Intro: Welcome to A Hire Future in Healthcare, where we're exploring obstacles and solutions to healthcare's growing workforce demands. Tune in to hear from thought leaders as they share their perspectives on strategy, technology, AI and people who are paving the way for transformative change. Ubaldo: Hey, everybody. Welcome back to A Hire Future in Health Care. I'm Ubaldo Ciminieri, and I'm joined by Karen Conway and Michael Isaacs. You've heard them before. They're back. This time, Karen and Michael are paired up, and we're talking about equitable health care access. When you think about that and how you might balance business with the social responsibility that comes with a lot of health care, quality of care, value-based care, community care, just taking care of each other, right? First of all, welcome. How are you two doing? Karen: Doing well. Glad to be back. Michael: Doing great. Thanks to see you again. Ubaldo: Let's dive in, because I think first and foremost, I'd love to hear from both of you how you define equitable health care access. I think it's something that because of the pandemic, there was a big spotlight on access to health care and who has it, who didn't have it, et cetera. I'd love to hear from both of you. Karen, if you want to go first, how do you define that? What does that mean? Karen: Absolutely. I think it's obviously that ability of anybody to be able to access the kind of care and resources they need to be healthy. I think a lot of the discussion, particularly with the Affordable Care Act, was about insurance. That is certainly whether or not you have insurance or whether you have the ability to have insurance or to pay for that insurance or to pay for the care that insurance doesn't cover. That's one kind of access. Certainly another is if patients are on Medicare or more importantly on Medicaid, sometimes it's just being able to find a doctor, a nurse, a provider that will take that kind of insurance, et cetera. But the other is, I mean, it can be as simple as do you have transportation to even get to the doctor? I know I did some work with Kaiser Permanente and they were noticing that people were not showing up for their appointments. What had happened is they had moved the bus stop and the bus stop was just now too far away. They literally had to go down to city council and say, you know, you got to change this. Sometimes it's does that individual have time off? I mean, there is a myriad of things. And the other is quite frankly, and we've seen this since the National Academies of Medicine did their landmark report back in 2005, that the reality is that even when insurance status, income, age, severity of conditions are exactly the same, the fact is that people of color get lower quality care on average and that equates to worse outcomes. So we'll start there and we can talk a little bit more about how do we address that going forward. Ubaldo: Yeah, that's fascinating. What about you, Michael? Because I think you have in the work that you do at Hopscotch Health, I don't know, is it similarities, differences? How do you define that? Michael: Yeah. So, you know, at Hopscotch, we focus on the rural and primarily the Medicare patient population. So we focus a lot on access and everything that Karen was just talking about is spot on. I think additionally to that, it's even when you have all of those services, assuming that you have the coverage and you have the access to care and you have the transportation to get to where you need, it's still navigating the system itself. Because now, okay, my doctor wrote me a prescription, but they don't have it at my local pharmacy. So how do I get this prescription that I need to be healthy? How do I maintain a good diet when there's not healthy options in my community? So I think access to healthcare happens to be a lot more than just going to see your doctor. It becomes a whole community involvement that becomes, it's very complex. Ubaldo: Well, and Karen, you brought up the black population and I think not only the black population, but many underrepresented groups, even just the talent that's reflected in their local healthcare system isn't reflective of them oftentimes, right? And that's, I think that's where that equitable access, that doesn't feel achievable to them because, well, this doctor or this mental health provider, or even this nurse, they don't understand me and my culture and my health. So why, it's like, I don't feel comfortable enough to go to them. I don't see myself reflected. Karen: It's a critical issue. Absolutely. In terms of trust. So one is, one of the other measures of access is whether or not you have access to a regular provider, that family doctor, that person that's been treating your family and you trust them. And certainly in the black population, many, many wrongdoings in terms of like the Tuskegee Airmen, et cetera, that have created some deep seated mistrust as well. The other issue, or we've seen in rural America, and Michael could probably address this as well, particularly when a hospital might close, somebody might not be comfortable going to the other hospital. Just, you know, and particularly if they're not seeing people that understand them. I had done in grad school some work on how we could treat pediatric asthma in children of low socioeconomic status. And it was really important that we develop different strategies. Like with the black population, we worked with the churches. And so we would have church, people from the church were trained by a medical professional on how to go into the home or work with the kids after service about how to use their spacers. With the Hispanic population, it was more a matter of one, to speak the language. Another was, what about the fear of those folks who think that they may be undocumented and so they don't want to talk? And working with the Native American population, a completely different approach. So it's, you know, the end goal is the same, but the care has to be very customized. Ubaldo: Yeah. I mean, Michael, I imagine is that in the rural communities that you all operate in, is that exacerbated? Michael: Yeah. I mean, we see obviously the incidence of disease that we see in the rural communities is much more than disease that we see outside of those rural communities and the urban communities. And the ability for us to be able to connect with minority patients in those rural communities is extremely important. So that just goes back to basic. What I see is basic good healthcare hiring practices is that you need to have providers and the rest of the staff that is reflective of the community. Often we think that a rural community is monolithic. It's always a white community. That's not the case. Not the case at all. So we need to have a diverse staff who again can reach our patient population where they are. You know, if you look at the studies and they don't have the numbers in front of me, but I know that when you bring in a Black physician into a community that does not have one, it increases the overall health of the community drastically. And that's not just of the Black community, it's of the overall community. So these are really important things for us to look at providing care in rural communities. So this is, I look at each clinic that I have and look at the breakdown of the patient population, the overall population, the patient population, and then my staff to make sure that I'm not alienating patients who I'm trying to actually serve. Karen: One of the things that I think we forget about when we've had this workforce shortage as well is think about one of the best things you can do when we were talking about access. Sorry, I'm going to back up for a minute. I get myself confused here. You know, when we talk about access, you know, sometimes it's not access to health care. It's access to that which improves your health. And for some people, it's having a job that makes a livable wage is the best thing you can do. So as we start thinking about more disadvantaged communities, and I have done more work, so I really enjoy getting Michael's perspective from more rural, I have done more of my work in the more urban environments. And you think about like on the west side of Chicago, where, you know, the life expectancy is dramatically lower than it is just, you know, five, six miles away in more downtown Chicago. And, I mean, there's a number of really great programs being done, led by hospitals and health care systems to increase economic development, create job opportunities for people. And, you know, that's the best one of the best things that you can do. One, they get insurance, one they have the money to afford because just because you have insurance, etc. But you still have to have that trust. But you think about think about a resilient workforce. People who have lived through adversity, you know, they're the kind of people who can really make a difference in the lives of people in the operations of our health care system. Ubaldo: It's interesting because so my wife works in health care and she's working on sort of this benefit program. And we were having this conversation and she had asked me who I thought, whose response what I thought, whose responsibility is it for somebody's health? You know, it's kind of an interesting question. And it's I'm sure there's many different answers and perspectives on that. But to that point about, you know, having a job, right, or having a place to live, having food on the table, like it's all connected, but yet, it doesn't seem to be in practice, everything's very separate, right. And I get my initial answer in that case was, well, maybe it's the insurance company, because they don't want to pay out for, you know, major sickness or anything like that. So what can they do to help somebody stay healthier? But now you've got me thinking like it's it's way more connected, and there's way more involved there. Karen: It is all of us. It is, you know, a lot of times it does fall to the hospital or the health care system. And as an anchor institution, you know, one of those institutions, much like a university that, you know, they're anchored to the community, they're not apt to pick up and move and go someplace else. They are potentially apt to close if you know, they can't continue to operate. But but they can't do it alone. You know, particularly hospitals and health care systems dealing with some of the most financially challenging times ever. But, you know, it's also up to the community, the local businesses, the government, and it's up to all of us, you know, we all have a responsibility to keep ourselves as healthy as possible. So, you know, we need to work together. It's a system. Michael: So really interesting. I was talking to a physician earlier today, not not one of mine, not a you know, a member of my group yet. And I asked him what you know, if you could design your ideal role as a physician, what would that look like? And he started to describe what his clinic would look like. And his clinic had a gym with personal trainers, not for him, but for his patients. And his gym had a kitchen with chefs to teach his patients how to how to cook and it had a grocery store with only healthy food. And it was a very holistic approach to health. And he said, you know, I spend all my time not doing anything with health care. This is all sick care. Yeah, I could just actually teach people how to be healthy. That'd be nice. Karen: You know, I've got a I've got a good story that plays off of that, that I think, you know, is a little bit of his vision. One of my favorite success stories is what's called the Geisinger Fresh Food Pharmacy. Geisinger is a health care system that is in Pennsylvania, dealing with, you know, a fairly large Medicare and Medicaid population. And what they discovered is that they had a much higher rate of type two diabetes than the whole country. And type two diabetes is really an epidemic proportions in this country and a lot of other developed countries. And so they figured out, you know, they looked at who these patients were. And they discovered, you know, that they were getting a lot of their food from the food bank. And the food from the food bank was the worst food ever. Or people with type two diabetes. So what they did is they they worked with the clinicians, the dietitians and the supply chain to source better food for these folks. But they also recognized that in many cases, they didn't know what was good food for them for their particular condition. Some of them didn't have a hot plate, didn't have a refrigerator, didn't know how to shop or cook. So they surrounded them and provided all of these different kinds of services. And I'm very, very proud of some of the work that the supply chain did. But what's amazing is their the data, the patients were showing up less in the ED, they were being admitted less. Their labs were better. They were happier. The clinicians were happier. It was it was not just one thing. Ubaldo: Yeah. So how does that? Okay, so this is a perfect segue then into the business conversation, right? Business versus social responsibility. How do you do that? But also approach this as a business, you know, many for profit systems and things like that. How do you balance the two? Can you why is there not more of that happening? Like you both described that more holistic approach to health versus sick care? Michael: Yeah, and I've been on both sides of this equation. And I don't see the I don't actually see the the disagreement as much as there needs to be. I see it as a if you approach it from a value based care perspective. And our whole conversation has really been a really from a value based care perspective. You know, how do you drive true health outcomes as opposed to, you know, treating episodic illness? If you approach it from that way, whether you're nonprofit or for profit, you're driving the good in health care. And where I am now is is for profit. But we're driving the good for communities. And that's really what matters. I've been with nonprofits who that are very, you know, fee for service based and lose sight of the fact that there's a community involvement. And it's all about how many patients can we get in, I'm going to buy the practice and how many surgeries do we get and let's keep our our beds filled and the mission of health care can get lost even though they are a nonprofit. So I think it really comes down to, you know, not not what your tax status is, but what your core what you're really doing with it. Karen: Yeah, what's your mission? You know, this isn't about that I spend a lot of time thinking about and I have the opportunity to work with a lot of hospital CEOs and or health system CEOs and and CFOs. And so I really look at and again, I kind of I have to look at everything as a system and how things are connected. And, you know, so I'll talk I'll talk to them and you think about it, as I mentioned before, some of them worst financial year ever last year. Their patients are sicker, many of them put care off. They're staying in longer, they're more expensive to care for. In the meantime, inflation, everything's get costing more, you still have labor shortages, supply shortages, and the staff is burned out. And so you come, hey, we want you to address health equity, and access to care and also things like climate change, which are which is also a critical need because the sad fact is, is that healthcare operations are a major contributor to greenhouse gas emissions. But that's a whole nother. But anyway, you go, now you want me to deal with these things, I can't do it. Yeah, my argument to them is actually if you look at the intersection of health equity, environmental sustainability, and the economics of healthcare delivery, particularly around chronic disease, we spend 90% of our national healthcare expenditures on chronic disease. So you go, how do we lower chronic disease, because in a volume based healthcare system, we have tended to focus on those high dollar procedures, you know, and so what's going to bring money in the door. And it's just a matter of doing business. It's not that people are bad because they're doing that. But in a value based business, we need to have good financial business practices based on keeping people healthy. And so it is about focusing on, you know, so you got to get to the root cause. What's causing the rise in healthcare and you know, folks like Fitch would say, it's chronic disease, and the growth in the number of chronic diseases that people have, that is a major, you know, a real drag on our national economy. So and the fact is, as people say, well, I don't make as much money on somebody with chronic disease. Well, you know what, you're losing money, because that person might come in for that high dollar procedure, like a knee replacement, a hip replacement, etc. And if they're obese, if they have diabetes, if they have any of these other things, they are a much higher cost patient to take care of. And they are very likely, much more likely to come back, be readmitted. And that's care that that hospital is no longer. Don't get reimbursed for that. They don't get reimbursed for that, right. Ubaldo: Wow. So, man, my mind's racing. I mean, there's, it's the well, and then I mean, if you think it's also a quantity number two, because you know, the population of people who are aging and getting older, does that is that equal to that chronic disease rate, right? Like that growth in chronic disease rate or, or is that more spread out? Karen: Well, you would think and yes, you get older, you get more chronic diseases, you know, you get arthritis, you know, you know, chronic disease. But the fact is, is that children who live at or below the poverty level have a 33% higher risk of getting a chronic disease and they're getting it 10 to 15 years younger than their white peers. As an example, it really is an issue of poverty. The fact is, is that people of color tend to be disproportionately more in the lower income areas. But the other fact is, is that you get one chronic disease, they're generally inflammatory, you are much more likely to get another chronic disease and another chronic disease. Michael: And, and to add onto this with, with many of these chronic diseases, they're often, they're mismanaged. I'm not saying that the physicians are mismanaged, but they, the people who have them are falling through the cracks. And so this is where we can do so much better because it's, it's not like, you know, a cancer where you're, you're diagnosed with it and then, oh my gosh, there's all these other things that may come. This is like, if you get in front of it, you're, it's very easy to manage these things. And so it's, you know, it's like a ground ball that you just like go through your legs kind of thing. And the other question you were asking. And we can just get in front of them. Karen: And who's responsible, you know, we always think it needs to be the doctor. You know, there's some very successful programs where it's called chronic disease peer management, where, you know, I have asthma and I could work with somebody else who has asthma and I could be a support system. So it's not always the doctor or the nurse that we need to help with this. Ubaldo: Well, so then, so final topic, and this goes right into the workforce, like how, what are some good approaches maybe to building your workforce with people who think more along the lines of social responsibility, right. And understand all of these ideas and strategies that you all have been talking about and can help play a role. It's almost like a Trojan horse to fixing this, right? Like if we hire, you know, more nurses and more techs who align with this part of the mission, you know, then maybe we can really solve for this at the ground level, right? Like they're the front lines. They can sort of help with this. Is that, like, how do we do that? Is that a good strategy? How do we get to balancing this better and taking care of the community better? Michael: Yeah, well, you know, as we were sort of talking about how COVID really created that bifurcation, if you will, of the workforce, where you had people who had the opportunity to go work in other industries and make more money or stay within healthcare because they were mission driven. And then as an organization, you had the opportunity to make the decision to, am I going to create a hiring plan that is mission driven? Doesn't mean I'm not going to increase wage rates, but am I going to create a mission driven retention plan or am I just going to throw money after money after money to try to keep people? And so I think that was sort of the first decision about that. And so now the organizations have made that mission driven organization, you know, decision that we're going to go after people who want to help people. That's the key decision right away, right? So now how do I retain these people? How do I continue to grow them and do all of that? It's a huge one, a huge lift, but it is necessary within an environment in which wages are going up and everything else. But that is really the key in an environment where all of that is moving right under your feet. Karen: I think the mission, you know, that's certainly one of the keys in particularly. I think, you know, I don't like to generalize about, you know, different generations, but I think we are seeing more of that. You know, people want to work for companies that are taking care of the people who work there as well as, you know, taking care of people in their community. There's lots and lots of data. I want to make one point related to kind of our value-based and our volume-based because a lot of times people, you know, we were saying, really, if you're moving to a value-based healthcare system, you're going to see a lot more of these drivers. But I'm seeing even in markets that are still very fee for servicencompensation, like the CEO of Freight Art in Milwaukee, still very much fee for service market. And she said, we must work on the economic development in the communities. And that includes looking to people in those communities to hire because the reality is we can't with the workforce that we have, we can't handle this demand. So one of the things that they're actually doing is investing about $100,000 a year in each, in different individuals, training them while they're on the job to become, for example, surgical techs. Filling a need. But they're making this investment. And, you know, what kind of loyalty do you have in an organization? You know, and then I, you know, I think I've mentioned before possibly but a program that I learned about in Chicago called Jump Higher, where they were, this was a supply chain program, where they, they had identified that they had, you know, they had shortages in supply chain. And so they worked with some different institutions and had a cohort of people who got stipends if needed, transportation if needed, childcare if needed. And they were, they were given opportunities to learn like life skills and soft skills or power skills, as some people call them, like communications, customer service. But they also were able to do job shadowing. And a job shadowed with the supply chain. This was at Rush University Medical Center and also with their distributor concordance. Every single person who graduated from that first cohort got a job paying at least $65,000 a year. Wow, that's great. And that's a career. People don't think about, you know, supply chain is not until the pandemic. But that's it. There's a career pathway. Yeah. So that, you know, it's those kinds of things. And again, looking at all the different kinds of workers and talent and skills that we need in our organizations to keep the wheels of healthcare moving. Ubaldo: That's incredible. Well, and I love, you know, when you were talking about going into the community and sort of teaching people at the churches how to go and take care of, you know, their neighbors. You know, you see a lot of that. I was part of an organization called CU Peru that would do that in the Amazon, right? They would teach community health workers to go back to their villages in the very remote parts of the Amazon to take care of their village. And it's sort of a fascinating and what an interesting strategy to consider as we fight this workforce problem that we're facing of finding enough people to help take care. Like, and what a maybe what a great way to solve that, that, hey, nobody looks like me in this healthcare system. Well, community healthcare workers could be an interesting solution and like programs like you just talked about, Karen, like, how do why don't we go out and create something within the community where now I look like someone who's trying to help me stay healthy. And it's true healthcare. I just think that could be really interesting and really fascinating to think about. I love that. I love that. Karen: I think it's a matter of to use a really bad healthcare analogy. It's different between putting a bandaid on the problem. Yeah. And I don't remember, somebody told me this story once and it was about doctors were standing at the side of a river and babies were floating down the river. And so they were pulling these babies out of the river as fast as they possibly could. And suddenly one of the doctors just walked away. People are going, where are you going? We need you. And he goes, I'm going upstream. I want to know why the babies are ending up in the river to begin with. So, you know, understand root cause and then find out, you know, what's customized the solution and find out who the partners are and, and create more of a systemic solution to the problem. Ubaldo: I love that. That's, I love that as a great final thought, Karen, for you and Michael, what any, any final thoughts on this conversation? Michael: Yeah. I just, hard to follow that one to be honest. Ubaldo: I was already asking cause I'm like, that was like, wow, that's a great place to end. Well then let's leave it at that. That's a great, great conversation. Thank you both as always. You know, we got to keep having these conversations. This is, this is our lives we're talking about. And so thank you both. Thank you audience for continuing to tune in and listen. Stay tuned cause we'll have more episodes just like this coming, coming your way. All right, everybody take care. Extro: A Hire Future in Healthcare is a production of IIA Healthcare, a healthcare technology company and creators of interviewIA, an interview platform for healthcare organizations to streamline their interview processes to deliver unparalleled candidate experiences and to create a true competitive advantage for delivering quality care. Learn more at www.iiahealthcare.com.