Techquity Series: Cultural Perspectives in Health Tech

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[00:00:08] Hello and welcome back to the HIT Like a Girl Podcast. I'm your host, Joy Brios, and today we continue our deep dive into Techquity, our five part series focused on digital health equity. Each episode we'll explore different facets of how technology can bridge gaps in health care to ensure equitable outcomes for all.

[00:00:26] Joining us again to kick off this interview is Jana Guidon from the Health Foundation. Today, Jana will discuss the coalition's current endeavors, including drafting vital recommendations and those best practices that can be used in the health care industry.

[00:00:41] Welcome back, Jana. It's wonderful to have you share these initiatives with us. I'm so grateful for you.

[00:00:46] Hi, Joy. Thanks for having me back. For anyone who is just joining us for the first time today, Health Foundation is a nonprofit organization that has an initiative called the Techquity for Health Coalition.

[00:00:58] And as Joy mentioned, we're working on developing best practices, recommendations and also metrics for digital health equity or Techquity.

[00:01:07] We just finished our first Techquity for Health case study competition in February. So in this series, you will hear from five different winners in an interview. And here we are, Joy and I are just kind of giving you some context here about the coalition and about Techquity to set up these interviews.

[00:01:23] So they'll be, you'll have a little more context for the conversation. So now that we've concluded the competition, we have the coalition has a really fantastic, rich database of information from our close to 200 submissions that we got through this competition.

[00:01:40] And this is what we're going to use to kind of learn and to check our understanding of perceptions of Techquity, practice of Techquity today and where we think it should be.

[00:01:50] So we want to provide evidence based information on how to use digital health and data to reduce health disparities and also to avoid or eliminate, eliminate inequities in health care.

[00:02:01] And there have been many famous examples of how Techquity could really get in the way of that, but also just as many I think of how technology can be extremely helpful in like decreasing barriers in many ways and making health care more accessible, potentially more affordable and effective.

[00:02:18] So that's what we're working on. And we are only focused on underserved populations. So the people most in need in our country.

[00:02:26] We just want to influence how every single stakeholder in health care technology. I shouldn't use the word just because this is such a bold thing to say, but we hope that this happens.

[00:02:36] The dream is to influence the way stakeholders in health technology consider health equity from the outset of any project.

[00:02:44] So whether it's an app or telehealth program or any other tech enabled intervention or use of data or algorithmic analytics, like all of it just needs, we need to have that consideration.

[00:02:55] So using these insights right now, we are preparing a white paper that highlights what we identified as best practices through this case study and our prior work.

[00:03:04] And we're also planning to publish the individual winning projects. And we want people to see in detail these case studies and to make them visible to a wider audience.

[00:03:13] And then the next kind of thing that we're planning, we're launching a Techquity Learning Collaborative.

[00:03:18] And this will be a chance for our winners, case study winners and our advisors at first. We're kind of treating it like a beta.

[00:03:25] And the goal is to foster this community of mutual support and knowledge exchange in Techquity.

[00:03:31] So again, it's sort of going to be beta at the beginning, but our winners expressed a strong desire to get to know one another, to learn from one another.

[00:03:38] And our advisors are also equally invested. So we're going to start with them and just we'll see how it goes right after that.

[00:03:46] If everything goes well, and we think that we have some real value to offer everyone else, then we'll consider opening it up to make a larger like industry wide Techquity Learning Collaborative.

[00:03:55] We'll just see. And then generally, I will say that this is going to be a huge year of outreach for the Techquity Coalition.

[00:04:02] A few of the things we have coming up are a roundtable which will host Health Europe.

[00:04:07] And the purpose of that is really to just begin to get feedback on our best practices and recommendations that we're putting out shortly.

[00:04:15] And gather information from people in other nations about the conversation, you know, the culture of health equity, of digital health equity.

[00:04:23] Who are the leaders? What are the projects? Just start to understand so that eventually we can build that bridge and adapt our recommendations.

[00:04:31] For other places. And then, you know, I'm working on, I won't go into it all, but I'll just say I'm working on bridging to other organizations, developing partnerships.

[00:04:42] One important one for me this year is sitting on the Digital Health Collaborative that Peterson Health Technology Institute has rolled out.

[00:04:50] I'm very thrilled that they are considering Techquity as a really important aspect of the work that they are doing.

[00:04:57] And we'll be, you know, conducting workshops and out there speaking about Techquity this year. Again, just a big year of outreach for us.

[00:05:03] You guys have so much going on. You've come so far and you have so far to go.

[00:05:09] But it's just really, really, really exciting to see how far you have come and the progress that has already been made.

[00:05:17] And it's remarkable how many insights you've been able to collect in just this short amount of time.

[00:05:22] And so I am so excited to see the progress and how you guys are taking this conversation globally.

[00:05:29] And that like the expanse and impact of your work is really, really impressive.

[00:05:35] So thank you so much for what you're doing. Now let's turn to the exciting part.

[00:05:40] Who is joining us today, Jana? Can you tell us a bit about our interviewer and the incredible awardee we'll be hearing from?

[00:05:47] This is going to be a great conversation. Today's guest is Chrissy Kawahine, who is director of clinical and patient informatics at the Waianae Coast Comprehensive Health Center in Anahuahua in Hawaii.

[00:05:59] She is being interviewed by Dr. Michael Penn, who is a physician advisor for health equity and innovation at the American Medical Association.

[00:06:08] And I will say this is a giant of a conversation. I know you were there for it was just been it was really interesting.

[00:06:16] And they just brought so much to the table in this conversation.

[00:06:19] So Chrissy's project addresses digital literacy and connectivity among elderly Native Hawaiians.

[00:06:25] And I'll just point out a couple of things. One really interesting aspect she mentions is the use of digital navigators.

[00:06:33] And they're people who helped the program participants feel comfortable engaging with technology.

[00:06:38] This is just she she did a lot of work to understand what it would take to get people to to really engage.

[00:06:44] She also weaves in a few Native Hawaiian words, which I just loved hearing.

[00:06:48] That's a fun bit. She's a really good cultural ambassador.

[00:06:51] And it's something that when you meet her, you'll just hear it's just a part of how she how she lives every day, like knitting together Native Hawaiian culture together for the rest of us who may not like.

[00:07:03] Really understand the values, the words, etc. So that was fun.

[00:07:07] Chrissy's an informatics leader and she has a really deep data set like an enviable data set at her fingertips decades of patient data.

[00:07:16] And because she serves a large indigenous population, her project was set up to combine a really tight like evidence mindset, very experienced group there.

[00:07:26] The soft skills of valuing community, respecting culture.

[00:07:31] And there's also a big piece of this at the beginning that talks about historical context and the meaning of historical context and why it's important in delivering programs around equity.

[00:07:41] So I'm going to say to anyone who is listening, who's a skeptic about the importance of soft skills and how those can lead to results.

[00:07:48] So I guess we will send until the end because another really exciting part of the conversation does come at the end.

[00:07:54] YNA Coast has developed what they call an impact ability score.

[00:07:58] This is something that they made up. This shows just because of the data they have.

[00:08:02] Let me just add it's just because of the depth and the breadth of data.

[00:08:06] They're able to show what kind of influence they can have on individual patients and their behaviors.

[00:08:12] And they can pinpoint the approaches that will influence that patient's behavior and cost.

[00:08:17] So overall, my takeaways from this conversation are that when you develop programs with collaboration and respect for culture and then you have appropriate data capture, eventually, and this is what Chrissy leaves us with, eventually you will be in a place where you can negotiate your own models with payers.

[00:08:35] So this is a really good one. Let's turn it over to Michael and Chrissy.

[00:08:39] Hello, I am Michael Penn, Physician Advisor for Health Equity and Innovation at the American Medical Association and also Advisor to Health Foundation's Tech-O-D for Health Coalition.

[00:08:51] And today I'm here with Chrissy Kuahine, Director of Clinical and Patient Informatics at the YNA Coast Comprehensive Health Center.

[00:09:00] Welcome, Chrissy.

[00:09:01] Aloha, kakākiakā, Michael.

[00:09:04] Aloha. Kākiakā means morning, right?

[00:09:07] Good morning, yes.

[00:09:08] Tell us about who you are, what you do and how that helps the health center that you work at.

[00:09:17] Sure. Well, mahalo first of all for having me here. I really, nice seeing you again by the way, Michael. We were both at ATA.

[00:09:24] Yeah.

[00:09:25] I work at the Wānāi Coast Comprehensive Health Center. We're a federally qualified community health center in Hawaii on the island of Oahu on the west side of Oahu.

[00:09:35] And I always say the west side is the best. It's interesting, west side is best side. For community health centers, it's interesting folks always ask what do we do?

[00:09:43] And quite honestly, we do everything.

[00:09:45] I think the last statistics that I've heard from NAC, National Association of Community Health Centers, one in four folks in the United States have received or are receiving services from a community health center.

[00:09:57] Sometimes whether they know it or not. And so really for our health center, I think we're unique in the fact that we, our patient population is predominantly Native Hawaiian of Native Hawaiian descent.

[00:10:09] And so with that, we have to address some unique cultural aspects as well as historical.

[00:10:15] And so I've been here now for 34 years when people ask what I do and worn many hats over that time. So I have some good clinical insight.

[00:10:23] I was a medical assistant for many years and then move over to the technology side when we switched from our paper to an electronic medical record, which is now gosh 24 years.

[00:10:33] So I will have to say our health center is really, I think, a testament to community driven health care.

[00:10:39] I think we've done a really good job of blending tradition and innovation. Western medicine and Native Hawaiian medicine.

[00:10:47] We have a Native Hawaiian Healing Center. And so we know the importance of reconnecting or keeping the connection of health care when it comes to there's a place for Western medicine, but also traditional practices.

[00:11:01] I want to unpack the cultural aspect a bit because I think one of the greatest opportunities, I think in health care is to actually tailor and target the delivery of care through the lens of a patient's cultural lived experience.

[00:11:19] And so one, can you give us insight into how that impacts care? Right. So how do you make decisions based on insights that you have from a cultural perspective?

[00:11:32] And then I want to ask a broader question. Sure. Absolutely. I think what it comes down to really from a community perspective.

[00:11:40] So wherever you serve, whatever their cultural background is, again, we're predominantly Native Hawaiian, but we also have other cultures.

[00:11:47] We have our Pacific Islanders in our Asian community. And so really it's the connection with community.

[00:11:53] And I was just talking to some folks who came out here to introduce a particular new technology and they asked the same question.

[00:12:01] And so really it is about going out into the community. So it helps I'm born and raised here.

[00:12:06] I live in my community, work in my community, but going out to our different community summits, to our grassroots, different organizations, and really hearing what our communities priorities are and what their needs are.

[00:12:18] And in terms of health care, I mean, there's lots of health inequity. There are a lot of in terms of digital, there are a lot of digital inequities that we know exist.

[00:12:27] And so really what I feel like my job and the value I bring to my organization, my community is listening.

[00:12:34] Listening to really what folks needs are. I might think that they need something. My executive team might think that the community needs something.

[00:12:41] But really it's about making sure you listen, you communicate, being open to what people's lived experiences are because really that's going to shape what we can do best for our community.

[00:12:52] Thank you for that. So you recently won the Tequity in Action Award for a specific project that addressed some of these barriers that you just alluded to for the indigenous older elderly population.

[00:13:06] And this was a special award sponsored by the American Medical Association in conjunction with the Health Foundation's Tequity for Health Coalition.

[00:13:14] So tell us at a high level about this project, right? What problems were you trying to solve and what did you actually accomplish?

[00:13:22] Well first and foremost it really was kind of a surprise. I mean I submitted the case study just in hopes of having 10 minutes to share what we experienced and what I really feel like is something that's replicable in other communities.

[00:13:36] So really honestly as I go through it, you'll kind of break down and go wait. There's not really anything special or hard about it. It's just a matter of understanding the greatest need and then having in our case we targeted and focused on a particular population.

[00:13:52] And so from 2020 we were able to very quickly in our EHR system create a way that we could collect data. I think I alluded to that as to why our folks were connecting via telephone versus to televideo.

[00:14:06] And so what we quickly learned is we have two things. We have access issues, right? So whether or not again unstable or just no internet access at all.

[00:14:16] But we also saw that there were some little digital literacy issues and especially in our patient surveys that we take included in 2020, we started to include telehealth as an experience overall satisfaction.

[00:14:30] How hard is it to connect and we then break it down into age. So maybe not surprisingly but surprisingly to me as they got older, the ability to connect without having any problems was much higher for our 60 plus.

[00:14:47] But the other thing is too here we all live multi generational. I mean more a lot of it is cultural but then some is economics. It's high cost of living here.

[00:14:56] So I think we saw with our own families, our Kapuna were afraid of going out because they were getting sick. But at the same time when it comes to the digital literacy part they may be connected.

[00:15:07] But I don't know about other cases in the US but our folks because of cybersecurity and people are elders, Kapuna are elders getting scammed. It was always don't click the link, don't click the link.

[00:15:18] And then I remind folks to connect with your provider, you get a text or an email and how do you connect? You have to connect the link. I mean click the link right?

[00:15:28] And so it's a matter of educating our Kapuna in this case and we really targeted them because we also have a Kapuna council. So an elders council that runs our traditional healing side of our services.

[00:15:42] And they were giving feedback about hey my peers, my Kapuna friends, they're afraid but and so what was happening is they just weren't seeing their doctor, they weren't following up.

[00:15:52] And so I talked to my Kapuna, my auntie Nalani and we together said hey let's put something together. Make sure that we address everything that we need to in terms of creating a tailored computer basics.

[00:16:06] Not 101, 001 and get the right trainer and the right folks involved. And so we did that and then I needed access. So I made friends with the for profit and we're going to talk about that in a little bit.

[00:16:17] But we set up a community Wi-Fi which was essentially for that program but now has blossomed into a community Wi-Fi initiative. So the access part of it addressing that.

[00:16:26] I guess I want to challenge you a little bit around this is easy because I've learned a lot more detail from you since providing the award.

[00:16:35] You're a pretty unique individual and the things you take for granted in terms of being a connector, being really taking the initiative, being a native Hawaiian right like all of those things it seems to me are really critical.

[00:16:51] So what is translatable? Right so if you can distill down because not every place has a Chrissy. I mean they may have approximations but yeah talk to me about the generalizability.

[00:17:04] Sure. So number one, you can't do it by yourself. That's not only me. I will say probably one of my strengths is I like to make friends and I'm always honestly I'm always open to what others may not think is opportunity.

[00:17:17] And it's not to say that I make friends and somehow we end up with a project but you don't know unless you are open to the idea and then really what we call in Hawaii talk story.

[00:17:28] Right and I don't know if it's maybe folks don't have time or think that it's maybe not worth the time to talk story but it's pretty cool how far you can go with just letting folks know what your initiative is whether it's for you, your community, your organization.

[00:17:43] And then all of a sudden you find like there's some common goal. And so that's really I think putting the strategic partnership part together.

[00:17:51] In terms of what's relatable in each community, we all have a target population whether that's going to be a kapuna, your elder whether that's going to be if you're looking at the younger generation in Hawaii we call that our OPO right our young ones that are coming up.

[00:18:06] And if anybody that we want to make sure we instill whatever initiative it is right whether it's improving health literacy whether it's letting them know that they all know technology is here but how can we use it whether to shape a career path or in our case quite honestly when we set up the kapuna program we knew that they weren't going to come by themselves.

[00:18:27] So we said make sure bring your caregiver bring your mo'opuna right your grandchild and sure enough there are quite a few kapuna who brought their sixth grade mo'opuna right their grandchild because if anybody knows technology it's going to be them and how wonderful that is right to build that relationship between your kapuna and your mo'opuna.

[00:18:49] But then also to now they have a common bond and really now your kapuna is learning and not just no grandma I'll do it for you kind of thing and so that's I think that's relatable I mean right there's relationships and family.

[00:19:02] And then at the same time understanding I think going back to what your community culture is I understood we understood kapuna not going to come by themselves.

[00:19:11] I think just making sure we had digital navigators because kapuna more likely or they're not going to be willing to raise their hand if they're lost or left behind in that part of the training.

[00:19:20] So I think just making sure again you and I didn't do it myself auntie nalani what do we do how do we I issue with my connector and she had kapuna who like right up until the day before the class called her and said I don't know do you think I can do you think I have I feel nervous I've never turned on a laptop.

[00:19:38] And so having those folks that can also make the connection because I'm not kapuna yet and maybe pretty close but I'm not yet so having the kapuna peer so that they can motivate and bring confidence to each other.

[00:19:51] So the other thing I heard is somebody in the organization needs to have an external lens strategic partnerships lens and the personality that would support that and the skills and the gifts that would support that.

[00:20:07] I also heard your kapuna council your healing council forget exactly though so that's beautiful right like that recognizing that there's healing beyond western traditions and that it so talk to us about that marriage that blending because it seems to me that I know that fqhc is tend to have people from the community on their governing boards.

[00:20:33] But it sounds like what you've put together is even beyond that and so yeah talk to us about marriage of the council.

[00:20:40] Then you're right on so on the real beauty of community health centers is you have a board over 51 over 50% of your board has to be patients from your community.

[00:20:50] So really community health centers are driven by their community board on top of that for us our native Hawaiian healing center which we do have like a physical native Hawaiian healing center that was built here on campus and each in the kapuna council each of them are practitioners.

[00:21:04] So one may specialize in la la which is use of herbs and medicines herbs for medicine.

[00:21:12] No me and if I say don't be lonely massage so there's a practitioner for that so each of those folks have been blessed with that gift that healing gift and so they bring that to our community and how that's we've into western medicine the way that it works is our western practitioners don't refer like you would in a normal referral but our community normally.

[00:21:33] Our community knows that it's available because that's really part of everyone growing up and so they know that they can go there at any time and that's for employees as well and use any of those services in cleaning hope on a panel that's one of a big one I always like to highlight this one.

[00:21:48] Is a way for conflict resolution so it's a non traditional way of conflict resolution very important and native Hawaiian tradition and households so if you can imagine this if a family is having conflict whether some P.

[00:22:04] Some conflict that's happening some a lot of times that can manifest with all you going to your doctor and my stomach hurts all the time or I have a headache all the time or I just don't feel well a lot of times western medicine will hear let's take an acid or some kind of pill when in reality if you really break it down maybe there's some family strife that's happening.

[00:22:24] So hope on a panel is we're bringing everyone together and directing really the root of the issue which may not be physical but it's emotional that's now manifesting itself as physical so yeah there's I think that's really the beauty of just bringing those things together because then you're really truly from a traditional native Hawaiian aspect you are healing the person and that's the whole holistic approach and so I was so grateful fortunate we're able to provide that.

[00:22:51] To community who really just historically that has been had been lost because of European occupation and some things that have happened in the past but that now have brought us to where we're at so there's definitely a healing aspect that I think is so important.

[00:23:07] At the risk of opening a can of worms you mentioned essentially colonialism right European occupation and had a opportunity recently to travel to Montgomery Alabama and there's series of museums monuments and memorials that really unpack the experience of slavery and Jim Crow and reconstruction and racism and mass incarceration and I don't think until going through those sites a pre-release.

[00:23:35] And I think the healthcare community often looks at disparities almost through the lens of well why are these people doing this to them right like why can't they make better choices and if you actually look at the history right like the history of the world and the history of the world.

[00:24:25] They approach care delivery absolutely I'm so glad that you brought that up because you're right I think if you don't know the history of a particular in our case need a fine experience you might think that they're illiterate in terms of their own healthcare or their mindset.

[00:24:43] It's about this particular point in time and really it isn't if you go back to native Hawaiians they were the healthiest and if you look back at old photos Duke Kohanamoku is a great one he was our for a Hawaiian Olympics swimmer and if you look at his physique and his health.

[00:24:59] And that really was representative of native Hawaiians they left off the land everything that they had their I know their land their vibe their water they had everything they needed and then when with actually the.

[00:25:11] This captain cook discovering the islands I mean that really started off the whole disease right in terms of introducing this be that native Hawaiians did not have the immunity for so then you talk about now a decimation of a population from anywhere from there's really hard.

[00:25:26] Not true numbers but something as much as almost a million native Hawaiians once captain looked at and cook left and other European folks introduced other diseases like measles half the population was and then you have the US and long fall occupation and over there the monarchy.

[00:25:44] And literally I mean it's not even an exaggeration the whole identity of a native fine was stripped and so I'll give you an example if you're getting ready to go to high school and if you're not speaking only English you weren't allowed to go to high school so now what does that do for in terms of education and where you are in terms of level and your knowledge.

[00:26:03] And then losing your whole your language and how you can care for yourself in a way and then that was all awesome now we have where we are with health disparities our own community if we like a diabetes prevalence or double diabetes just in my community compared to the state so that's telling right and so these are things that we have to keep in mind because it seems like a long time ago but not really for native Hawaiians this hasn't been that long and it's just through generation and generation.

[00:26:30] So I tried to be I think first of all understanding it and then you can approach it in a way that diabetes was not part of your family this is not something that well my grandma grandpa has at my mom and dad that's I will have it no that's not doesn't have to be the case and so yeah thanks for asking that I appreciate it because I don't think most folks.

[00:26:52] You're welcome you had this ambitious goal of empowering your elder community with tech literacy with Wi Fi being able to access health care providers in a variety of different modalities how would you describe sort of the outcomes of this work.

[00:27:10] It's actually pretty remarkable so we started off with some of the partners that we worked with especially our trainer and that was really us I wanted to make sure that we had someone that was patient number one right and who really understood where our kōpuna was coming from in terms of being nervous not being confident a lot of them had cell phones but really they're either their mōpuna or their adult child set up everything for them they may have added email they don't know how to access it or they don't know how to access it.

[00:27:40] So I had a really great trainer native Hawaiian who had been around our state and specifically training kōpuna so very patient the other thing that we made sure to do was we wanted to not only train our kōpuna we wanted them to leave with a device so we partnered with actually three one of them was our state library system to have our kōpuna walk away with a refurbished laptop once they got done with their training yeah so after their first VR training they walked away with a free laptop.

[00:28:10] And then one of the things I did want to make sure I mean this is something too that can be incorporated for others and I'm thinking out my guess the things that was really important and me for some they make really but if you think from a culture's perspective we started off every single training session so did blossom from one to three based on kōpuna request right.

[00:28:29] We always started off with either a kule prayer or an oli which is the mele so or both and really that was for from a traditional standpoint it really is for gratitude for our generations that have come before us and then also to just asking that we all have all of us involved in this process that we all have strong minds open hearts learning new things and so we always started off that as a reminder and I think that honestly can resonate and however that is even if you're not a kōpuna person.

[00:28:59] Even if you're just saying it let's go in with an open mind and then technology doesn't seem so scary them right so some of the outcomes we started off with a survey so baseline how comfortable are you with technology.

[00:29:12] Are you seeing are you visiting or have you thought about using telehealth to visit with your provider so at the end of our three VR sessions we did surveys on all those things and so 70% 76% of our kōpuna felt more comfortable with using their and there's this case that I'm going to be talking about.

[00:29:29] And then we also had a lot of people who were on a laptop some of them had never turned on a laptop ever so just turning it on was like everyone was cheering yay we got on 83% said that they felt more comfortable with their computer skills and then this is what I really love 72% so most everyone reported that they would be interested and or we're ready to connect with their provider via televideo and that's really what it what it's about when it comes to component having the knowledge and then now the confidence to do it because.

[00:29:59] Yeah, what was really sad in me was that they just accepted that they wouldn't see their provider until it was over and look it was almost four years right during that year.

[00:30:09] Yeah, yeah it was definitely something that and then we left we have our Wi Fi sites on hey bring come to our cafe. We have it's we have a cafe on campus I forgot to mention my lots of things here, but come back to our cafe where you learned how to get connected, and then you bring your laptop and you can meet up with your friends.

[00:30:26] One of the things too that I don't think folks realize we think Capone they're retired they're not busy, but I tell you our component they're very much into civic engagement and so one of the things that I like to it brings me so much joy that happened.

[00:30:41] At the end of our third class where we all had done zoom and folks are ready to go out into the go into their digital world right across the bridge over.

[00:30:49] Thank you so much because all this time.

[00:30:55] To our neighborhood board meetings, I've been volunteering for these grassroots activities but it was all in person once everything got shut down he wasn't able to connect and his friends were calling and saying hey come on you gotta get on zoom music.

[00:31:07] I don't even know how they said once we got on zoom he said now I can get back to my neighborhood board meetings, I can do the get sign up for the positions that they want me to take.

[00:31:17] So think about it now people go oh great for him is to know but that think even bigger right he's now being able to get back and being active and doing things for our community see if that's one person, but how many people in the community now are going to benefit and are touched by this one class right that's big.

[00:31:37] I think we often overlook the ripples that one intervention can radiate out to the community so the other thing that I just thought was amazing when I read your case study is how intentional you were to leverage leading bleeding edge technology right so a measuring sort of the cost savings the outcome so give us a high level view of that.

[00:32:05] For a CHC I like to say in the middle of the ocean literally.

[00:32:09] We're really a diamond that folks are pretty surprised at how advanced in terms of innovation but you know part of our mission statement believe it or not is that in order for us to make sure that we provide the best quality of care to our patients is that we will use innovation and emerging technology.

[00:32:28] So I think that's pretty telling right we're made 52 will be 52 years this year so when you think about our founders and what they were thinking so far ahead then our CEO who really knew that data was going to be important and that we're talking 30 years ago.

[00:32:43] We need to pause on that.

[00:32:45] Yeah.

[00:32:46] Because we're talking decades worth of data.

[00:32:50] So when you say AI, you're talking about decades worth of patient information, very few centers, even health systems right large health systems have been right in depth of richness of data.

[00:33:06] So I want to give a shout out to your CEO. What's his name, his name is rich between me and I tell you used to say he rich to where's your crystal ball because for someone really, and we're talking about care enabling social services, the kinds of services that we know contribute

[00:33:23] outcomes from a holistic approach rates and that we're not just talking CPT diagnostic codes we're talking about. If you're in anyone in the healthcare industry knows it's not just about meeting your provider you need to office if there's a referral to a specialist or if there's a new medication added to your, you know, list of medications, or some new health diagnosis.

[00:33:43] If there's time that someone either you the provider your clinical team a case manager sits and explains what's happening with your care or what next what is the next step or with your family.

[00:33:54] Now if you don't code that appears don't know they don't see that complexity, especially in a community that we serve right underserved marginalized community so there's so many other things that contribute to a person's well being, and we all know that as social determinants of health.

[00:34:10] We've been collecting all of that data for 30 years, no we didn't use it we know we knew we would use it at some point. Right. And then if another kind of just giving an idea of how I'm going to say technologically advanced for community health center we've had our electronic health record for 20 years,

[00:34:27] we purchased our electronic health record with our own money not with the grant. So that's, I think that I like to say that because that's even telling about how we knew our data would help to prove our value.

[00:34:39] That's one thing I think that all community health centers, and even other organizations to the folks that are making the rules in terms of reimbursement in terms of whether or not in this case telehealth really is it going to help with healthcare comes is it going to cost more money

[00:34:55] is it going to be a cost savings, we have to prove it that's on us. Right, because we know what we do is important. Our patients are so in order to do that you have to have the data for sure congratulations because that is a huge accomplishment, but more importantly,

[00:35:10] but just positions you to really serve your community and provide the best care possible. My view is that, you know when you look at kind of the annual sort of costs to our country of health disparities based on race and ethnicity it's nearly half a trillion dollars

[00:35:28] excuse me 500 billion each year, and it's only going up that if we don't leverage the best of what innovation and technology and data has to offer I just don't think we have a real shot so that this is part of why I joined the AMA to look at this why I'm a member of the

[00:35:47] equity coalition because we have to lift up this idea and so one it was just a delight to learn of the work that you guys are doing. So to your point around proving value, but can you give us a sense of the conversations you've had with like health plans as it relates to that, like are you capturing reimbursement for these other pieces so unpack that for us.

[00:36:13] Done with our AI advanced analytics and we work with a company for state health care solutions and actually been using AI for gosh almost five years now so yeah so for some it's you know that's the new buzzword well I don't know it's been our buzzword for quite a while, but again,

[00:36:28] But again, you can do without the data so just very quickly we've been able to capture not only so those HTC codes in our peers if you're not if any for those not familiar peers look at patient risk based off of really one one form of data and that's the HTC codes that Medicare then

[00:36:45] Medicare then a side to risk right for if you have diabetes high blood pressure. Well we are comprehensive risk model is way more than that right so it's besides that we have our S to H survey data. We have been able to, I'm going to say make friends with our peers or these have negotiation where they send their

[00:37:02] claims data to us every month. So having that is really truly invaluable and then of course our HR data and then we also have our we use natural language processing that's another it's not a buzzword it's been around for a while, but we use it to look at our community health worker notes and for those in that field.

[00:37:21] It's not going to be discrete data. So if you're picking up those particular words that can really illustrate the comprehensive nature of the kind of patients you're seeing and now imagine being able to use that analytics to give you really truly a comprehensive illustration of the risk or of an individual.

[00:37:42] Now that's your predictive analytics rate what their cost is going to be in terms of accessing resources hospitalizations and then the overall cost. Now imagine if you can have with all of that data, calculate an impact ability score. I think we made that up by the way I don't know if there is such a thing as impact ability score.

[00:38:01] Sounds good. It says what it is what it says right that you so you may identify these patients at high risk for costs and poor health outcomes, but what kind of impact does an organization can we have based on sometimes peers attribute you a patient that maybe doesn't even live in your area anymore or maybe a patient really just doesn't want to engage and we have ways to measure that.

[00:38:23] So then you make sure you focus on those that you can have a great greatest impact. That's predictive stuff. Now you get into prescriptive once you've identified those wouldn't it be great if you knew as an individual patient out of all these 10 things these services that we provide social services enabling services care services.

[00:38:42] If we could identify the top three things that would help improve your health care outcome the best and have a cost savings. That's like a cheat sheet for helping someone to achieve and realize their best health outcome what we've been able to do that with all of our data all of our analytics partner.

[00:39:01] So just to give you an idea we piloted with a two of our local peers and because that gives you negotiating power rate. So, I'm my CEO says it's the grand bargain the grand bargain is that if we say we're able to do what I just explained, and whatever is in that risk pool whatever is left over we're going to have it here you get back with the savings is, and then the 50 we get goes back into our same programs and to be able to it goes back into our community.

[00:39:28] So we're able to provide because food programs like food in our food is medicine program our community health records. Those are not typically reimbursed that service by appear and so that's really the grand bargain there's a lot you can do it, it really gives you that negotiating part for sure I suspect that

[00:39:45] I suspect that will resonate with a lot of listeners right because everyone's searching for that's our value based care, by the way. Right. So, you don't have to go with the model that's being served to you, that's, I think that's probably the takeaway, you can as a community health center

[00:40:02] I'm going to say, create the rules that others now can go oh okay we can and there's no downside risk for us to me it's we're doing it all preventive care as well as addressing really truly what the needs are now your data actually serve, I mean, provides true information right and insight act upon and tweak and obviously

[00:40:23] greater level of confidence. So I love love love that clearly government and policy are important stakeholders in this game. So, what have you been able to bring to them, and perhaps maybe get from them as a result of this effort and surely I'm in the digital front when it comes to telehealth and then also just digital inclusion as a super social determinants of health

[00:40:50] I did not make that up. I would like to remind folks that our FCC back in 2015, they did their own study and I would love for folks to read up on it because if our federal government can identify that.

[00:41:03] I mean, they've done all the studies I don't think we need to do anymore I think we just need to know that really truly exists and we need to start addressing it.

[00:41:11] And in terms of policy, each state Medicaid system works differently and so with the study that we've done in terms of the impact that were really maybe a paradigm shift to really truly looking at a hybrid virtual care model right in primary care so I think behavioral health there's a lot of great information on that and we see that there's really truly benefit for both telephonic and tele video and primary care not so much, but we've done a study and that's actually what I recently did.

[00:41:38] We've done a study and that's actually what I recently presented at the ATA as well as a NAC conference just a few weeks ago and I'm hoping what we're hoping for that is that will impact at least our state Medicaid director and seeing really the value of telephonic care in primary care because it helps so many but honestly during COVID and the fact that now it's been rolled back in terms of we still provide it because it's a community health center.

[00:42:05] We want to break down any barrier to health care but in terms of reimbursement it makes it really difficult not only for us as a big CHC but for smaller CHCs in terms of financial feasibility to offer that as a service but you're not being reimbursed.

[00:42:20] Another thing that I found at least in our community when it comes to accessibility with our community Wi-Fi infrastructure we have been able to influence actually a recent bill that just went through that's creating the framework for all of the grant money that's coming in from the internet for all.

[00:42:36] We've invested millions of dollars into each of the states right it's billions of dollars that have been set aside for getting our communities connected especially rural but we've been able to influence it in a way that we can hopefully fund better fund the accessibility part right so the community Wi-Fi infrastructure part because without that I mean there's digital literacy but if you're not connected then you can't use any of those things and so it starts with access for sure.

[00:43:01] I'm just so grateful for you joining us today. Tell us where the project is now what your sort of vision is for the next 10 years maybe and then any parting words for our audience.

[00:43:13] Sure thing well first of all you know as you get older when I was younger 10 years seemed so far away as you get older 10 years is like I don't have enough time to do everything I want to do but I'm actually really excited I've partnered with University of Mississippi Medical Center so again getting back to

[00:43:29] really you can't do any of this alone there's collaboration and strategic partnerships but UMMC is one of two in the nation who are first the designated centerpiece entities for telehealth and so we have gotten together to do a data scarcity project and so what that's going to entail we're working with T-Mobile.

[00:43:49] We have 150 iPhone devices with unlimited cell plans that we're going to deploy out to patient participants who have uncontrolled or poorly controlled diabetes. We want to see if connection without limitations to their provider will help to improve their diabetes so their hemoglobin and UMMC that's going to be our indicator and that's going to be through not only the access to health care when they need it but also a health literacy part so we as a community health center are going to be able to do that.

[00:44:19] So we at UMMC and the medical center have created a mobile app and it's a community health network app where you have all your social services connection to your provider in one mobile app connection and so that's going to be deployed onto the phones and so really we're looking to see whether or not what kind of impact on hemoglobin and UMMC and then we also have a national health literacy survey that will do a baseline and then after the project it'll be a 12 month project really directly having the patients use whatever resources they need and then we'll also continue

[00:44:49] that on hopefully for another 12 months after that to see really a longer time frame and impact. The great thing about that is I was able to work with our T-Mobile partners and so during this summer before we deploy those phones out to the patient participants I'm going to have a computer for a community specifically on iPhones. Yeah and so because a lot of the work that we all know a lot of the work we do are on cell phones including applying for jobs including you can upload resumes now if you know how to use them.

[00:45:19] So I want to be able to the whole part of digital inclusion is access digital literacy and then that last part that people we all need to remember is that adoption and usability and for me usability means making sure my community not only knows how to use it but they're now they have the opportunity like everyone else that takes technology for granted rate access to the same opportunities beyond health care there's education there's workforce development and so on e-commerce and we've got a lot of opportunities.

[00:45:49] We have lots of entrepreneurial spirits out here in Y9 I want to make sure that they have the same opportunities so that's what I'm working with I'll leave you with this working at our last community summit our own community came up with a LEADS initiative so literacy education development sustainability accessibility I forgot the A in there.

[00:46:11] So and that's from our community they came up with a Y9 LEADS so there's lots of not only what that what each of those letters stand for but really we want to be the leaders not in not being the best at having the highest diabetes prevalence not being the best at having the highest obesity prevalence.

[00:46:28] We want to be the best at being innovative and having the same or if not better opportunities we want to be the innovation hub where folks come to us right and want to learn from us and we can uplift our community so I'm going to leave it at that because there's lots lots of work to be done but I know that if we all work together that's what I thought we're going to we're making good things.

[00:46:48] I love that thank you Chrissy. Well thank you so much for joining me today congratulations again on your award and for anyone interested in learning more about the work of the TechWiddy for Health Coalition please email info at healthfoundation.org that's info at HLTHfoundation.org thank you for joining us.

[00:47:12] Well mahalo Michael mahalo everyone appreciate it.

[00:47:17] Thanks for joining us as we've explored this winning TechWiddy case study to learn more about the amazing work being recognized by the TechWiddy for Health Coalition and see all the incredible winners we featured throughout this series head over to the dedicated TechWiddy landing page on the Hit Like a Girl website you'll find it linked in the show notes.

[00:47:38] Before you go remember to like follow and subscribe to the Hit Like a Girl podcast wherever you listen and if you've enjoyed this episode please share it with a friend who might be interested in digital health equity.

[00:47:48] Alright thanks see you soon.