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 conditions
• The power of narrative to shape policy choices towards either belonging or exclusion
• How California communities applied this framework to dramatically change school climate and reduce suspensions

Tony 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 health
• Building healthy communities: Five drivers of change
• Shifting from technocratic to democratic solutions: A radical vision for health and racial equality
• Unnatural Causes documentary

About 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.

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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 

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 innovation
• The technology and data infrastructure states are building for whole person health
• How states are partnering with nonprofit health data utilities 
• The big miss from the national EHR rollout: user-centered design 

Jess 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

About Our Guest

Jess Kahn has over 25 years of experience in national, state, and local healthcare programs in government, not-for-profit, and corporate settings. She is a partner at McKinsey specializing in state Medicaid and social services programs, public-sector data, and technology. Jess was recently named one of the four Most Influential Women in Healthcare IT by HIMSS for 2018. Prior to joining McKinsey, Jess led data and systems for Medicaid at the Centers for Medicare & Medicaid Services, including authoring major policies governing $5 billion in annual federal investments in state eligibility, claims processing, data analytics and health information exchange systems – establishing the Medicaid EHR Incentive Program, and building the flagship national Medicaid data set.

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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 

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 client
• Closing the gap between intellectuals (policymakers) and mechanicals (implementers)
• What policymakers can learn from agile 
• Using data as a compass not a grade

Jen 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 digital age. She founded Code for America in 2010 and led the organization for ten years. In 2013, she took a leave of absence to serve as U.S. Deputy Chief Technology Officer under President Obama and helped found the United States Digital Service. She served on the Defense Innovation Board, started by the late Ash Carter, under Presidents Obama and Trump. At the start of the pandemic, she also co-founded United States Digital Response, which helps government meet the needs of the public with volunteer tech support. She has received the Skoll Award for Social Entrepreneurship, and was named by Wired as one of the 25 people who has most shaped the past 25 years. Jennifer is a graduate of Yale University and lives in California with her husband, Tim O’Reilly.

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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.

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 members
• How member grievance and appeal data provides a roadmap to missed opportunities, discrimination and road blocks
• Health 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 partners

Dr. 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 HIV.

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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

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 systems
• That we should not bank on savings from whole person care
• The 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 inequity

The 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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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.

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 harms
• Organizations 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 data
• Success requires ecosystem thinking, effective partnering and purposely balancing power differentials 
• Addressing equity takes time and trust
• Learning in public – like we are doing on this podcast – is critically important to speed the national learning curve on health beyond medical care

Claudia 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.

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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.

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 health
• Deep dives on reentry and housing for health
• His suggestions for CalAIM: broader eligibility, improved access to services, and making community supports an actual benefit
• Creating sustainable work and impact

Clemens 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.

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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.

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 Diabetes
• The negative consequences of separating the brain and the body in healthcare delivery and policy
• Why she’s fired up about closing health equity gaps
• How Medicaid founders can get paid for outcomes and pick the right markets

Corbin 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. 

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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.

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 prison
• Behavioral health redesign, payment reform, transitions of care, and administrative integration of mental health and substance use disorder services

Jacey 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 [PDF 1] [PDF 2]

Reflections on CalAIM’s first year [Blog]

About Our Guest

Jacey Cooper serves as State Medicaid Director and Chief Deputy Director for Health Care Programs at the California Department of Health Care Services (DHCS). Ms. Cooper is responsible for the overall leadership of Benefits, Eligibility, Delivery Systems, Financing, Behavioral Health, Quality, and Population Health. Prior to serving as State Medicaid Director, Jacey served in various roles at DHCS beginning in April 2016. Prior to her work at DHCS, Ms. Cooper was Vice President at Kern Medical Center, a public hospital and a health care consultant. Through that work, she gained more than 15 years’ experience in health care policy, operations, integrated delivery models, managed care, business development, and quality monitoring.

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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.

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 horizon
• How equity and social drivers are becoming the new hustle
• Why healthcare should borrow less from other industries
• How “no margin, no mission” is creating ethical laxity
• Unfinished business from our time together at ONC

Sachin 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. 

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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.