Creating a New Healthcare

Friends & Colleagues,  The focus of this episode is of immediate importance to all of us. It’s especially important right now, in the month before the inauguration of President-elect Biden & VP-elect Kamala Harris. (Of note, this interview was recorded in late August, so we were unaware of the election outcomes). The topic is ‘fixing’ healthcare and our guest today is Dr. Vivian Lee, the President of Health Platforms at Verily. Dr. Lee recently published a book entitled –The Long Fix – Solving America’s Healthcare Crisis with Strategies that work for Everyone – in which she explains the fundamental problems in healthcare and provides practical solutions. The book speaks directly to policy makers, providers, payers & patients. In this interview, we’ll hit the high points of the book and get a sense of the priority Dr. Lee assigns to certain problems. The book is remarkable and so is Dr. Lee. She is a Harvard-Radcliffe College graduate who obtained a doctorate in medical engineering from Oxford University as a Rhodes Scholar and then earned an M.D. with honors from Harvard Medical School. She has also earned an Executive MBA at NYU’s Stern School of Business. Dr. Lee is a radiologist and medical researcher who has authored over 200 peer-reviewed journals. Prior to her current role, Dr. Lee was the Dean & CEO of the University of Utah Health – one of the nation’s leading hospital and academic medical centers. During her tenure, she and her colleagues achieved numerous nationally recognized accomplishments in quality, safety, patient experience, growth and entrepreneurial commercialization. In 2019 she was ranked #11 among the ‘Most Influential People in Healthcare’ by Modern Healthcare.  She has been elected to the National Academy of Medicine. In this episode, Dr. Lee and I will touch on: A broad range of issues ranging from the mind boggling complexities of billing and payment, to the lack of price transparency, to the crippling and uncontrolled costs of medications, to the impact of healthcare costs on suppressing employee wages and retirement funds. The one issue Dr. Lee calls out as the core off-the-charts problem in the American healthcare system. Why Dr. Lee believes that it’s critically important for all citizens to understand how healthcare delivery works and what it would take to make it better. Why universal access to healthcare is not only the right thing to do from an ethical perspective, but also from a public health, productivity and economic point of view. Why Dr. Lee believes we must shift to value-based care in order for universal coverage/access to be optimally effective. I have to say that it was a privilege and a pleasure to speak with Dr. Lee.  Given her remarkable accomplishments, her brilliance, and the enormity of her current position, I was struck by how down-to-earth and humble she is. We didn’t have the opportunity to directly discuss the issue of leadership in healthcare; but an unspoken message that came across is that we need a leadership culture that Dr. Lee embodies – data-driven, humanistic, socially aware, and selfless – leadership that is, first and foremost, for the people.  Dr. Lee wrote this book for the American public – to bring some clarity to our complicated, opaque healthcare system. I applaud her for that.  Most importantly, I applaud her for the explicit intention to deliver solutions that work for everyone. Until Next Time, Be Well Zeev Neuwirth, MD

The COVID-19 pandemic has shone a new light on the deep-rooted disparities and inequities that are built into the fabric of our American healthcare system. Triggered in part by the pandemic, as well as a number of deeply disturbing episodes of racist police brutality, and the Black Lives Matter movement, we’re experiencing a national re-awakening of concern regarding systemic and institutional racism in our society. Our two distinguished guests in this interview, Dr. Alisahah Cole and Michellene Davis, are nationally recognized leaders in the movement to eliminate healthcare disparities. Michellene Davis, Esq. is currently the Executive Vice President and Chief Corporate Affairs Officer at RWJBarnabas Health, the largest academic healthcare system in New Jersey. She is an attorney and has held positions at the senior most tier of government, including as State Treasurer, Chief Policy Counsel to a Governor, and CEO of a state lottery. Dr. Alisahah Cole is currently the System Vice President of Population Health & Policy at CommonSpirit Health, one of the largest integrated healthcare systems in the United States. She is a Family Medicine physician and has held multiple leadership positions including as Chief Community Impact Officer and Academic Chair, implementing novel approaches to improve health equity in vulnerable populations. This interview was recorded last month as a panel discussion during a virtual conference on patient experience. The topic was originally intended to be a discussion on the Social Determinants of Health (SDOH). But we felt that it would be culturally tone-deaf and socially irresponsible to discuss the SDOH without recognizing systemic and institutional racism as a root cause of the inequities and disparities in health care delivery and health outcomes. With that in mind, this panel discussion includes: A passionate discussion on this most recent ‘awakening of awareness’ about the systemic & institutional racism in our society – including the impact of the COVID-19 pandemic. The manifestations of systemic, institutional & interpersonal racism in healthcare. Practical, real-life recommendations regarding a systematic, data-driven approach to identify, understand & eliminate racism in healthcare. In addition to bringing their experience as clinicians and executives, Michellene and Alisahah also share their lived experience as professional Black women. The stories they share are honest, courageous, and at times, unsettling. For example, Michellene shares that, unlike her white colleagues, she does not have the luxury of putting racism aside, even for a moment. Alisahah shares that, as the mother of two teenage Black boys, she worries for their lives, literally, each time they leave home to venture outside. This conversation challenges the very core of our humanity – in our communities, our corporations, our social institutions and our government. One lesson this interview taught me is that the issue of ‘social determinants of health’ needs to be reframed in terms of eliminating the racial disparities and inequities in healthcare and in our broader society. Another is that good intention is not enough – we need to take sustained systemic action. There are so many lessons embedded in this podcast. Lessons about listening and building trust. Lessons about the unhealthful effects of racism on Americans of color. Lessons about the need to fundamentally reorient, redesign, reorganize and appropriately resource healthcare delivery so that it meets the needs of vulnerable populations. And lessons about the need to expand healthcare delivery beyond traditional medical boundaries – to apply a racial equity lens to how we reframe our education system, our criminal justice system, our housing and urban development system, our transportation system, our social services systems, our labor system, and our public health system. This was the most important interview I’ve conducted to date. I say that with Martin Luther King’s words ringing in my ears. Words that, sadly enough, have as much relevance today as they did when he delivered them over five decades ago, during a 1966 speech before the 2nd National Convention of the Medical Committee for Human Rights. Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death. I see no alternative to direct action and creative nonviolence to raise the conscience of the nation. Martin Luther King Until Next Time, Be Well Zeev

Dear Friends & Colleagues, Welcome to episode #106 of Creating a New Healthcare. This week has been a historic one for our country. As votes continue to be counted at the time of this writing, I want to turn our attention to what will undoubtedly be a key component of POTUS’ work over the next four years – our national healthcare policy agenda. This is the first time we’ve posted during a presidential election. But, it is not the first time we’ve tackled the POTUS question as it relates to healthcare. For those of you who have been listening to the podcast series this year, you’ll immediately recognize the question I’ve asked every guest this season. In this episode, it’s time for me to tackle this question. It’s Thursday, Jan 21, 2021 – the day after inauguration of the President of the United States; and you find yourself in the oval office, sitting on the opposite couch from the POTUS and VPOTUS. (As an important aside, you are socially distanced; and you are all wearing masks.) POTUS has asked for your opinion – your thoughts, suggestions & recommendations on what this administration should be focusing on in regard to HC policy & policy deployment over the next 4 years. What are you going to say to them? Listen to the podcast to discover the 5 Policy Principles I recommend to POTUS and the specific recommendations toward a solution for each. I hope you’ll listen with a discerning ear and let me know how you would answer this question. Finally – I have a request of you. I need your help. If you find value in this podcast series, please share it with as many colleagues as you can think to. I have heard from so many of you how valuable these episodes are to you; and if that’s the case, then it’s critically important that you spread the word about Creating a New Healthcare. Until Next Time, Be Well Zeev Neuwirth, MD

Welcome to episode #105, Season 4 of Creating a New Healthcare. Today we welcome one of the most prolific and influential healthcare policy experts of our era. Professor Ezekial Emanuel is the Vice Provost for Global Initiatives and Co-Director of the Healthcare Transformation Institute at the University of Pennsylvania. He is also a Special Advisor to the Director General of the World Health Organization. Dr. Emanuel was the founding chair of the Department of Bioethics at the National Institutes of Health. From January 2009 to January 2011 he served as a Special Advisor on Health Policy to the Director of the Office of Management and Budget, and the National Economic Council. He is also a breast oncologist, having earned his MD at Harvard Medical School, completed a residency in Internal Medicine at the Beth Israel Hospital in Boston, and then completed an oncology fellowship at the Dana Farber Cancer Institute, where he was also appointed as faculty. Dr. Emanuel has written and edited 14 books and over 300 articles, and is the world’s most cited bioethicist. He is a frequent contributor to the Atlantic, the New York Times, the Wall Street Journal, and the Washington Post, and regularly appears on television and radio. In this episode, we’ll touch on the following: The fragility of the US employer-based healthcare payment system and how the COVID-19 pandemic is nudging us to a universal payment system. The differences between a universal payment program and a single payer system. An illustration of a capitated primary care trial demonstrating the advantages to providers and patients. What the US can learn from other advanced nations in terms of primary care access and healthcare payment reform. The multi-pronged solutions that Dr. Emanuel recommends to address the insidious institutional racism and the inequities that are embedded in US healthcare delivery I believe it was H.L. Mencken who said that there are often simple solutions to complex problems, and those simple solutions are typically wrong. Dr. Emanuel does not offer simple solutions to the complex problems in our healthcare system. Instead, he offers thoughtful, studied, and ethical solutions that directly and realistically address the fundamental flaws in our healthcare system. These are serious flaws that leave tens of millions of Americans with no or sub-optimal health insurance, limit access to preventive primary and specialty healthcare for tens of millions of Americans, and create perverse and unethical incentives for providers and health systems that greatly inhibit them from delivering the type of healthcare they would like to offer. Dr. Emanuel is one of the most cited healthcare policy scholars and advisors of our era, as well as one of the most prolific researchers and authors. He is one of the finest healthcare educators and thought-leaders our country has ever produced. It is well worth our time to listen to and study the critically important lessons he is teaching us. Until next time, Be safe and be well. Zeev Neuwirth, MD

Welcome to Episode #104 (Season 4) of Creating a New Healthcare. I’m delighted to welcome back to this podcast Dr. Don Berwick – one of the leading authorities on healthcare quality & improvement over the past few decades.   Dr. Berwick is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement (IHI), an organization that he co-founded and led as President and CEO for 18 years. In July 2010, President Obama appointed Dr. Berwick to the position of Administrator of the Centers for Medicare and Medicaid Services (CMS), which he held until December 2011. An elected member of the Institute of Medicine (IOM), Dr. Berwick served two terms on the IOM’s governing Council, and was a member of the IOM’s Global Health Board. He served on President Clinton’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry. His body of work & contributions to the field of healthcare quality & safety are unparalleled, including two classics: the 1999 IOM report, ‘To Err is Human’ and the 2001 IOM report, ‘Crossing the Quality Chasm’. In 2005, he was appointed “Honorary Knight Commander of the British Empire” by Queen Elizabeth II, the highest honor awarded by the UK to non-British individuals, in recognition of his work with the British National Health Service. To say that Dr. Berwick brings a seasoned perspective on the current state of our healthcare system and the challenges we face as a nation is, to put it mildly, an understatement. What distinguishes Dr. Berwick even more than his record of accomplishment or his brilliant mind is his tireless reminders of the ethical responsibility we have to attend to the health of the American public – especially for those of us who are providers, administrators, policy makers, health insurance companies, as well as pharmaceutical and device manufacturers. A relevant quote from one of Dr. Berwick’s recent articles underscores this responsibility;  “Fate will not create the new normal; choices will.” In this episode, we’ll cover a range of topics, including the following: Dr. Berwick’s recent article, Choices for the “New Normal” – which is a call-to-action and a leadership roadmap outlining crucial choices in six critical domains that will play a significant role in determining the future of healthcare delivery. Inequality and Inequity –  the relative lack of social support services provided in the US as compared to other developed nations; which Dr. Berwick describes as “the most notable wake-up call”. An ethical reframing of the social determinants of health, described in his recent article, The Moral Determinants of Health; along with some shocking statistics on inequities related to poverty, hunger, homelessness, social isolation, and the uninsured. The tragic and insidious institutional racism that is embedded in our healthcare delivery system, as well as in other institutions such as our criminal justice system. A critical reframing of healthcare that Dr Berwick refers to as “What Matters to You Medicine”; which he suggests should disrupt and replace the legacy “What’s the Matter With You” paradigm. Dr. Berwick is one of the greatest healthcare humanitarians and transformational leaders of our era. He is the quintessential example of empathic ethical leadership. We need more leaders like this in and around healthcare. Dr. Berwick’s recent publications are seminal. In these articles, he courageously cuts to the stark realities of our healthcare system. He not only lays bare the truth for all to see but also outlines the crucial leadership choices of our time. And even beyond that, he lays out a pathway for positive action. Dr. Berwick writes, speaks & acts with intellectual integrity, academic rigor, and with a disarmingly insightful and honest authenticity – as well as with a powerful voice based in morals and compassion. At times, it’s unsettling, uncomfortable and inconvenient. Make no mistake about it, Dr. Berwick’s message is not an academic treatise. It is a call for ethical action. Until next time, Be safe and be well. Zeev E. Neuwirth, MD

Welcome to episode #103, Season 4 of Creating a New Healthcare. In this episode we are welcoming back to the podcast Dr. Mandy Cohen, the Secretary for the North Carolina Department of Health & Human Services. Dr. Cohen and her administration have been critical in responding to the current pandemic. Over the past 3 1/2 years, they have also been hard at work, developing and deploying a cutting-edge, state-wide approach to addressing the Social Determinants of Health – a critical national issue whose importance has been magnified by the pandemic. In this episode, we’ll cover: 3 major lessons that the COVID-19 pandemic has taught us: (1) equity, (2) system-ness and (3) care beyond walls. How Dr. Cohen and the NC DHHS adopted “an equity lens” in deploying targeted programs and policies to create a more equitable healthcare system. The progress in “health opportunity” programs such as the NCCARE360 closed-loop referral program. The central importance of Community Health Workers in building a ‘bridge of trust’ to creating better health. For me, there were three profound take-aways from this episode: As we were discussing the importance and necessity of collecting data on racial disparities and inequities in healthcare, Dr. Cohen paraphrased a mutual colleague – Dr. Mark Smith, the founding president and former CEO of the California Health Care Foundation. The lesson she shared is the cautionary note that one should not admire a problem too much at the expense of doing something about it. We should not wait around for perfect or publishable data before taking action. Heeding this advice, she is “full tilt” on deploying resources to assist traditionally marginalized populations – in particular, the Black and Latinx populations. Governor Roy Cooper has been fiercely promoting the importance of Medicaid expansion – which has become even more critically important due to the stressors of the pandemic on factors such as employment. There are currently 2.2 million people on Medicaid in NC, which accounts for about one-fifth of the entire NC population.  1.5 million of those individuals are children, which accounts for one out of every three children in NC.  If we accepted federal funding and expanded Medicaid in NC, it would provide insurance coverage for another 600,000 people – covering COVID-19 testing, behavioral health treatment, early childhood development programs, life-saving medical care and so on. As Dr. Cohen puts it – the fact that we are one of only twelve states in the entire country that has not yet expanded Medicaid is a “black eye” on the NC commonwealth. There was another profound ‘aha’ moment that happened during this interview that I don’t think I’ll ever forget. As we were discussing the ‘community health work’ (CHW) program she and her team are deploying, Dr. Cohen punctuated the key role that community health workers serve in the healthcare ecosystem. It’s well known that Community Health Workers serve to provide navigation and coordination of clinical care, and that they assist with social services and social agency. But, from Dr. Cohen’s perspective, their key core function is really about rebuilding trust. It’s about meeting people where they are, and starting to rebuild a bridge that has been broken. She went on to say that we have to acknowledge that we have a “trust deficit” in communities of historically marginalized people. More explicitly, Black and Latinx communities have been left out and let down by our healthcare system. And, some of the current health inequities are likely due to the fact that people don’t seek healthcare because they don’t believe they will be heard, listened to, and appropriately cared for. The “trust deficit” is based on decades of lived and learned negative experiences, and is supported by decades of published research. Dr. Cohen is a knowledgeable, forward-thinking, empathetic and highly competent public health leader. She has a definite bias to action – deploying programs that achieve measurable positive health outcomes for individuals and communities. Under her leadership, the NC DHHS is keenly focused on addressing the long-standing and systemic ‘dis-trust’ in our healthcare system, which to my mind may be the single most important ‘dis-ease’ we need to tackle if we are to achieve our full potential as a state, and as a nation. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, Welcome back to the Fall 2020 season of ‘Creating a New Healthcare’.  We are now entering the 4th year of our podcast, with over 250,000 downloads this year to date!  It’s clear that the issue of reframing healthcare has never been more important than it is at this moment.  So, if you find value in listening to the podcast, I would urge you to share it with friends and colleagues. There is so much going on in the world right now. It’s a time of great uncertainty, volatility, distress – and opportunity.   One of the unintended consequences of the sheltering-at-home and social-distancing – necessary to combat COVID-19 – is the devastating isolation, loneliness and despair it has wreaked across the US population.  Research, prior to the pandemic, informs us that somewhere between 40 – 50% of the population experiences social isolation or loneliness.  I strongly suspect that the pandemic has raised those numbers significantly.  We also know that it’s not just the elderly.  The second most affected segment of the population are college age adults.  We desperately need a national solution to address social isolation and loneliness. So, what can NASA teach us about social isolation & loneliness?  And, why is Humana, a major healthcare insurance company, collaborating with NASA to address social isolation? To answer those questions, we’ll be joined today by two distinguished experts in this area – Dr. Will Shrank,  the Chief Medical Officer at Humana; and Dr. Gary Strangman – a psychologist and researcher from the Massachusetts General Hospital (MGH).  Dr. Strangman is the Director of a “Neural Systems Group” at MGH and has also been working closely with NASA over the past 2 decades – currently as the Innovation Specialist for NASA’s Translational Research Institute for Space Health (TRISH). In this interview, we’ll dive into the following: The physiologic and psychologic impact of social isolation on astronauts and the types of solutions NASA is exploring to deal with this. Some of the similarities between space travel & sheltering-at-home in the era of COVID-19. Startling statistics on the impact of social isolation on Humana’s senior members, and the types of initiatives they’ve been deploying to combat it. Next steps for the collaboration between Humana and TRISH. During the interview it becomes abundantly apparent that Gary Strangman and Will Shrank are superstars in their respective fields.  The fact that Humana is collaborating with NASA’s Translational Institute for Space Health speaks volumes about the intense focus, commitment and highly innovative approach Humana is taking to better understand and combat the epidemic of social isolation.  Humana and TRISH are also collaborating, alongside others, in a public health awareness campaign, called ‘Far from Alone’.  This program addresses health-related social needs and promotes understandings of loneliness and social isolation – issues that are exacerbated by the Coronavirus pandemic. I recently read a quote from Atul Gawande that provides a meaningful context to the work that Dr. Shrank and Dr. Strangman, and their respective organizations, are engaged in. “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival.  But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive.” Until Next Time, Be Safe & Be Well. Zeev Neuwirth MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode here.  During this series, I interviewed forward-thinking, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way we’re delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In order to share the remarkable insights from these timely interviews, we have been releasing episodes as quickly as possible.  Over the past 8 weeks, we’ve posted 20 episodes! Today’s episode is the final interview in this limited podcast series.  In this episode, I’ll be sharing some of my key learnings and lessons from the past few weeks, and the impact I hope it will have on our healthcare system. In this episode, I’m joined by Chitra Ragavan, a nationally recognized journalist and host of her own podcast, When It Mattered.  Chitra will take the mic in this episode and interview me about my perspectives on how COVID-19 is reframing American healthcare.  Chitra is an unusually skilled podcast host in that she brings deep experience in television, radio, and print – including at National Public Radio (NPR) and U.S. News & World Report magazine (U.S. News).  Chitra also is Founder and CEO of Goodstory, a strategic advisory firm helping companies with strategic growth and positioning, using brand architecture, narrative and storytelling.   A preview of the topics we’ll touch on include: The fundamental flaws in the American healthcare system that have been exposed and magnified by this pandemic. The major reframes we MUST deploy post COVID-19 in order to create a new and better healthcare. Why I’m hopeful, energized and enthusiastic about the future of healthcare, and health, in our country. In addition to being the final episode in this limited series, it will also be the final episode of this ‘Creating A New Healthcare’ season.  We’ll take a summer break and kick off the 4th Season in September.  Stay tuned – we have an exciting lineup for the Fall! I’d like to thank the guests who graciously agreed to be interviewed for this limited series.  The stories and stats they shared ran the gamut from enlightening to startling to heart warming to incredibly helpful.  Under normal circumstances, it takes weeks to schedule these interviews; but these incredibly accomplished leaders arranged to participate in a matter of days – out of a shared sense of purpose.  Their insights and profound humanitarianism left me with a deep sense of hope and renewal after each interview. Finally, I would like to take this moment to thank you for listening in and offering your feedback and encouragement via social media and emails.  Please continue to write in and share your thoughts.  And please share the podcast series with your colleagues.  The only way we’re going to create a new healthcare is together. Until next time, Be Safe & Be Well Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introductory episode here.  In this series, I’ve been interviewing visionary, courageous healthcare leaders and entrepreneurs –  asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this interview we’ll be speaking with Sami Inkinen, the founder and CEO of Virta Health.  Virta is a completely virtual diabetes clinic whose brand promise is to not only improve type 2 diabetes but, in many instances, to reverse it.  Virta has completely reframed type 2 diabetes care with the physiologic approach they take; the data-driven, digital, AI-enabled technologies they deploy; and the personalized, empathetic and highly responsive care they provide.  Sami is a remarkable person and entrepreneur.  He’s a physicist, turned business and tech guy, turned online real estate entrepreneur, turned healthcare reframer/entrepreneur.  I met Sami about 6 years ago and have had the great privilege of working with him and getting to know him.  And, in full transparency, I have served as an advisor to Virta. Some of the topics we’ll touch upon include: Virta’s approach to type 2 diabetes – which allowed it to be far better prepared to continue delivering exceptional clinical care and outstanding consumer experience during the COVID-19 pandemic. One of the most remarkable statistics I’ve heard during this pandemic – having to do with risk of mortality from the SARS-COV-2 infection in individuals with uncontrolled diabetes. Some of the crippling flaws in the American healthcare system that were exposed and exacerbated by the COVID-19 pandemic. A fundamental misalignment in our healthcare system that represents the most serious impediment to delivering empathetic, value-based care, and superior outcomes. Sami’s top recommendations for what we need to do to create a better healthcare system coming out of this COVID-19 pandemic. Virta Health is an example of what reframed ‘great’ looks like in chronic disease management.  We could spend quite a bit of time breaking down the principles, approaches, processes, technologies, behavioral and relational aspects, payment model, culture, and so on that make Virta so successful.  But the bottom line is that the value proposition, experience and outcomes are far superior to the standard of care across the country.  Virta represents, similarly to others we’ve interviewed in this series, a path to what markedly better healthcare can and should look like.  Sami and his colleagues have paved a path to the future by reframing the care of people with diabetes. One major take-away I’d like to leave you with is one of the key lessons I’ve learned in this limited series.  Organizations – like Virta – that have reframed healthcare, have fared far better during this pandemic than organizations that have not.  This has been a common theme that has come up repeatedly during these in-depth interviews.  It speaks to the fact that our current legacy approaches to healthcare delivery are vulnerable, fragile and simply not oriented, designed or organized around our healthcare needs.  Reframed organizations appear to be much more adaptable, resilient, anti-fragile – and consumer-oriented.  This observation was not lost on me and should not be lost on you. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introductory episode here.  In this series, I am interviewing future-facing, courageous healthcare leaders and entrepreneurs,  asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this interview we’ll be speaking with Dr. Shreya Kangovi about Community Health Workers.  Community Health Workers are individuals who have been hired from their community, and given training and support to provide customized, culturally sensitive, non-clinical care.  Their focus is on the social determinants of health – at the individual level, and delivered in a highly personalized and relationally oriented way.  To my mind, this workforce and approach to care is one of the most untapped opportunities we have to reframe healthcare and create transformative change.  It addresses the overwhelming impact that the Social Determinants of Health (SDOH) have on healthcare outcomes, utilization, costs and the experience of care. The issues of SDOH, chronic disease and disparities of care have been some of the fundamental problems in our healthcare system – problems the COVID-19 pandemic has exposed and exacerbated.  One of the solutions to our present moment and to a better future is the focus of today’s discussion. Dr. Kangovi and her colleagues have pioneered a rigorous, evidence-based approach to building, deploying and measuring the impact of a Community Health Worker (CHW) program.  Dr. Kangovi is the founder & executive director of the Penn Center for Community Health Workers – a national center of excellence dedicated to advancing health in low-income populations through CHW programs. She and her colleagues have spent nearly a decade creating and refining a world-class CHW model called IMPaCT (Individualized Management towards Patient-Centered Targets).  Now, they are offering this program to other institutions to encourage widespread deployment. In this interview, we’ll dive into the following: Six major problems in healthcare – caused and/or exacerbated by the COVID-19 pandemic – that are leading to American deaths. What Dr. Kangovi refers to as the “structural racism” embedded in our healthcare delivery system – and what can be done to reverse it. A detailed description of the Community Health Worker approach to COVID-19 contact tracing, and… The one critical question that drives the highly effective and personalized IMPaCT Community Health Worker approach. The Community Health Worker model is proven to be cost effective, replicable, and complementary. However, in order to implement this model throughout the country, we need a system of care that pays for outcomes, not for procedures or transactions.  Fee-For-Service payment is the “big but” in American healthcare. This has been a common mantra that has emerged in most of the interviews I’ve conducted during this pandemic.  If we shifted to a capitated, value-based payment approach (at least with primary care), we would be able to rapidly and easily deploy effective, humanistic solutions such as Community Health Workers. From my perspective, one of the most important lessons the COVID-19 pandemic has taught us is that Fee-For-Service payment makes both providers and patients vulnerable. It is unsustainable, and frankly harmful to the health of the American public and the American economy.  It’s also not the type of compensation model that fosters meaningful, relationship-enhancing careers for primary care providers as well as specialists. We can talk about a lot of things, but until we fix this one major impediment, we will be propagating an out-dated and misaligned approach to healthcare delivery.  My hope is that this current crisis serves as a catalyst for changing that, and addressing many of the other fundamental flaws in our healthcare system, like disparities in care.  We need courageous leaders to speak up, step up, collaborate across the various stakeholders, and to take directed actions to create a new, and more humanistic, approach to healthcare. Until next time, be safe and be well. Zeev Neuwirth, MD