Rae Woods: From Advisory Board, we are bringing you a Radio Advisory. My name is Rachel Woods. You can call me Rae. Rae Woods: As the crisis phase of the pandemic wanes, we all should be reflecting on the valuable lessons that COVID-19 has taught us. And as an industry, we should work to apply those lessons to other challenges in healthcare. That's exactly the conversation I want to have today. And to do that, I've brought Dr. Kavita Patel to Radio Advisory. If you know Kavita, you know that she has an incredibly impressive resume. She's a primary care physician here in D.C. She previously worked at the Brookings Institution on health care reform and is the former director of policy in the Obama administration. She serves on the board of several organizations and is a venture partner at new enterprise associates. And most recently she served as an advisor to the organization Stop The Spread. Well, welcome to Radio Advisory, Dr. Patel. Do you mind if I call you Kavita? Dr. Kavita Patel: No, no. Thanks for having me Rae. Rae Woods: And you are here in Washington, D.C. Right? Where are you dialing into this recording from? Dr. Kavita Patel: I'm in my clinic, which is in the Southwest part of D.C. Rae Woods: Well, that's where we're dialing in from too. I should say I'm in the suburbs. I'm in Alexandria, but we love it when we get to share thought leadership and voices from our hometown, which is Washington, D.C. Rae Woods: I want to start by giving you a chance to talk about the organization that you recently partnered with, which is Stop The Spread. The title kind of gives it away here that this is an organization that came together when the public health emergency first began. But give us an update. Where does it stand today? Dr. Kavita Patel: Stop The Spread started about two years ago when the pandemic started and former CEO of American Express and the Education Guild, Ken Chenault and Rachel Romer Carlson came together, [inaudible] and New York Times got over 1500 CEOs to come together- Rae Woods: Wow. Dr. Kavita Patel: ... to think about what could the private sector do with the pandemic. Fast forward hundreds of community initiatives, lessons that I hope that we can get into a little deeper today, basically the organization is being sunset, not because the pandemic's over, but we're in next phase and hopefully we can carry these lessons into our own communities. Rae Woods: And that's exactly what I want to spend our time on because the truth is there's a lot that we can learn from the last two years. And hopefully, that the industry can come together and apply those lessons into other aspects of healthcare. Frankly, I have some of these conversations with clinical leaders, but they're mostly focused on saying, what can we take from this public health challenge and apply it directly to other public health challenges? Things like the opioid epidemic. Dr. Kavita Patel: Health equity, I think has been a theme in healthcare for a long time, but it's the theme you'll see in some of these lessons too, that naturally carry over probably into every aspect of what anybody that touches the healthcare system in any way would be interested in. Rae Woods: And that's exactly what I think is different about what you and what Stop The Spread are saying. You're saying that there are barriers that we've certainly faced in this health challenge, but we're going to face them in all health challenges, not just other epidemics. Right? Dr. Kavita Patel: Yeah. Rae Woods: And I want to get into what those barriers are today. You mentioned health equity is one of them. But what are some of those other barriers that you want to call our attention to? Dr. Kavita Patel: I'll call it out for what it is, misinformation. I think it's been of growing concern in the pandemic, but it's been in place for a long time. People who have used social media for just getting advice and sometimes many times now is the case, that's not the best science. So misinformation, community based trust for initiatives that deliver kind of high value. So this is not just health care, but just care in general. And it spills over into education and other things. Children, I think that so little attention gets focused on kind of unique aspects of children's care and especially connecting it to the life cycle of primary care. Rae Woods: Mm-hmm (affirmative). Dr. Kavita Patel: And then finally something that at Stop The Spread we're calling "the last mile problem". Something that people have heard of. But we see millions of people who are eligible for services like health insurance, SNAP, WIC, helping with their heating bills and electricity bills. But these things don't get connected to each other. And you would think in 2022, that's not the case, but it still is. And I think those are some big lessons we learned through community initiatives. Rae Woods: These are all huge challenges and we're going to get into them individually. And I know we're going to talk about applications beyond COVID-19, but I want to come back to something very important that you said, and that is that the pandemic is still very real. And it's especially real for the young children who cannot get vaccinated, but will hopefully be getting vaccinated very soon. Tell me, how is the pandemic disproportionately affecting children? Dr. Kavita Patel: Yeah, it's something that I think you've heard in the media probably even had some experts discuss that the COVID is not so bad for kids [inaudible]. But that's compared to what? Compared to much older adults. And I agree, Rae, I really hope of a vaccine soon is approved for kids under five. I have one of them. But even if they- Rae Woods: Me too. Dr. Kavita Patel: ... even if they had a vaccine, survey show that only 21% of parents of children under five say they want to get the vaccine, yet, we've had over 1300 deaths in the pediatric population. We have had tens of thousands of children with long COVID various forms that we still are trying to get our hands around that we don't understand, is it really long COVID? Is it something else? And then countless, also thousands of hospitalizations, in fact, literally breaking records on a daily basis. We're still hospitalizing kids. So when you ask the question, what's happening with children, one, we still don't know. And two, it's still something that I think should be a high priority, which we made at Stop The Spread. Rae Woods: And I think the focus on children provides a good case study for talking about all the different barriers that you mentioned. We're going to be having a last mile problem. How do we make sure that we get this vaccine into the arms of children who need it? How do we address the mis and disinformation that parents are feeling as they're questioning whether or not to vaccinate their children? We still see different outcomes among white children and black children and Latinx children. All of the barriers that you mentioned come together. Dr. Kavita Patel: Yeah. Rae Woods: So what do we do about that? What lessons have we learned from maybe the adult population that we can apply in the coming weeks, coming months when we can actually vaccinate these kids? Dr. Kavita Patel: There's so many lessons that we've tried to keep it to bitesize. In fact, hopefully people listening will go and read some of these briefs, because these are not 20-30 page briefs. We try to keep them short on purpose. Get the lessons, get the message out there. If you want to do a deeper dive, we have everything available. But bottom line what we learned is that we need to use every touchpoint with families to try to educate everyone involved in the care of a child about that child's health. So that means schools, helping them find pediatricians if they don't have one. Also thinking about where do the adults get care because they have touch points and we can ask, "Hey, do you have children in your household? Do they have a pediatrician?" And then also talking about it in a way that engages parents. So not just coming to the doctor for 15 minutes, but having community forums so that parents can just ask questions about issues, not just for their children, but really what their concerns are overall about the pandemic. And those have all been helpful in tackling these barriers. Rae Woods: And one of the things that you've written about is to not underestimate the power of children. Now I know we are talking about the very, very young, under the age of five, as young as six months, but we've seen an opportunity to empower kids to actually advocate for the health of themselves and for the health of their peers. Tell me about the role of peer to to peer educators, especially in the context of misinformation. Dr. Kavita Patel: Yeah. So Stop The Spread partnered with youth organizations such as Rise and basically create a cohort of youth ambassadors. These are children, adolescents, they were people who were much more articulate than I could ever be on why kids could get vaccinated. And they really did kind of what I saw and maybe you recall from Get out the Vote movement. Just trying to shift it to like, "Hey, this is something that we can do. And it's something we have an obligation to do. And here's how you can get it for free on top of that." Dr. Kavita Patel: And I think that that's just one example, youth ambassadors. Stop The Spread also did a refer a friend program as we called it. Also kind of being very like, "Listen, if you have a friend or a loved one that needs to get vaccinated..." they could literally give them a card and information so that they could really help empower. And studies have shown that when you get some information about health from a friend, or a peer, or someone you trust, you're up to five times more likely to do something about it versus just talk me who nobody knows talking about it on TV or in the radio or something. Rae Woods: And I think that can also help with some of the misinformation problem. I'm not saying that these child ambassadors are necessarily health experts, nor should we expect them to become health experts, but it creates a space for people to talk about what they are scared about. Dr. Kavita Patel: Yeah. Rae Woods: Or to say, "Why did you feel comfortable getting it? Because I have these, these concerns that I've read about online, et cetera." And that can be a small way of getting against what people are calling another public health challenge, which is misinformation and disinformation. Dr. Kavita Patel: Yeah, absolutely. I actually think disinformation, misinformation, sometimes I just call it scientific lies, because that's what they are. Rae Woods: [inaudible] go there. Yeah. Dr. Kavita Patel: That's what they are. They are lies. I actually think that could be our true crisis that we haven't really labeled in the pandemic. Rae Woods: Mm-hmm (affirmative). Dr. Kavita Patel: Anyway. So yes, it's a great topic to talk about. Rae Woods: And this is one that is absolutely not limited to COVID-19. I think we felt it pretty strongly in the context, I think, especially of vaccinations. But let's talk about addressing these lies, these scientific lies outside of COVID-19. Dr. Kavita Patel: Yeah. Rae Woods: We speak to health leaders on this podcast. What advice do you have for them? Dr. Kavita Patel: Yeah. So one of the things that I noticed in my own health system that I work in is that we don't really create content that crosses a digital divide. So we put out a lot of content, it's got footnotes. It's sometimes so wonky and full of clunky words that nobody's actually going to read- Rae Woods: Super academic. Dr. Kavita Patel: Exactly, exactly. Like it would pass muster with any top-notch academic, but regular people, even like my own family are like, "I don't know what this means and I don't look at it." Plus, we don't give it to people in places where they're getting information. How often do you see information on WhatsApp that's generated by trusted sources? Dr. Kavita Patel: So content that can cross the digital divide. Getting viral networks of science and truth... I talked about scientific lies, getting the opposite, counter detailing. Think about what we did in the pharmaceutical industry to get counter detailing so people understood what drugs they were prescribing and then really funding these proven community based programs. Some of the things we just talked about, like referring a friend or youth ambassadors. That can help with so much beyond COVID and misinformation. Rae Woods: We had a conversation with a physician, an author, Aaron Carroll, who you might know or have read some of his work a couple of months ago. And he talked about this concept of digital citizenship and that every single person in the healthcare industry, not just physicians like you, have a responsibility to make sure that the things they're talking about online, even if it's on social media, it has to be grounded in truth because it gets picked up so, so easily. And you don't want to be that doctor, that health system leader that pharmaceutical company rep who's putting something on Twitter that somebody is going to read and take as truth if it's not. Dr. Kavita Patel: Yeah, absolutely. And I think you're right. You hit it on the head. It's so easy to put information out there and walk away, a tweet, a Facebook post, Instagram, like a video, TikTok. It's amazing how that can have a life of its own and you don't even realize it. So I love to see what Aaron said, I think is spot on, but it would be nice to think about how do we make everyone a digital citizen? How do we start that at pre-K? Because my kids know how to use an iPad. They're probably going to figure out how to get on social media pretty quickly. How do we do that at a very young age? Rae Woods: Yeah, absolutely. Absolutely. We'll be right back with more Radio Advisory after this short break. Rae Woods: Another key lesson that I think we've learned the hard way, which you mentioned at the very, very beginning is that all health leaders need, frankly, a relentless focus on health equity in their communities and for their patients. This is something that's so much easier said than done, especially when it comes to connecting the things we offer, whether it's social services, whether it's testing, treatment, vaccination to the vulnerable populations who need it the most. What are some examples of what Stop The Spread has done to make that connection happen? Dr. Kavita Patel: One thing that we've touched on, but I'm going to reemphasize because Stop The Spread found this time and time again and we highlight this in our briefs, every touchpoint is an opportunity to help with health equity and that includes helping families sign up for social services because with the reason we have these health disparities is because access to education, access to digital services, access to broadband, these things matter when it comes to making decisions and having the ability to have freedom about your health. Dr. Kavita Patel: So every touch point is an opportunity to help connect people. And we saw that time and time again with helping to plug people into programs just to get them vaccinated, for example. Investing in redeploying the trusted workforce. So you just mentioned it takes people to get these programs set up, testing, tracing. Think about all those things that we did. We don't need to have that exact same apparatus forever because we're getting vaccinated and hopefully that'll keep the virus back. Rae Woods: We probably can't use that apparatus forever either. Dr. Kavita Patel: Apparently we have no federal funding for it either. So it's just going to go away anyway. But I do think that having that structure is absolutely critical. Honestly, this is going to sound, I work in a safety net environment, a federally qualified health center, we need to start thinking about ways to make it just easier to be in the safety net. It is so hard to do some of these things and it doesn't need to be. So modernizing it a bit, if you will. Rae Woods: Stop The Spread actually called this effort Vaccine+. Get your vaccine and then something else, whether it's a connection to a social service, diabetes screening, et cetera. Can you share your favorite story or example from the Vaccine+ program? Dr. Kavita Patel: My favorite one is actually a mental health partnership so that while people were waiting for those 15 minutes, they could also do very simple, very straightforward, two nine question screeners. Picking up so much depression, anxiety, up to 10% of the population having these issues and going undiagnosed. And then a second one... You didn't ask for a second one, but I have to do it. A second one was partnering with some of the food based startups and doing something that helped when people were getting vaccines, if there were food insecurity issues, they could help through a technology based food access platform, plug people in, again, while they were waiting. So it's a great way to take advantage, 15 minutes, because you got to watch patients for any side effects and having an audience that could use those services in the moment. That's the best part of Vaccine+. Rae Woods: I'm glad you shared a second example because I think that one is really cool. Because most folks think about their partnerships in a limited way. They think about community partners. They think about food banks. They think about churches. They think about libraries. But you just said a tech startup. Dr. Kavita Patel: Yeah. Bento was the name of this particular one. They use a tech-based platform to connect people to food supply. It's meant to also address food insecurity, but it really connects local restaurants, local entrepreneurs with excess food supply or time when they have extra meals, et cetera, extra groceries on hand, connecting them to people who could use that and modernizing the safety net, but doing it through technology that's entrepreneurial as well. Rae Woods: We're talking about how to deploy these new innovations outside of just the COVID-19 pandemic. I know you in particular have worked with Stop The Spread, but you've also worked with other parts of the private sector. You've worked with the federal government. You know how all sides of this industry work. My question is, at what point do we need to go further? At what point does regulation need to step in? When do we need legislation to do what private healthcare stakeholders just can't? Dr. Kavita Patel: I used to joke when I worked in the Senate and the White House, that if you did a policy, rule making and everybody loved it, you did something wrong. And if everybody hated it, you did something wrong. The right balance was having people who were both pissed off and happy about it. And then you knew you did something good. So I think in that vein, I think we're going to have to see some, you can call it new legislation or you can call it CMS and agencies just exerting authorities over things like telehealth access and capabilities. How we provide these vaccine services, for example. Believe it or not, there's actually a limit to how we can provide home-based vaccines. Dr. Kavita Patel: There was a lot of exceptions that were made for the public health emergency and COVID, but why wouldn't I be able to regularly deploy services to home-based care and taking care of some of the regulatory barriers to that I think is an incredible way to do that. So those are things that I think providers would get around. But I think on the other hand, there needs to be some accountability. There's a big debate about telehealth and how much is too much, how much is too little? And I think there is going to be- Rae Woods: What your reimbursement be- Dr. Kavita Patel: Exactly. Right. There is probably going to be some level setting of that. And that might be paying for me as a physician. If that's what it takes to see it continue permanently, I'm willing to negotiate and talk about it. Rae Woods: I guarantee that every single person listening to this podcast is watching for what changes in regulation that we've benefited from over the last two years are going to be made permanent. Dr. Kavita Patel: Yeah. Rae Woods: Or at least are going to be extended. That is a big open question right now. Rae Woods: And frankly, that brings me to a question about sustainability. Dr. Kavita Patel: Mm-hmm (affirmative) Rae Woods: I don't think anyone would disagree that the things you've talked about are innovative, that they are important, that they are doing good work, but there's a question of how do we make it last? You mentioned that there's this whole new workforce popped up to deliver meals, help with vaccinations, et cetera, but we don't have funding to do that indefinitely. So what's your recommendation for how we make these things stick beyond COVID-19? Dr. Kavita Patel: I was an executive in a hospital system. I've been on hospital system boards. And I think one of the things I've observed over the years is how poor our skill task alignment is. We often hire people into clinics and hospitals on very traditional roles, coding, revenue cycle, delivery service lines. And that works up until a point. And we're probably at that point where we need to rethink the workflow and that will offer, especially if we have our eyes on the prize that doing these community based, I'll call them value plus services beyond what we traditionally have done, help people. We can actually take existing... I truly believe this, existing money, existing workforce and just being smarter and more efficient about it. It's not just waste. It's also having people who are better at doing community based work, doing exactly that versus, having everyone stick to more traditional roles. So I actually hope that innovation follows, once hospitals get just a period to breathe both financially and truly physically, I hope that that work can happen. Rae Woods: And you said something really important that I want to make sure doesn't get missed in that that work has to be proactive. I know I just said that everyone is kind of waiting for what the federal government is going to say, but the chances of everyone getting the perfect answer are very slim or maybe to your point, isn't actually the right answer to begin with. Dr. Kavita Patel: Yeah. Rae Woods: So for example, you have to figure out how to make telehealth work for you, even if you're not going to get the reimbursement that you've seen across the last two years. Dr. Kavita Patel: Yeah. That's absolutely right. And that might mean different infrastructure, that might mean thinking about remote work a little differently than how we traditionally thought about in healthcare. It might be literally taking budgets from things that were very kind of stable, but with COVID and changes in primary care, we can alter how much money we allocate for remote services or in-home services, for example. And that might actually end up being a higher productivity task. It might be more efficient for me to go into people's homes, keeping them healthy, versus, dragging them to clinic and having missed appointments, for example. Rae Woods: We talked about the sustainability question in the context of individual innovations or individual programs, processes that people have been testing. But for me, there's also a sustainability question when it comes to partnerships. Dr. Kavita Patel: Yeah. Rae Woods: We saw all new kinds of partnerships, new ways of thinking pop up at the start of COVID-19, Stop The Spread being one of them. Their charter is purposely coming to an end. But how do we think about keeping these kinds of partnerships going into the future? Dr. Kavita Patel: It's kind of like bookends. Stop The Spread really started with the private sector going, "Listen, we can sit on our hands or we can be part of the solution." So I would actually just repeat some of those lessons that from the beginning, what happens when you create an opportunity and a space to bring multiple stakeholders, private and public together to come and solve really big problems like we did with COVID-19. Take any problem, [inaudible] health, fill in the blank. It doesn't even have to be a health issue. Rae Woods: Mm-hmm (affirmative) Dr. Kavita Patel: Food insecurity, because that is a health issue. Transportation, also a health issue, but maybe not on the front of mind with everyone. That's an opportunity to test. And then here's the part that I hope people do. You're going to test and you're going to fail. It's not like Stop The Spread got everything perfect and everything just works. Things happen and things fail. And you have to go through that to know how to decide what works and what you want to keep and what you want to allocate resources and time to. So I think that's an incredible lesson to keep in mind and it'll keep some of this going because that's exactly what started it in the first place. Rae Woods: Yeah. Do you have any examples of partnerships that you would like to see continue and expand beyond COVID-19? Dr. Kavita Patel: One of the best Vaccine+ initiatives really was around... this is, again, very healthcare. So it's not as cool and sexy. But it was really around a partnership between Stop The Spread and the Community Healthcare Network, which is a federally qualified health center and Cornell, all to gather in a community based way to do diabetes screenings, blood pressure screenings, all inside of houses of worship. So inside of churches, in that 15 minute period. And houses of worship love this. Sharon Knight was the executive director of Stop The Spread. She was really passionate about what people trust and people trust institutions of faith. So it was just an incredible partnership. And I have to tell you, that the FQHC involved, Cornell. Everybody is still kind of talking, which is great about keeping these things going. It may not be around vaccines. It might be around something else, but they see the value and those people have met each other now face to, and those relationships have been forged. Rae Woods: We've really just begun to scratch the surface. We've talked about some of these huge challenges that we faced in COVID-19 that we will continue to face. Misinformation, the focus on children or other vulnerable populations, making sure you're connecting social services to the people that need them the most, last mile problems. What other solutions have you seen deployed during COVID that you want to see invested into the future? Dr. Kavita Patel: Community based partnerships are a common theme with Stop The Spread, but let me go, maybe just a level deeper and actually thinking about the cross sector partnerships that also were so interesting. Rae Woods: Yes. Dr. Kavita Patel: So the Bento example, that's the startup that did the text based connection to food. Uber and Lyft offering free rides to vaccine clinics. That didn't just happen overnight. That really was kind of, again, private sector CEOs and public sector coming together. I do think that wastewater surveillance, not sexy to talk about sewage and monitoring, but that also happened because of universities partnering with some of the best minds in the private sector around what could be done. Dr. Kavita Patel: And I do think that surveillance, it doesn't need to stop at COVID-19. We have so much that we can understand from patterns that we see in wastewater surveillance for other viral diseases, for even other kind of pharmaceutical interventions that we could try, for example, with diabetes. We know that there's so much more to offer. So I would love to see on the health side, some of those cool, outside the box partnerships, but then also these epidemiological foundations taken forward. Rae Woods: Science is always sexy as long as it's true. My perspective is science is always sexy. By the way, you took the words right out of my mouth. There is not a single organization that I talk to that isn't interested in some kind of community partnership. But what they don't see them doing is thinking about partnering with other people, partnering with a private sector, partnering with the payer and their community, partnering with the employer and their community. And that's what we need to see more of. Dr. Kavita Patel: I'll take responsibility. It's a bit on us and the healthcare side. I'm going to speak with clinic hat, kind of hospital leadership life on. I think it's hard, we don't make it easy to have communities say, "Hey, we want to partner with you." Rae Woods: Mm-hmm (affirmative). Dr. Kavita Patel: So again, I'll reiterate something that Stop The Spread did was kind of emphasizing you have to make this space. And when you're in this power dynamic, well funded healthcare institution, usually like a real focus of any community, small or large, name recognition, you need to find a way to make that space. And I think that's the kind of investment that we're talking about. That'll go way beyond COVID and give you value that you could not even predict. Rae Woods: Well, Kavita, before we go, I do want to give you the chance to speak directly to the health leaders listening to this podcast. As we enter the next phase of the pandemic, what is the one thing you want our listeners to take away or act on? Dr. Kavita Patel: I want people listening to think about creative budgets to accommodate the sustainability of these programs. We talked about so many interesting things that comes with the need for people, money, resources, and anytime something is seen as an add-on, it's just not prioritized. So I want everyone to think of about that black and white, sometimes red, fiscal budget and really reorganizing it to prioritize community partnerships and the possibility of the private sector partnerships that we talked about. Rae Woods: Spoken like a true leader, not just what we want to get done, but how the hell you're actually going to do it. Dr. Kavita Patel: Right. Exactly. It's hard to do all of it, but I find that sometimes the biggest challenge I would often see is, "Well, we don't have a budget for that," or, "We don't have the resources for that." Rae Woods: Yeah. "We don't have the time." Dr. Kavita Patel: And, "We don't have the time." So again, it's making that space, but making it black and white and having it be part of the budget process will be an amazing start. Rae Woods: Well, Kavita, thanks so much for coming on Radio Advisory. Dr. Kavita Patel: Thank you so much for having me, Rae. Rae Woods: If you felt like that episode was a sprint, it is because we covered so much. But if I'm honest, we've really only scratched the surface on the lessons we should be taking from this pandemic and applying to every single challenge in healthcare. We and Stop The Spread have so much more to say on this. So please visit the links in the show notes to learn what you can do next. Because remember, as always, we're here to help.