The Other 80

With the election just days away, Larry Levitt joins me to discuss where Harris and Trump stand on key health issues: reproductive health, affordability and Medicaid. While health has not taken center stage (as it has in the past), the outcome of this election will have profound impacts on every aspect of health in the years ahead. 

We discuss:

• Why the ACA is no longer a political battlefield
• The shifting dynamics of abortion as a single-issue vote
• Why medical debt and drug prices are key affordability issues to watch
• Whether we could see bipartisan progress on AI governance, long term care or PBM reform over the next four years

Larry reminds us that health IS an economic issue:

“People think of the economy and health care being separate issues, but they're In fact, not separate issues at all. I mean, we spend an enormous amount on health care. A lot of people's household budgets go to health care. So, you know, when you talk about an economic issue, health is an economic issue, issue for people.”

Relevant Links

KFF panel: What the 2024 election could mean for health coverage, affordability and the budget

KFF election 2024 page

How medical debt is the canary in the coal mine for health affordability [article]

Project 2025

Abortion-related state ballot measures

About Our Guest

Larry Levitt is the executive vice president for health policy, overseeing KFF’s policy work on Medicare, Medicaid, the health care marketplace, the Affordable Care Act, racial equity, women’s health, and global health. He previously was editor-in-chief of kaisernetwork.org, which was KFF’s online health policy news and information service and directed KFF’s communications. 

Prior to joining KFF, Levitt served as a senior health policy adviser to the White House and the Department of Health and Human Services, working on the development of the Clinton Administration’s Health Security Act and other health policy initiatives. Earlier, he was the special assistant for health policy with California Insurance Commissioner John Garamendi, a medical economist with Kaiser Permanente, and served in a number of positions in the Massachusetts state government.

Levitt holds a bachelor’s degree in economics from the University of California, Berkeley, and a master’s degree in public policy from the Kennedy School of Government at Harvard University.

Source: https://www.kff.org/person/larry-levitt/ 

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How do you create a healthier city? As the climate shifts, screens dominate our lives and cities continue to grow - urban areas are grappling with how to put themselves on a better track to health. New York City Health Commissioner Dr. Ashwin Vasan joins The Other 80 to talk about his ambitious plan to increase health in the Big Apple, with the goal of increasing life expectancy from 78 to 83 years. 

We discuss:

• What Paul Farmer taught him about rejecting a scarcity mindset and reaching for bold goals
• The three cross-cutting challenges addressed in the Healthy NYC agenda: access to primary care, mental health and climate change
• Why NY issued a public health advisory on teen social media use and is suing Meta, Tik Tok YouTube and SnapChat

Ashwin shares why youth social media use is such a major public health priority:

“ Our kids are hurting … Fifty percent of teens are saying that they are either moderately or severely depressed …It's hard to ignore the role that digital media and social media is playing … And what we found was pretty troubling …The more time you're spending on social media, the worse your self -reported mental health is. Whether it's symptoms of depression, anxiety, hopelessness, fear for the future.”

Relevant Links

Article: “Using Law to Advance Population Health Management”

The City of New York’s Advisory on Social Media

More information on Healthy NYC

Viral Video of “Dancing Guy”

About Our Guest

Dr. Ashwin Vasan is the 44th Health Commissioner of New York City. He is a practicing primary care physician, epidemiologist and public health expert with nearly 20 years of experience working to improve physical and mental health, social welfare and public policy outcomes for marginalized populations in New York City, nationally and globally. Throughout his career, he has brought in a unique, unparalleled focus to combating the mental health crisis, releasing a comprehensive citywide mental health plan addressing the second pandemic – a crisis of mental health plaguing youth, vulnerable New Yorkers with severe mental illness, and those impacted by the overdose epidemic. Having begun his career in global health working at Partners in Health and the HIV Department of the World Health Organization, he most recently served as the President and CEO of Fountain House, a US-based mental health nonprofit. He currently serves as faculty at the Columbia University Mailman School of Public Health and Vagelos College of Physicians and Surgeons.

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In July, US Surgeon General Dr. Vivek Murthy issued a landmark advisory declaring firearm violence a national public health crisis. The advisory builds on decades of work from Dr. Megan Ranney and other researchers who advocate taking a public health approach to reducing firearm violence. She joined us at Aspen Ideas: Health to discuss what this means: namely moving from a focus on law and order to centering harm reduction and prevention. Now, as the Dean of the Yale School of Public Health, Megan is applying the same systems thinking approach to focus on the big changes we need to drive health in the US.

We discuss:

• What it means to be a great public health communicator
• How public health approaches were used to dramatically reduce automobile deaths over the last 50 years, and how the same strategies should be used now to tackle firearm deaths
• Her take on bridging the gap between medical care and public health

Megan says this is the moment for public health reinvention:

“This is a moment where we get to reinvent how we study, teach, and most of all, practice public health, not just locally, but also globally, as we come out of the COVID pandemic, and I think there's a real moral clarity, but also a moral imperative for us, as public health professionals, to seize this moment, to take this kind of pivot point that we're at as a field, and to move it forward in a direction that we will be proud of.”

Relevant Links

Megan Ranney testimony on gun violence as a public health issue

Gun violence panel at Aspen Ideas: Health

Surgeon General advisory on firearm violence

Yale Q&A with Dean Megan Ranney

Common health coalition

Bipartisan Safer Communities Act 

UC Berkeley School of Public Health course on urban gun violence prevention

More on Rahimi case

About Our Guest

Dr. Megan L. Ranney is an emergency physician, researcher, and national advocate for innovative approaches to public health. In July 2023, she joined Yale University as Dean of the Yale School of Public Health, where she is also the C.-E. A. Winslow Professor of Public Health. Her research focuses on developing, testing, and disseminating digital health interventions to prevent violence and related behavioral health problems, and on COVID-related risk reduction. She has held multiple national leadership roles, including as co-founder of GetUsPPE during the COVID-19 pandemic and Senior Strategic Advisor to AFFIRM at the Aspen Institute, focused on ending gun violence through a non-partisan public health approach. She was previously the Warren Alpert Endowed Professor of Emergency Medicine, Deputy Dean of the School of Public Health, and Founding Director of the Brown-Lifespan Center for Digital Health at Brown University. She is an elected member of the National Academy of Medicine, a Fellow of the Aspen Health Innovators’ Fellowship, and a member of the Aspen Global Leadership Network. She earned her bachelor's degree in history of science, graduating summa cum laude, from Harvard University; her medical doctorate, graduating Alpha Omega Alpha, from Columbia University; and her master’s degree in public health from Brown University. She completed her residency in Emergency Medicine and a fellowship in Injury Prevention Research at Brown University.

Source: https://ysph.yale.edu/profile/megan-ranney/

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Deena Shakir is an investor who is obsessed with expanding access to the basic health services people need and often can’t access: pediatric care, community health and women’s services. Her journey to investing passed through policymaking, journalism and big tech and her early techno optimism has given way to a much more nuanced and pragmatic view. She is able to see the big opportunities for impact hiding in plain sight.

We discuss:

• The two obvious megatrends hitting healthcare: GLP1s and AI
• And the not so obvious opportunity: doing basic things better
• How Dobbs was an accelerant, not a deterrent, for investments in women’s health
• Why Public Health is great training for healthcare founders

Deena is excited about “asset light” investments that combine new care models – like community health workers – and technology:

“There are some things that won't change. And there are things that hopefully tech can help to navigate. And so these asset light models, these models that are leveraging under leveraged care workers – like community health workers that are providing culturally competent care – and at the end of the day, that are improving metrics and outcomes, are the ones that get me excited.”

Relevant Links

Lux Capital

Jonathan Haidt article in The Atlantic titled “Why the past 10 years of American Life have been uniquely stupid”

President Obama’s Cairo speech

ARPA-H Sprint for Women’s Health

Health companies Deena mentions that she invests in:

Waymark

Summer health

Maven Clinic 

About Our Guest

Deena's investments span stages and sectors, and include women's health, digital health infrastructure, health equity, foodtech, and fintech. Above all, she seeks out extraordinary, often underdog, founders on a mission. Prior to Lux, Deena was a Partner at GV (formerly Google Ventures), led product partnerships at Google for health, search, and AI/ML, and directed social impact investments at Google.org. Deena also served as a Presidential Management Fellow at The U.S. Department of State under Secretary Clinton, where she helped launch President Obama’s first Global Entrepreneurship Summit.

Deena is a frequent speaker and commentator and has been featured in print and television on Bloomberg, CNBC and NBC, in print in the Wall Street Journal, Fortune, Forbes, Techcrunch, Marie Claire, STAT, and more, and has delivered keynote addresses at major industry conferences. She was named a "Top 30 Under 40 in Healthcare" by Business Insider and "Top Senior Woman to Watch in Venture Capital" by the Wall Street Journal in 2021, "Top 50 in Digital Health" by Rock Health and 40 Under 40 by Fortune Magazine in 2022.

Source: https://www.luxcapital.com/people/deena-shakir

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Government systems often take a lot of flack for their (sometimes) built-in inability to take risks and make big bets. So, what would it take to encourage the government to take those big, risky moonshots? For Health, that’s the role of ARPA-H – to fund new ways of improving health by investing in people with big ideas. We sat down with ARPA-H Director Renee Wegrzyn at Aspen Ideas Health to talk about how it’s going and what comes next. 

We discuss:

• Why ARPA-H is personal for President Biden.
• How ARPA-H’s special authorities – from flexible hiring to novel contracting – are its secret weapons for speed and scale.
• The critical role of Program Managers – single decision maker driving the vision and execution of each $50-$200 million initiative.

Renee says ARPA-H gives her the ability to direct funds into areas that are sometimes left off the list of “must haves” for innovation:

“...one of the only top down things I've done as a director is said, ‘Why aren't we funding more in women's health? We don't have any program managers in the pipeline that want to exclusively focus on this’. But I think we all inherently understand that women are underrepresented in almost every aspect of health. So I asked our [Program Managers].. who wants to raise [a] hand and pick a topic that is really either unique to women, or is disproportionately affecting women that we can do a sprint and invest around. And so I got six Program Managers to come up with topics, everything from Women's Health at home, to brain health, to understanding and quantifying pain – and through the Investor Catalyst Hub we have worked with investors to understand what kind of convincing scale do we need to get to for you to be the second investor. And we competed this across the country.”

Relevant Links

• About ARPA-H
• ARPA-H Health Equity Factsheet 
• The Minor Consult Podcast Episode
• ARPA - H Timeline
• Youtube Conversation with New Yorker writer
• White House FAQ Sheet on ARPA-H

About Our Guest

Dr. Renee Wegrzyn is the first director of the Advanced Research Projects Agency for Health (ARPA-H), appointed by President Biden on October 11, 2022. Previously, she was the Vice President of Business Development at Ginkgo Bioworks and Head of Innovation at Concentric by Ginkgo, where she focused on synthetic biology for combating infectious diseases like COVID-19.

Wegrzyn has experience with DARPA and IARPA, the models for ARPA-H. At DARPA, she used synthetic biology and gene editing to enhance biosecurity and the bioeconomy, managing programs like Living Foundries, Safe Genes, PREPARE, and DIGET. She received the Superior Public Service Medal for her DARPA work. Her career includes leading biosecurity and gene therapy teams in private industry, developing immunoassays and diagnostics. Wegrzyn has served on various scientific advisory boards, including those for the National Academies and the Air Force Research Labs. She holds a Ph.D. and a bachelor's degree in applied biology from the Georgia Institute of Technology and completed postdoctoral training in Heidelberg, Germany, as an Alexander von Humboldt Fellow.

Source: https://arpa-h.gov/about/people/renee-wegrzyn#:~:text=Dr.,Biden.

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The US is living through an affordable housing crisis - in fact, we are short millions and millions of affordable housing units. During the pandemic, homelessness flattened with an influx of resources to help keep people housed. But, those resources have long expired and now we are seeing an uptick in homelessness across the country. Jeff Olivet, the director of USICH (United States Interagency Council on Homelessness), says the problem is complex – but the math isn’t. We need more affordable housing. 

We discuss:

• Biden’s proposed budget, which includes guaranteed vouchers for every low income veteran and person aging out of foster care
• The new frontier; pairing emergency response such as shelters with robust prevention strategies
• How prevention starts with helping families through periods of financial crisis
• What happens when heat crises turn deadly for people who are homeless

Jeff reminds us that the people affected most by the affordable housing crisis are those who have experienced trauma and domestic violence:

“50 years ago, we still had domestic violence, we still had addiction, we still had mental illness, and we didn't have perfect systems to address that – but we had enough housing for everybody, and we did not see homelessness on the scale we see it today. So when we're responding to homelessness, it's critical to individualize support for people to make sure they have access to the care they need in terms of health and mental health and recovery and all of those important things. But if we don't solve the underlying structural stuff, the lack of affordable housing, the ongoing discrimination that people of color and LGBTQ people face in jobs and trying to buy a home or rent a home in the criminal legal system, in education, if we don't solve that underlying stuff, we're gonna keep seeing homelessness for a very long time to come.”

Relevant Links

Jeff Olivet testimony to Congress on strategies to reduce Veteran homelessness

Federal actions to increase housing supply and lower housing costs 

HUD-VASH vouchers to support homeless veterans 

USICH guidance document for healthcare

Article about the SCOTUS ruling 

About Our Guest

Jeff Olivet is the executive director of USICH. He has worked to prevent and end homelessness for more than 25 years as a street outreach worker, case manager, coalition builder, researcher, and trainer. He is the founder of jo consulting, co-founder of Racial Equity Partners, and from 2010 to 2018, he served as CEO of C4 Innovations. He has worked extensively in the areas of homelessness and housing, health and behavioral health, HIV, education, and organizational development. Jeff has been principal investigator on multiple research studies funded by private foundations and the National Institutes of Health. Jeff is deeply committed to social justice, racial equity, gender equality, and inclusion for all. He has a bachelor's from the University of Alabama and a master's from Boston College.

Source: https://www.usich.gov/about/staff

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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.

California is the latest state to address healthcare affordability through cost growth targets. Elizabeth Mitchell – President and CEO of Purchaser Business Group on Health  – Joins us to discuss the nuts and bolts of the 3% cost growth target recently adopted by the state. Healthcare affordability is a big issue across the country. More than half of us skip or postpone care due to cost and medical bills are a leading cause of bankruptcy. Reining in medical costs is also how we’ll  free up resources for what we know works to build health in America: prevention, addressing the social drivers and fostering health in communities.

We discuss:

• Two proven strategies to reduce healthcare costs: advanced primary care and effective specialty referrals
• Why better consumer “shopping” is not the path to healthcare affordability 
• How price transparency gives employers new tools to negotiate, and reveals troubling facts about purchasing intermediaries

Elizabeth reminds us how troubling it is that we don’t have clear prices in a sector that makes up 20% of the economy:

“The idea that you can't find out what something is going to cost before you agree to it is outrageous. Name any other industry that refuses to show you a price. It is incredible to me that we are still fighting about transparency when it is 20 % of the US economy. I mean, this is a multi-trillion-dollar industry who feels no accountability to show pricing. So, I just think it is incredible that we do not have meaningful transparency yet.”

Relevant Links

California’s Office of Health Care Affordability sets cost growth target

Federal hospital price transparency requirements

Purchaser Business Group on Health (PBGH) website

PBGH white paper on advanced primary care

US Department of Labor clarifies the fiduciary responsibilities of self-insured employers purchasing healthcare

About Our Guest

As President and CEO, Elizabeth Mitchell advances Purchaser Business Group on Health’s (PBGH’s) strategic focus areas of advanced primary care, functional markets and purchasing value. Mitchell leads PBGH in mobilizing health care purchasers, elevating the role and impact of primary care, and creating functional health care markets to support high-quality affordable care, achieving measurable impacts on outcomes and affordability.

At PBGH, Elizabeth leverages her extensive experience in working with health care purchasers, providers, policymakers and payers to improve health care quality and cost. She previously served as Senior Vice President for Healthcare and Community Health Transformation at Blue Shield of California, during which time she designed Blue Shield’s strategy for transforming practice, payment and community health. Mitchell also served as the President and CEO of the Network for Regional Healthcare Improvement (NRHI), a network of regional quality improvement and measurement organizations. She also served as CEO of Maine’s business coalition on health (the Maine Health Management Coalition), worked within an integrated delivery system (MaineHealth), and was elected to the Maine State Legislature, serving as a State Representative.

Elizabeth served as Vice Chairperson of the U.S. Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee, Board and Executive Committee Member of the National Quality Forum (NQF), Member of the National Academy of Medicine’s “Vital Signs” Study Committee on core metrics and a Guiding Committee Member for the Health Care Payment Learning & Action Network. Elizabeth holds a degree in religion from Reed College and studied social policy at the London School of Economics.

Source: https://www.pbgh.org/staff/elizabeth-mitchell/

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The scope, scale and timeline of what California is trying to do with CalAIM is truly breathtaking. Two years after the launch of the ambitious program, which offers integrated medical and social care for California's 15 million Medicaid members, Dr. Palav Babaria joins us to discuss how it’s going and what comes next. Dr. Babaria is a primary care physician who leads quality and population health management for California’s Medicaid program, Medi-Cal. 

We discuss:

• Which community supports are used most, or least? 
• One of the big learnings from CalAIM: the enhanced care management models that work for adults dont work for children
• How Medi-Cal is leveraging health plans as the organizers of social care because that’s where the members are
• The soon-to-be-released population health management service will address two big issues: standardized and equitable approaches to identifying high risk members and integrating state level benefits data, like for WIC 

Palav reminds us that CalAIM was built through listening:

“Not everyone may know this, but CalAIM was generated from a statewide listening tour. Our previous state Medicaid director went around the state and literally asked communities… rooms full of plans, members, providers, what do you need from Medi-Cal that isn't working today? [The]  smorgasbord of recommendations is what turned into CalAIM … Listening to the community and responding to the community's needs is in the core DNA of this program.”

Relevant Links

• Listen to our related episode “Reflecting on Year One of CalAIM with Jacey Cooper”
• CalAIM dashboard
• Population health management policy guide
• California and other states require managed care plans to reinvest in local communities
• NY waiver summary

About Our Guest

Dr. Palav Babaria was appointed Chief Quality Officer and Deputy Director of Quality and Population Health Management of the California Department of Health Care Services beginning in March 2021. She was formerly the Chief Administrative Officer of Ambulatory Services at Alameda Health System. In that capacity, she operationally and clinically oversaw 26 specialty clinics, four large primary care FQHCs, specialty and integrated behavioral health, and is responsible for all outpatient value-based payment programs. Prior to that role, she served as Medical Director of K6 Adult Medicine Clinic. She also has over a decade of global health experience and her work has been published in the New England Journal of Medicine, Academic Medicine, Social Science & Medicine, L.A. Times, and New York Times. Her areas of interest include ambulatory transformation in resource-limited settings, shifting to value-based care, and issues of gender in medicine. Babaria received her bachelor’s from Harvard College, as well as her MD and Masters in Health Science from Yale University. She completed her residency training in internal medicine and global health fellowship at the University of California, San Francisco

Source: https://carolemmottfoundation.org/fellow/palav-babaria-md-mhs/

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To achieve whole person care, we can try layering new social services on top of medical care. But Dr. Rishi Manchanda believes we should move further upstream and ask, what will it take to actually improve health in communities? From founding Rx the Vote to HealthBegins, Rishi is committed to building community social capital in America. 

We discuss:

• Why he created HealthBegins, which is now halfway to its goal of transforming equity in 250 communities by 2025
• How California is making practice transformation a foundation of whole person care
• Rx the Vote and the important role of health organizations in voter engagement
• Kaiser Permanente's health, housing and justice initiative

Rishi thinks all public health students should study and know how to shift the political determinants of health:

“I think we can recognize there's ways to… get the dollars out the door, get the services out the door, get the access that we need while [also building] local governance. And I think that's what I see as a really interesting opportunity for us in California… There are opportunities here for public health schools, including Berkeley, to [help] public health students… understand the political determinants of health and then understand their role [to]... address them and improve them.”

Relevant Links

HealthBegins website

Rishi’s book The Upstream Doctors

Rishi's TEDx Talk: "What Makes Us Get Sick? Look Upstream."

New collaborative community health planning model in California

Policy requiring California Medicaid health plans to invest 5-7.5% of profits into local communities 

California Medicaid investments in practice transformation

Kaiser Permanente's health, housing and justice initiative

Oregon CCO model

An interview with Rishi Manchanda

About Our Guest

Dr. Manchanda is Founder and President of HealthBegins, a social enterprise that provides training, clinic redesign, and technology to transform health care and the social determinants of health. Dr. Manchanda is a dual board-certified internist and pediatrician, a board member of the National Physicians Alliance, and a fellow in the California Health Care Foundation’s Healthcare Leadership Program. He is the lead physician for homeless primary care at the VA in Los Angeles, where he has built clinics for high-utilizer homeless veterans with complex chronic disease. Dr. Manchanda was the first Director of Social Medicine and Health Equity at a large community health center network in south Los Angeles. In 2008, he started RxDemocracy, a nonpartisan coalition that has registered over 30,000 voters in doctors’ offices and hospitals nationwide. His 2013 book, “The Upstream Doctors,” introduces a new model of the health care workforce that includes clinical “Upstreamists” who address social determinants of health.

Source: https://sirenetwork.ucsf.edu/staff/rishi-manchanda

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June 18th is “Maya Petersen” day in San Francisco, in honor of her work building disease models that guided the region through the early days of COVID and saved countless lives. 

With projects spanning from developing HIV prevention strategies in East Africa to shaping new Medicaid models in California, the UC Berkeley epidemiologist is building a future where local public health leaders have the tools and data to ask and answer complex policy decisions in real time. Now that’s a world I want to live in.

We discuss:

• How much better our pandemic response would have been if Public Health had access to integrated and linked data
• Her work to bring sophisticated data tools to the point of decision in East Africa
• How California is building population management infrastructure

San Francisco’s Director of Health, Grant Colfax, taught her an important lesson about showing up and helping:

“I remember… saying, ‘You know what? You really need to find somebody who's an expert in this, I'm not an expert in this.’ And he said, ‘Okay, Maya, but if you're gonna find me someone it needs to be in the next 24 hours, because I need help.’ And it was just a reminder that, you know, you're not always going to be an expert, sometimes you just need to show up, do your best… be clear about your uncertainty and communicate well, and that can be… a big service”

Relevant Links

Local Epidemic Modeling for the San Francisco Department of Public Health

San Francisco’s COVID strategy

Multi-sectorial Approach to HIV in East Africa

Maya Petersen Day in San Francisco

Maya’s UC Berkeley page

About Our Guest

Dr. Maya L. Petersen is Professor of Biostatistics and Epidemiology at the University of California, Berkeley. Dr. Petersen’s methodological research focuses on the development and application of novel causal inference methods to problems in health, with an emphasis on longitudinal data and adaptive treatment strategies (dynamic regimes), machine learning methods, adaptive designs, and study design and analytic strategies for cluster randomized trials. She is a Founding Editor of the Journal of Causal Inference and serves on the editorial board of Epidemiology. Her applied work focuses on developing and evaluating improved HIV prevention and care strategies. She currently serves as co-PI (with Dr. Diane Havlir and Dr. Moses Kamya) for the Sustainable East Africa Research in Community Health consortium, and as co-PI (with Dr. Elvin Geng) for the ADAPT-R study (a sequential multiple assignment randomized trial of behavioral interventions to optimize retention in HIV care).

Source: https://publichealth.berkeley.edu/people/maya-petersen

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