The Other 80

Before the phrase “social drivers of health” was commonly used, Community Health Centers had already developed a model of care that was holistic, grounded in social change and embedded in the community. At this year’s HLTH Conference in Las Vegas, I sat down with Dr. Kyu Rhee, the new CEO of the National Association of Community Health Centers. Dr. Rhee brings a fresh perspective to NACHC as a clinician and an immigrant with broad experience in policy, clinical practice and technology.

We discuss:

• What medicine would look like if every doctor was trained in a community health center, not just in fancy hospitals.
• How CHCs knock quality metrics out of the park while improving equity.
• One secret to community embeddedness: Every CHC must name patients to at least half of the governing board seats.
• The new prescriptions to improve health: food and iPads.

Kyu reminds us that changing an entire system can’t happen overnight, we need patience and passion:

“Earlier in my career as a medical director, I was like, “We got to fix this!” And I think I had to learn that there's so many angles on how you see a problem … so that passion of advocating for health equity and the injustices, you have to be thoughtful about allowing that passion to be part of your purpose, but also being patient in the process.”

Relevant Links

Website for the National Association of Community Health Centers

Economic Impact of Community Health Centre in the United States [PDF]

America’s Health Centers by the Numbers [PDF]

"How the Civil Rights Movement Gave Rise to Community Health Centers" [BLOG]

About Our Guest

Dr. Kyu (“Q”) Rhee, MD, MPP, joined the National Association of Community Health Centers as CEO in 2023. He leads efforts to advance health equity and support the mission of community health centers, which provide high-quality, affordable, transdisciplinary primary care services to more than 31.5 million people at over 14,000 sites across the nation. He has held leadership roles as the Senior Vice President and Aetna Chief Medical Officer at CVS Health, as the Chief Health Officer at IBM, and as Chief Public Health Officer at the Health Resources and Services Administration. Dr. Rhee has a medical degree from the University of Southern California and a masters degree from Harvard University’s John F. Kennedy School of Government.

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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 

Is whole health here to stay, or is it a shiny new object? Our guest today is Dr. Shantanu Agrawal, Chief Health Officer at Elevance Health. He falls soundly on the “here to stay” side of the ledger. He shares that whole health is not a side business for Elevance Health and its 47.5 million members. It is the core strategy for how the company will achieve value and affordability. And it’s also what patients want.

We dive into:

• Whether the US could get better outcomes at the same cost by redirecting resources from medical to social care.
• Why and how Elevance developed its Whole Health Index.
• The Elevance foundation’s three-part focus: maternal health, food as medicine and substance use disorders.
• The need for a new quality paradigm that measures whole health, not clinical care for individual body parts.

Shantanu calls for a deeper look at US health spending and outcomes compared to other countries:

“People often make this comparison, ‘well, our health outcomes are generally worse, we spend a lot of money in health care’. However, when you actually look at the total expense on health and social care across all these countries, it actually looks pretty similar. We are more on par with our peers, or they're more on par with us from a cost standpoint. But it is true - our health outcomes are worse. Well, why is that? Well, maybe it's because we've emphasized health care, and not care of a person's health, which means being inclusive of social and being upstream and working earlier in their life. Perhaps if we do this, we will right size the equation for our country.”

Relevant Links

More information on Elevance’s Whole Health Index [PDF]

Health Affairs article on “A Whole Health Population-Based Payment Approach”

Committing to Whole Health: A Conversation with Felicia Norwood & Dr. Shantanu Agrawal [VIDEO]

Distinguishing Health Equity and Health Care Equity: A Framework for Measurement 

About Our Guest

Shantanu Agrawal, MD, MPhil is chief health officer at Elevance Health, where he oversees the enterprise whole health strategy, including medical policy and clinical quality, as well as the company’s industry-leading work to address health-related social needs and health equity. Passionate about improving health outcomes and reducing disparities, Agrawal draws on his clinical and business expertise to push for a more equitable health space for the people Elevance Health serves. He also leads Elevance Health’s community health strategy and the Elevance Health Foundation. Previously, Dr. Agrawal served as president and CEO of the National Quality Forum, deputy administrator for the Centers for Medicare and Medicaid Services, and director of one of its largest centers, the Center for Program Integrity.

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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. 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.