Q&A: Violet CEO on measuring clinician inclusiveness: ‘It’s almost like a credit score’

PHOENIX, Ariz. — Gaurang Choksi is the founder and CEO of Violet, a health equity platform that aims to standardize and increase cultural competence among clinicians. The New York-based startup provides inclusivity training for clinicians in order to help promote identity-centered health care, particularly for patients who typically face greater barriers to receiving quality care because of their race, ethnic or gender identity.

Violet, which was founded in 2020, is offered to more than 30,000 clinicians and has about 10,000 clinicians actively using its platform, according to Choksi. Their clients include Headway, a mental health startup that connects patients with therapists; Northwell Health (also an investor), New York state’s largest health care provider; Galileo, a telehealth and primary care startup; and Eden Health, which provides virtual care services to employers.

Choski spoke in November at the “Going Digital Health’s Behavioral Health Tech Conference” about the importance of driving inclusive behavioral care. After his session, Choksi sat down for a chat with STAT to talk about how his company leverages digital health tools like courses and profile badges to tackle challenges of equity and access within behavioral health.  The conversation has been edited for clarity and length.

So to begin, tell me about yourself.

I always start with lived experiences. I’m Gaurang. I grew up in India until the age of ten. Starting at the age of ten, I was a translator for my parents. And I’m a gay man.

So whether it was growing up on Medicaid, being a gay man, trying to work through the health care system and being a translator as a child, I had a lot of experiences where health care just was broken. That really shaped my desire to build health equity. And then professionally, I built a health plan called Oscar. And at Oscar, people would call in all the time and say, ‘I want a clinician that shares my identity.’ The truth is we don’t have that data and we know even if we have the data, there aren’t enough diverse clinicians. And so that’s where the idea for Violet came from.

Why do you think people were asking for that?

Oh, I know why. As a gay man, I’ve gone out of my way to find clinicians that are also gay because it allows people to feel safe and ask the questions that are hard to ask. As a gay man, it’s extremely difficult to talk about your sexual orientation with somebody if you don’t know how they’re going to react. And so people look for shared lived experiences to feel safe. But the reality is that everyday humans don’t know how not diverse our clinical workforce is.

So what is Violet? What is it you all do and why?

Violet is the first-ever credential for culturally competent care. We look at inclusive health care as a hard skill. It’s a skill that we can measure, and by measuring it, we can actually invest in upskilling clinicians and then in recognizing clinicians.

The core secret sauce of Violet is the way we do the measurement of how inclusive clinicians are. It’s almost like a credit score. So for every provider, we look at all of their experiences and interests. We look at what communities they’ve worked with, what communities they’ve studied about, what communities they want to work more with, what communities their family and them belong to and more. And then using all this data, we can show them in real time how they’re doing compared to all their peers in that specialty.

So does a provider or a physician or someone, do they come to you and say, Hey, I want to get my inclusivity credit score? Is that how that works?

Yes, it’s literally badges and it’s by a community level. And so someone could be phenomenal working with, let’s say, gender identity. But they have a lot of room for growth working with sexual orientation

or working with Black and Brown communities.

At Violet we use claims data for every provider in America. We already have a baseline of what communities all providers have worked with. Then when a clinician joins our platform, they can actually see how they’re doing and they can invest in upskilling themselves. It’s like Netflix, but for population health and inclusive health care.

And what is the score out of it? Out of 100? Is it like five stars?

Great question. Right now it’s three different levels of Violet benchmarks, but there is culturally aware, culturally proficient and culturally excellent. But really what we’re doing is recognizing the top 50% of clinicians in a given specialty for the ones that have the most experience working with a specific community in that specialty.

You offer courses as well? How does that work? Does a clinician take a course in, say Black health equity, and then once they complete it they’re now culturally competent in treating Black patients? Is that how it works?

Conceptually, yes, but it’s not that easy. You know, one thing we’re very cognizant of is this isn’t a virtue signal. This isn’t greenwashing health care. It takes a lot of effort to actually earn a badge. And so the way it works is for every provider in that specialty, they’re constantly being compared to all of the providers in that specialty for that community. So if you’re a psychiatrist and we see that, let’s say you have a little bit of experience working with gender identity specifically, what we’ll actually show you in real time it’s an accumulator that says, hey, you’re 10% inclusive compared to all 55,000 psychiatrists. And now it may require them to do 20 hours of training. But the trainings are quite nuanced. They’re about unique disparities.

Where does this badge live? Is it on a clinician’s LinkedIn profile or is it on their personal medical website? Do you walk into their clinic and it’s similar to what you see on the outsides of restaurants? It’s like a B-rating or an A-rating, or something that says, ‘Here we’re culturally competent in treating gay Indian men?’

Our goal is all of the above. The truth is, for us to build health equity, we need to normalize and celebrate clinicians investing in delivering quality, inclusive health care. Right now we’re a pretty young company. So the way our badges work is we have an API and people can buy access to that. So we partner with health plans so that in their directory they could personalize it. Across all of these organizations they’re able to not only know how well their team is doing, they invest in the team’s growth and then they show that to the world, specifically diverse patients that they’re serving.

How do patients come across Violet? Are they literally Googling, ‘I’m looking for a doctor who could work with a Black guy on mental health?’ And then Violet pops up saying, ‘Sure, here’s this clinician who has this Violet score?’

I have a lot of strong opinions on this question. I think in America, we’ve put too much of the burden of navigating our health care system on patients. I grew up helping my parents move to the health care system as non-English speakers. And being a translator at the age of 11 is extremely painful and frustrating because the burden fell on my family and me to figure out who to work with. So at Violet, the way we work is once a clinician or a provider has earned those badges, anybody, any directory, any health plan can buy it. And the vision is every health plan, every ZocDoc like company in the world, they should have a dropdown that says ‘What communities do you want your doctor to be trained with?’ And it will say “verified by Violet” and patients will know that that clinician is trained and recognized by a third party.

How many badges do you currently have?

We have three. We have one focused on the BIPOC communities. We have one focused on LGBTQ communities for sexual orientation and then one focused on the Transgender and Gender Nonconforming communities. I am proud to say that we’re actively contracting with one of the three biggest health plans in the country. And in our contract, we are committing to building a match for veterans and for the Neurodivergent community. But BIPOC is a very large set of communities. So the goal is that we keep getting more and more granular to the point where all of us can actually find somebody that’s inclusive of all of our identities.

Any last aspects about Violet that we didn’t touch upon?

We’re just getting started. What I really believe is that in our country we badly need a health equity system of record. And we need to normalize the concept of ongoing learning for clinicians to keep learning about how culture is changing and how health care disparities are changing.

Is that what you see you’re building at Violet? That system of record for health equity?

Exactly.