Episodes
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Today’s guest is Susannah Fox, author of Rebel Health: A Field Guide to the Patient-Led Revolution in Medical Care. The book is a deep dive into the expert network of patients, survivors and caregivers who are charting a new path of innovation and research. It is for anyone who feels alone, forgotten or lost in the shadows of suffering as they navigate a new diagnosis. But, it’s also for anyone working inside healthcare who is fed up with the status quo.
We discuss:
How patients – like those first affected by long COVID - accelerate solutions by making invisible problems visible That data liberation is often the foundation for patient rebel movementsThe pop up peer groups forming in Amazon reviewsA framework for understanding, and embracing patient expertise: seekers, networkers, solvers and championsSusannah reminds all innovators to talk with people living with rare and life-changing diagnoses:
“If you are going to try to understand the intersection of healthcare and technology, you need to put down your clipboard – which is the classic status symbol of a survey researcher – and get out there and just talk to people. Talk to people especially who are dealing with rare and life-changing diagnoses, because those are the people who are going to use technology in ways that we can't even imagine.”
Relevant Links
Susannah’s book Rebel Health
Susannah’s blog: Wow! How? Health
Patient-Led Research Scorecards
An article about how patient-led research could speed up medical innovation
A story about Tidepool Loop receiving FDA clearance
OpenAPS and #WeAreNotWaiting
Hugo Campos’s TedX talk about not being able to access his cardiac device data
Graphic used by Sarah Riggare to show the time spent in self-care for Parkinson’s disease
About Our Guest
Susannah Fox is a health and technology strategist. Her book, Rebel Health: A Field Guide to the Patient-Led Revolution in Medical Care, was recently published by MIT Press. She is a former Chief Technology Officer for the U.S. Department of Health and Human Services during the Obama Administration, where she led an open data and innovation lab. Prior to federal service, she was the entrepreneur-in-residence at the Robert Wood Johnson Foundation. For 14 years she directed the health portfolio at the Pew Research Center’s Internet Project where she helped define a new market at the intersection of health, social media, and patient engagement. Fox currently serves on the board of directors of Cambia Health Solutions of Portland, OR, and Hive Networks of Cincinnati, OH. She is an advisor to Alladapt Immunotherapeutics, Archangels, Article 27, Atlas of Caregiving, Before Brands, Citizen, Equip Health, Faster Cures, and the Lemelson Center for the Study of Invention and Innovation at Smithsonian Institution. Fox is a...
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We'll be unpacking lessons from the COVID 19 pandemic for many years to come. Dr. Tomás Aragón, who leads public health for the State of California, joins us to discuss what he learned guiding America's most populous state through this challenging and disruptive period.
We discuss:
That public health’s deepest power lies in the ability to help diverse groups reach consensus under great uncertaintyHow California redeployed an army of census workers to support the COVID responseThe biggest opportunities to use AI for public healthThree great book recommendations: “How Emotions Are Made” by Lisa Feldman Barrett, “High Conflict” by Amanda Ripley and “Fifth Discipline” by Peter M. SengeDr. Aragón shared insights about leadership:
“The other thing is to really appreciate the importance of human psychology. It is so incredibly important … You're going to come up against people who are going to “resist”. I don't think of it as resistance. I just think they're being human. That's just all it is. People have variability in how they process information … And so rather than seeing things as resistance, you really just see it as part of the diversity of ingenuity that exists in an organizational culture.”
Relevant Links
Dr. Tomás Aragón’s UC Berkeley Public Health profile
Dr. Tomás Aragón’s GitHub blog
Article on Bay Area pandemic response: The epidemiology and surveillance response to pandemic influenza A (H1N1) among local health departments in the San Francisco Bay Area
“How Emotions Are Made” by Lisa Feldman Barrett
“High Conflict” by Amanda Ripley
“Fifth Discipline” by Peter M. Senge
About Our Guest
Dr. Tomás Aragón, MD, DrPH, has served as the director of the California Department of Public Health and the State Public Health Officer, since January 4, 2021. Prior to coming to CDPH, he was the health officer for the City and County of San Francisco and director of the public health division. Dr. Aragón has served in public health leadership roles for more than 20 years (communicable disease controller, deputy health officer, health officer, community health and chronic disease epidemiologist), including directing a public health emergency preparedness and response research and training center at the University of California, Berkeley School of Public Health.
Connect With Us
For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter @claudiawilliams and LinkedIn.
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Using AI in healthcare comes with a lot of promise - but access to data, lack of clarity about who will pay for these tools and the challenge of creating algorithms without bias are holding us back.
In 2023, TIME named Dr. Ziad Obermeyer one of the 100 most influential people working in AI. As a professor at UC Berkeley School of Public Health, and the co-founder of a non-profit and a startup in the AI healthcare space, his work centers on how to leverage AI to improve health and avoid racial bias.
We discuss:
The idea of a safe harbor for companies to discuss and resolve AI challengesHow his company Dandelion Health is helping solve the data log jam for AI product testingWhy academics need to spend time “on the shop floor”The simple framework for avoiding AI bias he shared in his recent testimony to the Senate Finance CommitteeZiad says without access to the right data, AI systems can’t offer equitable solutions:
“I think data is the biggest bottleneck to these things, and that bottleneck is even more binding in less well-resourced hospitals… When we look around and we see, ‘well, there are all these health algorithms that are in medical journals and people are publishing about them’. The majority of those things come from Palo Alto, Rochester, Minnesota [and] Boston. And, those patients are wonderful and they deserve to have algorithms trained on them and learning about them, but they are not representative of the rest of the country – let alone the rest of the world. And so, we have these huge disparities in the data from which algorithms are learning. And then those mirror the disparities and where algorithms can be applied.”
Relevant Links
Dr. Obermeyer’s profile at UC Berkeley School of Public Health
Ziad Obermeyer’s testimony to the Senate Finance Committee on how AI can help healthcare
More about Nightingale Open Science
More about Dandelion Health
Article on dissecting racial bias in algorithms
Article On the Inequity of Predicting A While Hoping for B. AER: P&P 2021 (with Sendhil Mullainathan)
About Our Guest
Dr. Ziad Obermeyer is the Blue Cross of California Distinguished Associate Professor of Health Policy and Management at UC Berkeley School of Public Health. His research uses machine learning to help doctors make better decisions, and help researchers make new discoveries—by ‘seeing’ the world the way algorithms do. His work on algorithmic racial bias has impacted how many organizations build and use algorithms, and how lawmakers and regulators hold AI accountable. He is a cofounder of Nightingale Open Science and Dandelion Health, a Chan Zuckerberg Biohub Investigator, a Faculty Research Fellow at the National Bureau of Economic Research, and was named one of the 100 most influential people in AI by TIME. Previously, he was...
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Black women in the US are 3-4 times more likely to die than white women from a pregnancy-related cause and overall the US has the highest rate of maternal mortality in the industrialized world. These deaths are preventable.
Dr. Monica McLemore, a Professor at the University of Washington School of Nursing, says we should stop blaming women for their own deaths and instead address the underlying social and healthcare drivers that impact pregnancy outcomes. In other words, we need to focus on the other 80.
We discuss:
The Momnibus, a comprehensive legislative package to improve maternal health in the US which has still not been passed into lawHow disruptive periods, such as the COVID-19 pandemic and Dobbs, provide opportunities to re-imagine maternal and child health in the USWhy community-centered research is essential for improving health equityMonica says we need to change our views on scientific evidence:
“There is no way we're going to get … changes in health outcomes at a population level if you don't bring the social and the clinical together, it's just not happening. And so that requires a change in mindset of the scientific community about what is evidence, who generates evidence, who can contribute to evidence, what evidence is needed and what methods are we going to use to obtain said evidence? Because community is over extraction. They are over participating in studies and not getting anything back. They are over funding science as taxpayers and not being able to access it.”
Relevant Links
CDC’s Report on Maternal Mortality
JAMA Articles on trends in maternal mortality:
https://edhub.ama-assn.org/jn-learning/audio-player/18796651https://jamanetwork.com/journals/jama/fullarticle/2806661?utm_source=podcast_platforms&utm_medium=referral&utm_campaign=related_article_linksSummary of JAMA webinar on maternal mortality
Op-Ed: How We Can Reimagine Black Maternal Health in the Changed Landscape of Dobbs
Centering the health of mothers
To Prevent Women from Dying in Childbirth First Stop Blaming Them
About Our Guest
Monica McLemore is a preeminent scholar of antiracist birth equity research, community-informed methods, and policy translation. Dr. McLemore is a Professor in the Department of Child, Family, and Population Health Nursing at the University of Washington School of Nursing. She earned a bachelor’s degree in Nursing from The College of New Jersey in 1993 after declaring at eight years old that she would become a nurse. She has a Master’s in Public Health from San Francisco State University and a PhD in Oncology Genomics at the University of California, San Francisco. She’s worked her entire career in reproductive health, rights, and justice. Monica retired from active...
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What is your just cause? Karen Dale is DC Market President for Amerihealth Caritas. She is a bold and fearless leader whose “Why” is to be a catalyst for change to promote equity and deeply support people encountering difficulties. In this episode she shares the leadership practices that support this work from sharing power, to community co-design and embracing disagreement on teams.
We discuss:
A powerful partnership with the Children’s Law CenterThe path to value-based payment for community organizationsThe future of public health education: providing the system, structure and culture that encourages every student to be a catalyst for positive changeHow DC is starting to address decades of under-investment in Wards 7 and 8 through its equity budget reviewKaren discusses the just cause for a school of public health in today’s world:
“It would be to create … a system, structure and culture that infuses what every student needs to be a catalyst for positive change for human beings … [A] school that creates that culture, gives people the tools, gives them the encouragement, gives them the freedom to try and fail, but learn and apply – that would be amazing. Because … we need a whole generation of people who are in the fight.”
Relevant Links
Karen’s commencement address to George Mason grads
NPR piece on partnership with Children’s Law Center
New payment approaches for EPSDT
Guidance for Health Care Entities Partnering with Community-Based Organizations: Addressing Health-Related Social Needs in Alternative Payment Models. [hcp-lan.org]
About Our Guest
Karen M. Dale is Market President for AmeriHealth Caritas District of Columbia, a mission-based Medicaid Managed Care Organization in Washington, D.C., and the Chief Diversity, Equity, and Inclusion Officer for the AmeriHealth Caritas Family of Companies. Her focus includes applying a health equity lens to impact all levels of policies, processes, decisions, laws, and outcomes for the communities AmeriHealth Caritas serves.
She also leads a decidedly metric-driven business approach to mobilize leaders and accelerate strategies to advance diversity, equity, and inclusion inside and outside the walls of AmeriHealth Caritas. As a result, opportunities for people to experience health, wholeness, and belonging are enhanced by addressing the social, economic, and environmental conditions that are drivers of poor health.
Her hobbies include gardening, creating healthy Caribbean recipes, traveling, and watching her son’s soccer games.
Connect With Us
For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter...
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We may be politically divided, but when it comes to healthcare there is actually a lot we agree on as a nation. We want healthcare that is affordable. We want a healthcare system that is easy to understand and navigate. We want to know we will receive good care when we need it most. These insights are something our guest Natalie Davis takes to heart in her work at United States of Care. She and her team are fighting hard to help create a more dependable healthcare system for diverse and underserved Americans.
We discuss:
Why we should never use the term “value-based care” ever again.Braidwood vs. Becerra: The court case that may eliminate free preventive services for half of all Americans.The double whammy of US healthcare: system failures and personal shame.How to nurture listening and belonging on a team.Natalie says before you start listening, you need to consider who is being failed by the healthcare system and prioritize hearing their stories:
“If we look at something like maternal health – which is a work that we're doing right now – if you look at the data, it is women of color, especially Black women who are left behind and facing a real failure of our system, which is causing morbidity and mortality. And so, for our organization, we are listening loudly to Black women and we are talking to people in communit[ies], we are talking in focus groups to really make sure we understand those issues. Because, if the people who are not served by this healthcare system are listened to and then served it will make the healthcare system function better for all of us.”
Relevant Links
United States of Care's website
United Solutions for Care
Patient-First Care (a.k.a. Value-Based Care) Messaging Findings
United States of Care Preventive Services Resource Hub
Insight Report from November 2023
The amicus brief United States of Care submitted on Braidwood vs. Becerra
About Our Guest
Natalie Davis has worked for nearly two decades shaping and implementing American health care policies to improve the lives of all people. In 2018, she and fellow national health care leader Andy Slavitt launched United States of Care to ensure that everyone in the country has access to quality, affordable health care regardless of health status, social need, or income. She is relentless in her person-centered approach to building health care solutions and has a history of building partnerships – with organizations, patient advocacy groups and everyday people – that work to create positive change in our country’s health care system. From 2010-2016, Natalie served at the Centers for Medicare and Medicaid Services, with the final two years as Senior Advisor to former CMS Administrator, Andy Slavitt. In 2017, Natalie served as the Director of Strategic Engagement at the Bipartisan Policy Center. A social entrepreneur, Natalie also helped found Town Hall Ventures and The Medicaid Transformation Project, both of which focus on bringing the best of innovation and care
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The modern world, and the products we use everyday, are making us sick. But what if we could shift this trend and start to build health into everyday life? That’s exactly what Steve Downs and Thomas Goetz, co-founders of Building H, are working on. Steve, the former CTO of the Robert Wood Johnson Foundation, joins us to discuss how Building H is helping companies and designers re-engineer products and “product environments” so they improve rather than harm health.
We discuss:
Shocking trends in American health: 48% of Americans are lonely, 35% dont get six hours a night of sleep and 60% of adult calories come from ultra-processed food.The mistake of thinking of our daily choices as “individual” decisions, when these decisions are profoundly shaped by our environments and the products we use.The Building H Index, which evaluates everyday products against five metrics of health: eating, physical activity, sleep, social connection, and spending time outdoors.Culdesac - A real-estate developer that is building “cities for people without cars”.Steve asks how we could broaden consumer product regulation to focus on broad health impacts, not just safety:
"McDonald's is not responsible for all the food related chronic illnesses in America. But you might argue that they are, I don't know, 1.7%, responsible or 3.8% responsible … I think we ultimately need to get to a place where if your product is leading to unhealthy behaviors, which is leading to illness and disease and cost, there may need to be some accountability for that."
Relevant Links
Building H website
Building H Index
AJHP paper on the product environment
Daniel Lieberman’s book on the history of the human body (no affiliate fee taken)
Culdesac website
HBS Impact-weighted accounts
International Foundation for Valuing Impact
ANNOUNCEMENT: Building H is seeking volunteers with a background in public health, healthcare or health policy to help build the Building H Index by rating products and services on their health impacts. If you’re interested in participating in a short scoring exercise, please go to this site for details and sign up https://www.buildingh.org/index/volunteer-signup
About Our Guest
Steve Downs works at Building H as a co-founder. Prior to his role at Building H, Steve was the chief technology and strategy officer at Robert Wood Johnson Foundation (RWJF) where he led a transformation of the Foundation’s practice of program strategy, putting in place an approach that is highly flexible and adaptive. Over his career at RWJF, Steve held a variety of management roles — including chief...
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Rural America is facing a healthcare crisis. Home to 60 million people, rural areas face a 23% higher mortality rate compared to urban locations due to lack of infrastructure, lower socio-economic status and provider shortages. Indeed, rural areas have half as many primary care providers and an eighth as many specialists as urban locales.
In this episode, Homeward’s CEO, Jennifer Schneider discusses how her company uses remote monitoring, telehealth and a novel staffing model to re-architect care delivery in rural America with the goals of improving access and health outcomes.
We discuss:
Why Jennifer and her co-founder decided to make Homeward a B Corp.How Homeward uses technology and non-physician providers to expand access to care in rural America.Lessons from Homeward’s early rollout in Minnesota.Jennifer says we often underestimate how large the rural healthcare market is:
“I jokingly say [to] people when we started Livongo... we initially started in diabetes care. And people said, “That's amazing, it's going to be a huge business. There's 30 million people living with diabetes, so great that you did this nice little niche company for your next company”. And so well, how many people do you think live in a rural health care markets? [I] kind of get a blank stare. And the answer is – double the size [of] the population of people with diabetes… 60 million people live in… [a] rural market.“
Relevant Links
Homeward website
Lack Of Access To Specialists Associated With Mortality And Preventable Hospitalizations Of Rural Medicare Beneficiaries [Article]
U.S. Government Accountability Office: “ACCESSING HEALTH CARE IN RURAL AMERICA” [PDF]
Forbes: “Healthcare In Rural America Isn’t A Little Broken, It’s A Lot Broken: A Conversation With Dr. Jennifer Schneider, Founder And CEO, Homeward Health”
About Our Guest
Dr. Jennifer Schneider is the co-founder and chief executive officer of Homeward, a company focused on rearchitecting the delivery of health and care in partnership with communities everywhere, starting in rural America. Previously, Dr. Schneider served as the chief medical officer and president of Livongo. She also served as chief medical officer of Castlight Health. Dr. Schneider has been honored by Modern Healthcare as one of the “100 Most Influential People in Healthcare” and by Fierce Healthcare as a “Woman of Influence” for her work empowering women and modeling diversity and inclusion in the workplace. Dr. Schneider is also on the boards of Maven and Jasper. Dr. Schneider completed her bachelor's degree in biology at the College of the Holy Cross. She went on to get her MD at The Johns Hopkins University School of Medicine and her master’s degree in Health Services Research at Stanford University.
Connect With Us
For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter @claudiawilliams and
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Before the phrase “social drivers of health” was commonly used, Community Health Centers had already developed a model of care that was holistic, grounded in social change and embedded in the community. At this year’s HLTH Conference in Las Vegas, I sat down with Dr. Kyu Rhee, the new CEO of the National Association of Community Health Centers. Dr. Rhee brings a fresh perspective to NACHC as a clinician and an immigrant with broad experience in policy, clinical practice and technology.
We discuss:
What medicine would look like if every doctor was trained in a community health center, not just in fancy hospitals.How CHCs knock quality metrics out of the park while improving equity.One secret to community embeddedness: Every CHC must name patients to at least half of the governing board seats.The new prescriptions to improve health: food and iPads.Kyu reminds us that changing an entire system can’t happen overnight, we need patience and passion:
“Earlier in my career as a medical director, I was like, “We got to fix this!” And I think I had to learn that there's so many angles on how you see a problem … so that passion of advocating for health equity and the injustices, you have to be thoughtful about allowing that passion to be part of your purpose, but also being patient in the process.”
Relevant Links
Website for the National Association of Community Health Centers
Economic Impact of Community Health Centre in the United States [PDF]
America’s Health Centers by the Numbers [PDF]
"How the Civil Rights Movement Gave Rise to Community Health Centers" [BLOG]
About Our Guest
Dr. Kyu (“Q”) Rhee, MD, MPP, joined the National Association of Community Health Centers as CEO in 2023. He leads efforts to advance health equity and support the mission of community health centers, which provide high-quality, affordable, transdisciplinary primary care services to more than 31.5 million people at over 14,000 sites across the nation. He has held leadership roles as the Senior Vice President and Aetna Chief Medical Officer at CVS Health, as the Chief Health Officer at IBM, and as Chief Public Health Officer at the Health Resources and Services Administration. Dr. Rhee has a medical degree from the University of Southern California and a masters degree from Harvard University’s John F. Kennedy School of Government.
Connect With Us
For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter @claudiawilliams and LinkedIn
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Is whole health here to stay, or is it a shiny new object? Our guest today is Dr. Shantanu Agrawal, Chief Health Officer at Elevance Health. He falls soundly on the “here to stay” side of the ledger. He shares that whole health is not a side business for Elevance Health and its 47.5 million members. It is the core strategy for how the company will achieve value and affordability. And it’s also what patients want.
We dive into:
Whether the US could get better outcomes at the same cost by redirecting resources from medical to social care.Why and how Elevance developed its Whole Health Index.The Elevance foundation’s three-part focus: maternal health, food as medicine and substance use disorders.The need for a new quality paradigm that measures whole health, not clinical care for individual body parts.Shantanu calls for a deeper look at US health spending and outcomes compared to other countries:
“People often make this comparison, ‘well, our health outcomes are generally worse, we spend a lot of money in health care’. However, when you actually look at the total expense on health and social care across all these countries, it actually looks pretty similar. We are more on par with our peers, or they're more on par with us from a cost standpoint. But it is true - our health outcomes are worse. Well, why is that? Well, maybe it's because we've emphasized health care, and not care of a person's health, which means being inclusive of social and being upstream and working earlier in their life. Perhaps if we do this, we will right size the equation for our country.”
Relevant Links
More information on Elevance’s Whole Health Index [PDF]
Health Affairs article on “A Whole Health Population-Based Payment Approach”
Committing to Whole Health: A Conversation with Felicia Norwood & Dr. Shantanu Agrawal [VIDEO]
Distinguishing Health Equity and Health Care Equity: A Framework for Measurement
About Our Guest
Shantanu Agrawal, MD, MPhil is chief health officer at Elevance Health, where he oversees the enterprise whole health strategy, including medical policy and clinical quality, as well as the company’s industry-leading work to address health-related social needs and health equity. Passionate about improving health outcomes and reducing disparities, Agrawal draws on his clinical and business expertise to push for a more equitable health space for the people Elevance Health serves. He also leads Elevance Health’s community health strategy and the Elevance Health Foundation. Previously, Dr. Agrawal served as president and CEO of the National Quality Forum, deputy administrator for the Centers for Medicare and Medicaid Services, and director of one of its largest centers, the Center for Program Integrity.
Connect With Us
For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter
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For Dr. Tony Iton, we have to understand the past before we can shape the future. Our history of racism and exclusion laid the foundation for poor health in America. The way out is not simply delivering more and better services – it is building the voice and power of communities. Tony led The California Endowment’s nearly $2 billion and decade-long investment to test this approach.
He shares his journey from Canada to the US to attend medical school and his eye-opening awakening to the stark disparities in Baltimore that led him to coin the phrase “your zip code is more important than your genetic code in determining health.”
We discuss:
The ABC’s of health equity in California: agency, belonging and fundamental conditionsThe power of narrative to shape policy choices towards either belonging or exclusionHow California communities applied this framework to dramatically change school climate and reduce suspensionsTony calls on public health to move away from medicine and towards its community-oriented roots:
“[Public health has] essentially tried to mimic the healthcare delivery system. And it doesn't belong on that stage, it's a very different kind of entity. Where public health actually proves itself to be authentic, is when it's in direct partnership with community. And it's about bringing the people who are closest to the pain into these decision making processes, so that we get true equity, we get solutions that are grounded in an understanding of how these things play out in people's lives. That's where public health is operating at its best and highest purpose.“
Relevant Links
Building community power to dismantle policy-based structural inequity in healthBuilding healthy communities: Five drivers of changeShifting from technocratic to democratic solutions: A radical vision for health and racial equalityUnnatural Causes documentaryAbout Our Guest
Dr. Tony Iton is a Senior Vice President for Healthy Communities at The California Endowment. In the fall of 2009, he began to oversee the organization’s 10-Year, multimillion-dollar statewide commitment to advance policies and forge partnerships to build healthy communities and a healthy California. Iton serves on the board of directors of the Public Health Institute, the Public Health Trust, the Prevention Institute and Jobs For The Future. He is also an Advisor to the Dean and Lecturer at UC Berkeley’s School of Public Health.
Connect With Us
For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter @claudiawilliams and LinkedIn
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If we want people to experience whole person health – states will have to do a lot of silo-busting to integrate, streamline and coordinate disparate medical, social and economic programs. Data will be the axis of the strategy, but who owns that data and what guardrails are needed? How do we encourage not just data but also technology sharing across state programs?
Jess Kahn joins me to discuss state efforts to integrate programs, technology and data to support whole person health. She’s a partner at McKinsey specializing in state Medicaid and social service programs, public-sector data and technology. Before joining McKinsey she led Medicaid data and systems at CMS.
We discuss:
Dual lessons from COVID: the danger of public health data silos and the possibility of rapid innovationThe technology and data infrastructure states are building for whole person healthHow states are partnering with nonprofit health data utilities The big miss from the national EHR rollout: user-centered designJess highlights the dangerous gap in federal authority and accountability around the sensitive social data:
"So the risks are really clear… this is data that tells you a lot more about the vulnerabilities people have … There isn't a federal agency that asserts that they have some kind of legal authority to set boundaries … Who's going to write that regulation? Who's going to tell state Medicaid agencies – or any entity for that matter – what the guardrails are around collection, around sharing, around ownership?”
#healthcare #investments #housing #medicaid #health #socialdeterminantsofhealth #managedcare
Relevant Links
Health Data Utility Framework - a Guide to Implementation [PDF]
Hubert Humphrey Quote in HHS Building
Websites of Health Data Utilities Mentioned in Episode:
CRISP Health
Contexture
CyncHealth
IHIE
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In this episode, recorded live at the Civitas Networks for Health conference in DC, I sit down with Jennifer Pahlka, author of "Recoding America", to discuss how to improve implementation and impact of big new policy initiatives. The book and episode are essential reading and listening for anyone trying to make government – or any ambitious project - work for people.
We discuss:
The dangers of treating the bureaucracy – not citizens – as the clientClosing the gap between intellectuals (policymakers) and mechanicals (implementers)What policymakers can learn from agile Using data as a compass not a gradeJen points out that a waterfall approach to policy implementation is a pledge not to learn:
“... When you see us trying to implement law and policy by always having information flow from the top to the bottom, and never letting it return back, that's the problem. There can be no software development involved in this at all. And we can still be in a waterfall. The reason waterfall is a metaphor is that water only flows one way.”
#healthcare #investments #housing #medicaid #health #socialdeterminantsofhealth #managedcare
Relevant Links
Jennifer Pahlka’s book Recoding America
United States Digital Service
Code for America
Civitas Networks for Health
Clay Shirky’s book, “Here Comes Everybody: the Power of Organizing without Organizations”
Clay Shirky’s book, “Cognitive Surplus: Creativity and Generosity in a Connected Age”
About Our Guest
Jennifer Pahlka is the author of Recoding America, and a pioneer in making government work for people in the...
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As Chief Health Equity Officer, Dr. Pooja Mittal is charged with improving equity and care for Health Net’s 3 million California members. She brings a strong data focus, skills in community organizing and a passion for social justice to this work – continuing her mother’s path as a family practice doctor working with farmworkers in California.
We discuss:
Co-designing more equitable outcomes with communities and membersHow member grievance and appeal data provides a roadmap to missed opportunities, discrimination and road blocksHealth Net’s experience implementing a doula benefit which laid the groundwork for statewide rollout of doula services in Medicaid The importance of reducing complexity and administrative barriers for new community partnersDr. Mittal tell us how she combats fatigue on the road to health equity:
“How do I continue the work? … I try and think about the power of radical incremental change … How every little thing that we do actually has the power to have ripple effects that improve health for people, broadly. And so that's one way I sort of combat that. And then the other is really coming back to my why … Why am I in this work? Why does it matter to me, and what am I trying to accomplish?”
Relevant Links
Street Medicine - MLKCH and Expanding Access to Care (Page 5)
Street Medicine - $1.5M USC Grant
Unhoused - $114M with LA Care Health Plan
COVID Support - Initiatives
COVID Support - RV Program
About Our Guest
Dr. Pooja Mittal is Medical Director of Health Equity at HealthNet, a Medicaid managed care organization. She is a family physician and uses this lens to design strategic initiatives to improve care for the most vulnerable. She is a member of the leadership team that works to further equitable care through a population health model for all HealthNet members. She has an expertise in digital health through her work in the HealthNet Digital Platforms Workgroup devising a defined digital strategy to support quality and member engagement.
Dr. Mittal also works at the National Clinicians Consultation Center at UCSF, a national HIV/AIDS warmline, where she is recognized as a national expert on Perinatal HIV care. She is an Adjunct Associate Professor at University of California, San Francisco and Stanford University School of Medicine. In addition to her clinical work, she has published in the areas of well-child care, group visits, preconception care, health equity and perinatal...
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In Season 2 we’ll be drilling down on questions about what works and how to scale. Alan Weil is a great person to kick off this conversation. He is the editor of the premiere health policy journal Health Affairs, previously directed Medicaid in Colorado and led an ambitious health study at the Urban Institute.
We discuss:
How states use Medicaid to create entirely new delivery systemsThat we should not bank on savings from whole person careThe keys to successful implementation: focus on customer experience, implement iteratively and have strong feedback loops The missed opportunities to understand and solve for the underlying roots of inequityThe conversation ended in an unexpected place - a discussion of governance and power:
“If a pot of funds being used to improve the health of a population is governed by a nonprofit health system, a state or a state authority, a county or a local authority or government or a community based organization, each of those enterprises will begin the process differently, which leads me to believe that they will almost certainly end the process differently … And we don't have a lot of examples in this country have the kind of community governance of resources that I think would be most valuable,"
Relevant Links
Alan Weil’s podcast “A Health Podyssey”
A Conversation on Health Equity with Alan Weil
Commonwealth Fund ROI Calculator for Partnerships to Address the Social Determinants of Health
Building Community Power To Dismantle Policy-Based Structural Inequity In Population Health
Medicaid Transformation: Past, Present and Future with Alan Weil of Health Affairs
The Results of the CMMI Accountable Health Communities Model 1
The Results of the CMMI Accountable Health Communities Model 2
About Our Guest
Alan Weil is the Editor-in-Chief of Health Affairs, the nation's leading journal at the intersection of health, health care, and policy. For the previous decade he was the executive director of the National Academy for State Health Policy (NASHP), an independent, non-partisan, non-profit research and policy organization. Before that, he directed the Urban Institute's Assessing the New Federalism project, one of the largest privately funded social policy research projects ever undertaken in the United States; held a cabinet position as executive director of the Colorado Department of Health Care Policy and Financing; and was assistant general counsel in the Massachusetts Department of Medical Security. He earned his bachelor's degree from the University of California at Berkeley, a master's degree from Harvard's Kennedy School of Government, and a J.D. from Harvard Law School. Follow Alan Weil @alanrweil on Twitter for the latest developments in health policy and Health Affairs.
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When Claudia Williams started The Other 80 she was searching for evidence that whole person care – meaning the integration of social and medical care – is a viable model to bring more equity and health to all Americans.
We started with some big questions. Can we flip the US healthcare system, making it more compassionate, more effective and more focused on health? Can we better address poverty's impact on health by integrating the often siloed worlds of medical and social care?
In this episode Claudia sits down with her producer Avery Moore Kloss to discuss lessons learned and highlights from Season One and share what’s on deck for Season Two.
We discuss what we learned in Season One:
Data is the foundation of whole person health, but can also create new harmsOrganizations expert in sick care will not also be expert in community health We need new organizations and leaders combining these traits: health not sickness focused, the ability to scale, community-embeddedness and deep use of technology and dataSuccess requires ecosystem thinking, effective partnering and purposely balancing power differentials Addressing equity takes time and trustLearning in public – like we are doing on this podcast – is critically important to speed the national learning curve on health beyond medical careClaudia also shares her biggest takeaway:
“Underneath a lot of this is just poverty and how hard it is to live in the United States if one is poor. And so I think the question that I'm still grappling with is how far should we go in putting on people who are working in health the responsibility of the impact of poverty? And one one way to answer that is to say, well look at all the resources that are in healthcare, yes, of course, this is what's making people not healthy. Of course, we should spend these resources on housing, on food on other things. Other people, though, are saying, but wait a minute, those people are delivering health services, they're not even delivering health services well, why should there be this expanded mandate for them?”
About Our Guest
Claudia Williams is a healthcare executive and entrepreneur who is passionate about creating the conditions, policies, systems and learning to enable health for all. Claudia was the founder and Chief Executive Officer of Manifest MedEx – one of the nation’s largest health data sharing initiatives. She served as Senior Advisor for Health Innovation and Technology at the White House under President Obama, building policies and programs for care transformation, data sharing, and precision health. Claudia is a graduate of Harvard’s Chan School of Public Health, where she earned her MS degree in Health Policy and Management. Claudia served as a Peace Corps volunteer in Botswana.
Connect With Us
For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter @claudiawilliams and LinkedIn.
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For Dr. Clemens Hong, health is social justice work, rooted in the community-oriented primary care movement of the 1960s. He joins us for a powerful interview about on-the-ground implementation of whole person care in a county bigger than many countries. Dr. Hong leads community programs for LA County including housing supports, reentry and diversion programs, street-based outreach, and benefits navigation. We talk about the “mountain of challenges” people face when they return to the community from jail and prison, and the need to build the capacity and agency of community organizations and peer experts.
We discuss:
The impact of Intergenerational trauma, systemic racism and mass incarceration on healthDeep dives on reentry and housing for healthHis suggestions for CalAIM: broader eligibility, improved access to services, and making community supports an actual benefitCreating sustainable work and impactClemens shares the striking results from introducing community health workers with lived experience:
"There's a study that's been done by the Transitions Clinic, and one of our partner sites, Santa Clara, where they showed that arrival to the first appointment after incarceration increased from 30% to 70%, with their hiring … a community health worker with lived experience… Engagement is the foundation to anything we can do in delivering health to communities: engagement of the individual and the survivors of trauma, but also the communities organizations are really critical”
Relevant Links
Housing for Health - Housing For Health (lacounty.gov)
Office of Diversion and Reentry - OFFICE OF DIVERSION AND REENTRY (lacounty.gov)
Knitting Together Health and Social Services in Los Angeles
Impact Report from Whole Person Care Pilots in Los Angeles [PDF]
Community-Oriented Primary Care: A Path to Community Development
About Our Guest
Dr Clemens Hong, MD, MPH, is Director of Community Programs for Los Angeles County Department of Health Services where he oversees multiple County programs including Housing for Health, the Office of Diversion and Reentry, Whole Person Care, My Health LA, CalAIM, and COVID-19 Testing. In 2006 he co-founded the Transitions Clinic with Dr. Emily Wang in San Francisco. He taught for several years at Harvard Medical School, and joined Massachusetts General Hospital as a primary care general internist and health services researcher. Dr. Hong received his Bachelor’s Degree from the University of Washington and his Master’s Degree from Tufts University School of Medicine. He completed internal medicine training in the San Francisco General Hospital Primary Care Program at UCSF, as well as a general medicine fellowship at Harvard Medical School.
Connect With Us
For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and...
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Nearly half of Americans have a family member or close friend who’s been addicted to drugs. And most are not getting the help they need. The US has a 94 percent treatment gap for substance use disorders. Treatments are expensive, ineffective, or they’re simply not available. Corbin Petro is on a mission to close this gap. She is the CEO and Co-Founder of Eleanor Health, providing evidence-based whole person care for people with substance use disorders and mental health needs.
We discuss:
That addiction is a treatable chronic disorder just like DiabetesThe negative consequences of separating the brain and the body in healthcare delivery and policyWhy she’s fired up about closing health equity gapsHow Medicaid founders can get paid for outcomes and pick the right marketsCorbin reminds us that we need to lean more on community health workers and other non-licensed experts:
"One of the challenges with workforce is the belief that care needs to be delivered at all times by … a very expensive specialty clinician. And I think we need as a society to more embrace non-licensed people ... [such as] community health workers, peers, others who can really support and deliver great outcomes."
Relevant Links
Eleanor Health website
In Recovery with Eleanor Health (podcast with co-founder Dr. Nzinga Harrison)
Highlights from the 2021 National Survey on Drug Use and Health from SAMSHA [PDF]
About Our Guest
Corbin Petro is an experienced CEO, industry leader, and entrepreneur with a mission-driven, analytic approach to innovation. She is the CEO and co-founder of Eleanor Health, providing evidence-based, whole person care specializing in addressing the unique complexities of individuals and populations with substance use disorders and mental health needs. Eleanor Health leverages proprietary technology and data-driven insights, compassionate teams, and value-based payment to deliver superior clinical and financial outcomes. Prior to Eleanor Health, Corbin was the founding CEO of Benevera Health, a payer-provider JV and population health company. Corbin has an extensive background in healthcare including working on state Medicaid, advising a US Senator and in management consulting. She was honored as one of fifteen healthcare executives under 40 named a 2018 Up and Comer by Modern Healthcare. She received a BA from Yale University and an MBA from the Wharton School at the University of Pennsylvania.
Connect With Us
For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter @claudiawilliams and LinkedIn.
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Jacey Cooper, California’s Medicaid Director, gives us an on-the-ground look at California’s pathbreaking CalAIM initiative that pairs intensive care management with access to a broad range of social services. It’s been a year since the program launched and Jacey reflects on how much communication, coordination, planning and agility was needed to implement a program of this size and breadth. Claudia and Jacey talk about opportunities and challenges as plans and providers navigate new benefits and participate in local housing, food, and community development conversations.
We discuss:
Lessons learned from the first year of CalAIM including the need for more standardization of social care benefits across health plans More details about the first-of-its-kind Justice Initiative which provides pre-release Medicaid services to people in jail and prisonBehavioral health redesign, payment reform, transitions of care, and administrative integration of mental health and substance use disorder servicesJacey says whole person care is truly a community effort:
"As a collective force, we're making sure that plans are adapted to work with community-based organizations that have been championing these efforts for years. This is why we're focusing on embedding ourselves in the different aspects of care continuums - like housing and homelessness - within our local groups. We have to be present to have a voice in the decision-making, planning, and connection of individuals to vital services. It's not just about navigating people to housing, but ensuring they're connected to voucher programs too."
#healthcare #investments #housing #medicaid #health #socialdeterminantsofhealth #managedcare
Relevant Links
CalAIM Primer [PDF]
Final Evaluation of California’s Whole Person Care Pilots [PDF]
Fact Sheet on CalAIM Justice-Involved Initiative [PDF]
Fact Sheet on CalAIM Population Health Management [PDF]
Fact Sheets on CalAIM Community Supports
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Sachin Jain is setting out to build a very different kind of company—a nationally scaled nonprofit health plan, grounded in Scan’s founding story of 1970s community activists seeking a new future of health for vulnerable communities. In the last two years the 4.5 star Medicare plan has announced a merger with Care Oregon, launched verticals focused on delivering health services to people experiencing homelessness and LGBTQ elders, and expanded to new markets.
We discuss:
What’s possible with a longer time horizonHow equity and social drivers are becoming the new hustleWhy healthcare should borrow less from other industriesHow “no margin, no mission” is creating ethical laxityUnfinished business from our time together at ONCSachin calls for a new era of accountable leadership:
“We need more ethical leadership in health care. And what I mean by that is we need to make sure that the words on the wall of every healthcare organization, the ethical compass, the values, the mission statements, the vision statements, actually mean something, and that the behaviors of leaders actually align to things. I think we've gotten lost in this glib “no margin, no mission” chatter, that creates this ethical laxity in organizations to begin doing things like aggressively billing their patients, or, you know, going so far as to repossess their assets when they can't pay their bills.”
Relevant Links
Dr Sachin Jain on Combining SCAN Group and CareOregon: “We’re Trying to Build a Very Different Kind of Company”
L.A.'s state of emergency on homelessness: How a street medicine team is treating patients in a unique way
SCAN launches new Medicare Advantage plan for LGBTQ+ seniors
How One Health Plan Reduced Disparities in Medication Adherence
About Our Guest
Dr. Sachin Jain has worked in clinical medicine, academia, government, big pharma, and the health insurance industry. His passion is in accelerating the pace of change in health care and building a sustainable health care system that addresses the needs of patients. Dr. Jain President and CEO of SCAN Group and Health Plan, a $3.4B non-profit entity that serves over 220,000 patients. He also serves as a physician at the US Department of Veterans Affairs. Dr. Jain was previously president and chief executive officer of the CareMore and Aspire Health, the care delivery divisions of Anthem. He is an Adjunct Professor of Medicine at Stanford University School of Medicine and Co-Editor-in-Chief, Healthcare: the Journal of Delivery Science and Innovation and trained in internal medicine at Boston's Brigham and Women's Hospital. He received his undergraduate (AB), medical (MD), and business degrees (MBA) from Harvard. He has worked in leadership roles at Merck and Company and the US Department of Health and Human Services and has held faculty appointments at Harvard Medical School and Harvard Business School.
Follow Sachin Jain on Twitter @sacjai.
Connect With Us
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