Trust Is the Real Infrastructure: A Conversation with the CEO of Civitas

Gregg Church: Welcome back. We're live here at Civitas 2026 and I have the unique opportunity to sit down with Jolie Ritzo and she is the CEO of Civitas. And Jolie, first of all, tell us a little bit about yourself.

Jolie Ritzo: Sure, absolutely. First, thank you for having me. This is a treat and congratulations on launching a podcast. So yes, my name is Jolie Ritzo. I am the CEO of Civitas Networks for Health.

And I stepped into this role about a year ago, but I was a part of the leadership team that helped to form Civitas back in 2021, where we brought together two national networks with a goal of bringing those who are moving and making data, health data interoperable and more usable. To those who then can take that data into action in community and hopefully make an impact on improving health.

My background, you know, my undergraduate's community health, I have a master's in public health. I previously worked for an integrated health system that had both nine delivery sites and also health plan options. So I worked in the health management department. I was helping them at that time to build their chronic care programs.

And that was back in 2011, and we were we're just starting to talk more about social drivers of health and the need for community partnerships and having data insights that went beyond sort of clinical settings. So I led a team of health coaches, case managers, and others. And it was really amazing because that was right around the same time where we also started to get access to HealthInfoNet, which is the HIE in Maine, that was in the Portland, Maine area, and the ability to have the sort of combination of real time data at the point of care while also accessing claims data was was a game changer for us. And I know obviously this is continuing to evolve. It's an area I'm very passionate about.

I grew up in the in a very rural community in Maine. The reason I feel like I ever went the direction of community health and public health was because of those sort of the rural upbringings. So personally delighted that we're seeing an emphasis currently on addressing the rural health crisis in our country. But that's a little bit about me. I mean otherwise outside of that I have two kids. I I live in the Portland, Maine area, I'm an outdoor enthusiast, so

Gregg Church: All right. Well let's jump in. So Jolie, you have a unique view across HIEs, health data utilities, community information exchanges, public health organizations and other organizations across the country. When you hear the phrase dirty data, what does that mean to you and what are your members seeing on the ground?

Jolie Ritzo: Well first of all when I hear it it you know immediately I think what a bummer. You know it doesn't sound like it's going to be very usable and and I think it sounds like we need to work on it to make it you know less of a mess. And that's really what the Civitas members are doing in many cases. So you've already acknowledged that we represent HIEs, we have CIEs, we have APCDs and other health data organizations.

And you know, the from where we were, you know, back in 2010 to where we are now in 2026, we've we've made some significant progress. It's not perfect. But basically that's you know data at a point where it it needs standards, it needs normalization, it needs to be sort of cleaned up, we need to be able to, you know, match the patient's information and get it to a place where then you can you can actually do something with it.

Gregg Church: So in and I'll just kind of follow up with do you think dirty data is primarily a technology problem or is it really a people governance and trust problem?

Jolie Ritzo: Yeah. You know, I it's kind of I wanna I think it's kind of a both problem. You know, and and probably, you know, part of it is you do have to in my mind before you're gonna start moving data, you do have to solve for sort of your your governance and you have to understand in terms of like where you're situated in the country and what privacy and security regul regulations you're up against. You also then have to make sure you have the right people around the table to provide the right level of oversight.

Typically there's it starts with a need in a community for more information. And at that point, you know, HIEs and CIEs, others who are in the business of helping to make the data available, they you know, I think they want to do that, but it it it can be sort of clunky initially or the with the way in which the data is received is a bit messy. So I feel like we hear it a lot where it's like you're, you know, a provider's looking for the needle in the haystack but they have to truly like go through the haystack. So I think that is it presents an issue.

Technology can help solve for that. I mean at this point with uses of AI and other things, I mean we're getting, I think, much more precise about finding the data element that's going to actually be usable. But I so it so I don't know that it's one or the other. I feel like it's it's a bit of both, but I think before you can deploy technology you do have to have governance and oversight in place.

Gregg Church: That's very good. So we talk about creating a nationwide healthcare data ecosystem, but healthcare is ultimately delivered in communities. How do we make national interoperability work without losing the local relationships and trust that actually make data useful?

Jolie Ritzo: Yeah. I think so I I was just downstairs moderating a panel on HITECH and we were talking about kind of just that where in some cases we are making progress, in other cases we still have again it kinda came into the space of behavioral health or rural health providers, you know, those who are practicing more in social care spaces, community based organizations, how do we make sure they don't get lost in this? 'Cause in some ways they've we've already kind of left them behind and so h how do you continue to kind of maintain the forward progress and one of the things I think that has to be so is that going back to governance is to make sure that you're sort of increasing who is around the table so that you can better understand well how and why are we going to use that information for what purpose and what are the barriers to being able to do that.

And I think you know it's just one of those it it it is it's it's challenging because I know so in Maine, I am president of a nonprofit board, Crossroads for Women. They provide behavioral health and SUD treatment services through recovery.

But they just like within the last two years got Kipu, which is essentially like a EHR for behavioral health providers, and they're just starting to make some connections that again I was like, really? Like yeah, I was so surprised that that was where they were. Because obviously in in the healthcare space we've moved further with EHR adoption and the ability to sort of make data move much more fluidly.

Gregg Church: I think what you're saying and maybe the next question will help that is are we sometimes trying to solve nationally what really has to be solved locally first?

Jolie Ritzo: Yes. And and I think it's it's interesting because you have to like each community knows best what their needs are and they and in a way kind of like the data that's available, right? And and so I do believe that happens locally and there's a fair bit that has to happen around trusted exchange from a governance perspective because you know, for the HIEs or CIEs that are working within a set geography, they are confined to the regulations and the rules of the road there.

But it's also insufficient to think that it's going to stop there because really very few places or people are just moving data kind of in one locality. And so we have to also be able to meet the need for national exchange and scaling sort of some of those use cases that support overall sort of broader people. So,

Gregg Church: Let's talk a little bit more about the trust side. You've you've talked about it recently. We tend to think that if we create the right standards, APIs, infrastructure, organizational exchange data, but can you actually have meaningful interoperability without trust?

Jolie Ritzo: I don't think so. I yeah. I it I mean it it feels to me that it I think meaningful is the key word there. You know, you can have it be interoperable for a time, but without trust that process will likely erode, something will go wrong. Because as we always say, like this this is not a technology problem and if it was just that then we would have things, you know, we'd be much further along. So so my guess is no.

Gregg Church: Yeah, I think that's I love that answer because I think without trusted relationships then you don't actually get to what you're trying to achieve which is clean data.

Jolie Ritzo: Right. So right. And I just to go a little further with that, like, it it comes down to like because I I think we throw around the concept of trusted relationships quite a bit. But it it genuinely like it it actually means that somebody from you know a CIE or an HIE is gonna go directly to that provider organization, that health system, that FQHC, that community based organization, they're gonna sit down and figure out like where's the breakdown in the workflow, what are the actual data elements you're looking for? Like how could we actually solve the problem, like your big sort of issue? And then and then you know don't don't do it all at once. Like tackle one thing at a time and and sort of deliver on what you set out to do and then build from that.

Gregg Church: I love that. And I feel like that's the thing when we're talking about trust, like it's truly like you know, five people sitting around a table talking about how that's actually going to make a difference.

So we keep expanding what we mean by health data. We're no longer just talking about diagnoses, labs, and medications. We're talking about behavior health. You mentioned that before. Housing, food insecurity, transportation, and other social factors. Does whole person care fundamentally change what we have to think about as good data?

Jolie Ritzo: One hundred percent. I mean th there's no way to think about whole person care without sort of expanding the data set. We have more than enough data, right? Again it comes back to how do you stitch it together, how do you make sure it's appropriate for you to be using it and moving it and all of that.

But I I d there's just I mean we are so far beyond kind of knowing that like most of what keeps somebody well is outside the realm of health care. So we d absolutely need social care, behavioral health, like public health and and other data sources, demographic data, to be able to sort of have that much more like just a a much sort of clearer picture of where somebody currently is at and then also I mean if you have the the actual longitudinal record where you can look back and on kind of where they've been and and I that also now gives you the opportunity to start to have some real insights and potentially where they're going.

Gregg Church: So I guess the question is how do we bring clinical and community data together without losing context or trust?

Jolie Ritzo: Yeah. I mean I think you start with things like community co-design. Y you you don't force a solution on a community without starting to understand what's the actual problem at ha hand, what are you trying to solve? And if you're gonna use data, you know, in in various ways, whoever that sort of most impacts needs to be represented. And I think, you know, sometimes there's a desire because there's policy pressure or there's market forces to move fast and things get missed and that's when the solution does not stick, it can cause harm. So you have to sort of go slow to go fast initially, right?

Gregg Church: Slow to go fast. Yeah. So we're hearing more about health data utilities as part of the next generation of health information or I'm sorry, health information infrastructure. For executives who haven't followed this closely, what is an HDU and what problems are we trying to solve that traditional approaches haven't solved?

Jolie Ritzo: So in in HDU we're starting to really think about you know all of this honestly as critical infrastructure for health. A health data utility builds on HIE infrastructure, so you don't necessarily want to just start from scratch. It's important that the HDU is either nonprofit or state-led entity. And then from there it's sort of as I've already been talking a lot about governance, like that that sort of inclusive community governance is critically important. It's based off of public-private partners supporting the direction.

There's some I would say baseline use cases that are necessary. So partnerships with Medicaid, public health, social care, the ability to support the transition to value-based care as kind of baseline. And because it's really the the goal of going far beyond clinical data exchange and it's also going beyond just exchange. It's layering on sort of value-added services, having the ability to look at additional insights and analytics. And so it's it's a, I would say, an evolved model, but it does start from HIE bones.

And if you want to learn more about health data utility, I think the Consortium for State and Regional Interoperability, CSRI, they are Civitas partners. They've been working on an HDU capability model. We partner really closely with them on that because Civitas represents 68 of the nonprofit state-led HIEs in the country. So we have the ability to kind of bring the mass together, but they're going deeper on their model and really sort of testing it currently with some of the HIEs to say, do we have the excuse me, capabilities to meet certain use cases?

Gregg Church: Mm-hmm. So could health data utilities become part of the infrastructure for making sure we're not not just moving data, but we're moving better data?

Jolie Ritzo: Absolutely. Yeah. I mean that's that's I think they they have to be able to produce a level of data quality and have sophistication around patient matching and you know, data normalization, data quality, supporting interoperability and in much more sort of more sophisticated ways.

Gregg Church: So we had a little AI come up in the conversation. So it you know, everyone's racing toward AI. Yeah. But AI requires enormous amounts of data and ultimately asks us to trust what the technology tells us. What happens when we combine AI with healthcare data that communities, patients, clinicians may not completely trust in their first place?

Jolie Ritzo: I mean that's a great question because I mean it it presents potential problem and that's where you really do want to make sure it's quality data that is feeding the AI algorithms and and you know allowing it to learn because AI learns in sort of like where it exists and so if it is not quality data that could be potentially very problematic. We don't want health data in particular to either reinforce or make worse health inequities that already exist and that could absolutely happen without careful oversight.

Gregg Church: So what what worries you more? AI making a mistake because of bad data or people trusting an AI generated answer without understanding the quality of the data behind it?

Jolie Ritzo: I I sort of feel like th the second option I guess but you know I mean they're both concerning. And I think the like the whole trusting piece is, you know not everybody I guess is as maybe curious as they need to be or sort of questioning it like but can it, is that actually true? And so we have to be able to have sort of quick ways to audit the information to check against whether people are interacting with something that is accurate or not. There has to absolutely be those quality checks and the oversight is critical.

But well I mean in many cases we've already deployed AI, right? Like we're all looking at AI a all the time. And and and it's interesting 'cause you can. This is a outside of healthcare funny example. So my mom loves to like dream build and she was talking about an addition she wanted to do on her house and I was like, well let's just throw these pictures in in AI and let's just tell it to put the addition on so we just get a visual of what this would look like.

The first couple were pretty good. They weren't quite right. I asked it to do one more thing with the roof line and it went wacky. Like it was it was like upside down and you know, and so right. And so if I was just like, that looks good, and didn't question what happened, obviously that's an extreme example, but but there are things where like it could give you not totally the right information if you're not asking the right questions. And that's just sort of in the like LLMs. Obviously it's the higher stakes when we get into agentic AI.

Gregg Church: So we've talked about the dirty data side. Let's flip it around. You have visibility into organizations doing this work across the country. When you see healthcare data being done right, what do those organizations or communities have in common?

Jolie Ritzo: Well, I mean first and foremost they you know patients are gaining access to their data, which means both they have their information at the ready when they want it, but they also are able to share it. And then that gets integrated into their record and it can be used at whatever point they need care, real time, so that whoever is providing that care has the insights they need to know exactly what that person needs in that moment so that they can be well.

Gregg Church: So, if a if a healthcare CEO listening to us believes their organization has a data problem, where should they start? With technology, standards, governance, people or relationships?

Jolie Ritzo: I mean the reality is they should probably look at all of that and and it's if they think they have a problem, it's probably a really great opportunity for an analysis and evaluation to understand where the pain points are. Most of the time like I I it could honestly it could be a matter of like it could be the tech isn't right for them, but you know, I I would say you actually have to kind of check all of those things to first understand where's the issue.

Gregg Church: Yeah. So I have kind of my signature question real quick. Finish the sentence for me. Healthcare finally gets data right when?

Jolie Ritzo: Healthcare finally gets data right when anybody can go to get the services they need and they feel extremely well cared for. Their information is at the ready for their provider and they also are then very quickly able to access whatever they need or pick up their prescription that they need at the pharmacy. You know, and and it all falls into place.

Gregg Church: Well here's a fun question, our last question. You spend a lot of time bringing organizations with very different priorities to the same table. What's harder? Getting healthcare organizations agree on how to share data or getting a group of people agree on where to go for dinner?

Jolie Ritzo: Well, so it truth be known, I'm gonna say I'm gonna it's the first one. But I also I have to say this with sort of I so I listen to a lot of people that have to do that. The reality is I actually don't lead an organization that has to get people to share their data. But I do lead a lot of organizations that sort of we may try to encourage to move like in the same direction. And that has its challenges sometimes. With dinner, I think it's just easier to say where you're going.

Gregg Church: I agree. All right. Well we're here with Jolie. She's been just a wonderful guest to have today, and thank you for joining us.

Jolie Ritzo: Congrats on the podcast and delighted to join you. This was

Gregg Church: Congrats on a great conference.

Jolie Ritzo: Thank you so much. Oh my gosh, biggest one yet, and just like the attendee list, all the right people are here and the conversations are fantastic and thank you for being a part of it.

Gregg Church: Thank you.

Transcript lightly edited for readability.