of conversations.”

Sub: “I watched him code me”

No one really knows how the game is played
The art of the trade
How the sausage gets made
We just assume that it happens
But no one else is in the room where it happens — Hamilton

Tarbet has a personal story of implicit bias in claims coding.

“I'll use me as an example, as a Black woman and as a veteran with PTSD. I've also had five knee surgeries, which can involve associated codes for potential issues like mental health disorders. Using a mental health code for one individual versus another is really going to change how you look at the claim.”

The executive adds: “When I got my hip replaced, I also worked with a cardiologist who asked me: ‘Are you just trying to get pain meds?’ I said no, but I watched him code me as being at risk for dependence on opioids. I can’t even take them; they make me physically ill. The only reason I can think that he did that is because I was a Black woman. I asked him why he did that and he responded, ‘It's just something I need to do.’"

Tarbet’s example illustrates how the healthcare sausage has historically been made. That changed with an emerging pandemic and a long-standing reality: that people of color experience poorer healthcare outcomes and that 80% of all outcomes are based on non-clinical factors (social drivers of health). Claims coding is just one area that needs improvement for the industry to achieve health equity.

“Are we taking a step back and asking if we’re making an assumption in what we enter? If we're not, are we able to see the trends that could continue to perpetuate implicit bias that we didn't even realize?” Tarbet asks.

Referring again to her own experience, she adds: “I think it's important to tell these stories, to realize that this happens.”

The equity-experience intersection: Two added benefits

Tarbet notes two other areas that benefit from equity-experience integration at PHP: provider credentialing and patient data.

“If you start to peel back the onion, you have to ask: What are the outcomes for, say, a trans woman compared to a cisgender woman? How do we start to work with our providers on this?”

Tarbet adds: “I think all of this is incredibly important when we think about equity and my expanded role now in member experience. How are we able to advocate for patients, to look at care holistically with the equity overlay and ensure we're driving quality underneath?”

Another overlay area is data, including how to:

• capture as much as possible
• look for outliers
• track trends at the population level
• stratify by diversity factors
• analyze with potential bias in mind

“This is the only way we’ll see impactful, meaningful change,” says Tarbet.

Providence Health Plan’s equity-experience strategy

I’ve got to be in the room (the room where it happens)
I gotta be, I gotta be, gotta be (the room where it happens)
In the room (I wanna be in the room where it happens)

The rooms where Tarbet operates include PHP strategy and her equity and experience objectives for 2024 and beyond. These include:

strengthening the stakeholder value chain

advancing maternal health and HbA1c outcomes

improving Medicare Star ratings, especially consumer-reported metrics

Tarbet is looking for ROI on these and other clinical areas through Providence’s payvider integration and its partnerships — with PHP’s brokers, workforce, and the community at large.

“We need to be willing to work with our partners in ways we might not have in the past — to find unique and innovative ways, driven by data, that solve for root cause and not just the symptoms.”

For Tarbet, all roads connect to the member journey.

“When I first started [at Providence], I would ask questions like, ‘How many members does this affect? What is the membership breakdown?’” says Tarbet. “Now I'll go into the meeting, and they start the conversation that way. I want to drive people to think about these things because I'm not always going to be in the room.”

Even when Tarbet isn’t in the room, her influence is.