Latest / TeqTalk with Jas / Can FQHCs Fix America’s Healthcare Access Problem?
Transcript
- speaker-0: Thank you so much Malika for joining Tech Talk. Really appreciate your time. speaker-1: Thanks for having me, Jess. speaker-0: Before actually start and deep dive into our core topic, why don't you tell about your career journey from where you started, what exciting things you are doing now, and your contribution. speaker-1: Overall. If I think of my career, I'm going to date myself, but ⁓ I started ⁓ I'm an immigrant to the states. ⁓ and right after grad school I had an opportunity to work in strategy consulting and market research and it really gave me exposure to ⁓ a d different domains and industries as well as different kinds of business problems. And then ⁓ when I moved to the States, ⁓ I was fortunate enough to get into the tech space. So my first gig in tech started in semiconductor and then after that I transitioned over to Hewlett Parker, the old HP ⁓ working on both hardware and software as well as supplies. ⁓ and I would After that, I think, you know, it's been a series of ⁓ opportunities and ⁓ life transitions that have led me to where ⁓ I am today. ⁓ about 16-ish years ago, ⁓ I had an opportunity to ⁓ get into healthcare ⁓ when I moved to San Francisco. ⁓ and I think ⁓ the rest is history. ⁓ I've really enjoyed being in this space. I also grew up in a family of clinicians. So I think ⁓ It's in the black identity. Exactly. So it's in my DNA. ⁓ I guess I wasn't smart enough to become a doctor, but ⁓ you know, I had to sort of land there in a different format and so here I am. I think ⁓ when it comes to how every next opportunity has happened, some have happened because I pursued them and others I was fortunate enough to be given the opportunity. speaker-0: So speaker-1: ⁓ and I've always approached everything with an open mindset and also trying to figure out what is it that I should be doing and I should be doing differently to make an impact. I work in a federally qualified health center in Northern California, ⁓ Mendocino Community Health Clinics. ⁓ we offer ⁓ medical services, primary care, behavioral health, dental, pediatrics, OBGYN. Chiropractic care ⁓ as well as substance abuse disorder. Because we are a federally qualified health center, we are one of the only primary care ⁓ choices in the area that we are located. And we have roughly around 30,000 patients that are, I would say, active patients that see us, and we have four sites. And it's been an incredible experience, I would say, in the last three years being part of. ⁓ a community clinic, which is ⁓ you know, if you understand healthcare ecosystem is the safety net ⁓ providing healthcare to millions of people in the States. speaker-0: Of course, absolutely. And and I think it's very interesting. Today's topic is centered toward FTOSC. We will deep dive into that. Healthcare in the US is $5.3 trillion industry, which is approximat 18% of the entire economy. And community health serves close to 34 million people, which is 1% of that total spent. So if you see That number. speaker-1: Small speaker-0: community but big responsibilities. Malika, I would like you to explain the FQSC model, how it works, how it gets its funding, and what are some of the barriers you face every day. speaker-1: ⁓ so you're absolutely right. I think in the larger ecosystem of healthcare in the US, our contributions or spending might be relatively minuscule ⁓ compared to the large healthcare entities. But then at the same time, if you look at the community care model, we are the safety net, which means ⁓ because w you know we get support or federal funds to keep us running on top of getting revenue from just offering patient care services. We also are unique in the sense that we keep our doors open regardless of the patient's insurance status. And so we offer a sliding scale feed to those folks who are uninsured. So if you look at the diversity of the patient population or people and the community that we serve, anyone can walk into our clinic and get care. So I think that makes us ⁓ extremely unique. I think in in light of ⁓ some of the challenges and problem areas, I think healthcare as every entity is going through today is facing a lot of regulatory pressures. ⁓ and so any changes in the feder federal landscape do affect us. ⁓ so that is ⁓ a reality. I think secondly, the cost of healthcare continues to increase. ⁓ inflationary costs, supply-demand pressure. ⁓ in our case, we have an access issue. What I mean by that is we have a lot more patients requiring our help than we have the resource pro resources, providers, and support. So it's always a little bit of a catch-up game, so to speak. Ideally we'd like to keep our doors open and take in anyone that just walks into our door. But in reality, that can be a little bit challenging, especially if you don't have ⁓ enough care teams as well as providers. So that is a problem, not that's not just unique to us, it's actually a worldwide problem. speaker-0: That is what I was about to say. That in overall healthcare, if you see the demand is so high, and if you see the resources, there is always a crunch. Malika, what could be the reason why we are having less resources? Why people do not want to be a therapist or a doctor or a clinician? What what are the reasons? speaker-1: You hit a sensitive spot there, but ⁓ I think it's a problem that is well documented and ⁓ well recognized across the world. So I think ⁓ one of the biggest barriers slash reason why we have that supply-demand gap is we just don't have enough workforce who can support the healthcare, you know, the growing population across the world, the growing aging population, as well as all the people that need care. speaker-0: What is the reason of not having that workforce? Why people do not want to come into this line? Is it because of a a lot of burnout or a lot of pressure or speaker-1: Exactly. You hit on one very important and yet very well recognized barriers and ⁓ problems in the healthcare area. There is a lot of burnout, and a lot of the burnout has been due to increased regulatory pressures. So anytime there are more requirements, whether it's coming from the payer or the regulators in the industry, it puts pressure on healthcare entities like us. ⁓ and what that pressure essentially does is we have to do more in the way of administrative work as well as increased documentation. And so when you think about yourself or me as a patient, when I walk into a doctor's office, all I'm expecting to happen is that they know exactly what's going on with me and they have a prognosis or a treatment plan that's going to make me feel better. But what you don't see Is everything in the background that happens after that care is delivered and also what's happening during that care? You know, when your chart is open and then the provider is doing the documentation. There are so many details that are required for that patient care to be delivered successfully. When I say successfully, is it resulting in a better outcome? Are you able to get a treatment plan that you're able to follow through? Is your insurance coverage going through? Do you need any prior authorization? Are there any billing gaps? So the whole revenue cycle thing. So it's it's fairly complex. So I think obviously given the intensity of that administrative burden, it causes severe burnout. I think on the other hand, you know, if you took look at you know what it takes to go into medical school, it's extremely expensive. And here it can take a number of years. And there's just not a lot of resources that are available that can foster that, right? So you want a system that can encourage that, whether it's scholarships or other kinds of funding. And so when you don't have that available, it becomes one of those luxury products and areas. So I think that's that's another problem. I think ⁓ the third is you know rising costs of care can put intense pressure on healthcare entities. And so not everyone is able to be financially sustainable. And when financial sustenance becomes an issue, not everyone survives. And so then what happens is you have fewer number of institutions that are required to take care of the bigger population. And so there's always going to be that supply-demand gap. And so when you have that supply and demand gap, it puts intense pressure ⁓ on those that are already in the workforce and are required to take care of all those sick people, right? So th those I think, in my opinion, are some of the major reasons why you know, this industry it i it is the way it is. I think ⁓ the community's care model, we didn't have all the barriers and all the regulatory pressures can in a perfect world be the model of ⁓ how puck primary care is delivered in the future. ⁓ we also have a significant dearth of specialists. So when you don't have enough specialists and a lot of what has to be done in primary care, again it creates another supply demand gap and additional pressure. So that is also, I would say, another reason why this industry is facing all the challenges. speaker-0: County health rankings suggest that clinical care contributes only 20% to any health outcome of any human. And the rest, 80%, is still influenced by the social and economic factors. So these factors could be the nutritions in the household the person is consuming, transportation, ⁓ employment, what kind of community support the person is getting, right? And I can also see that there is a shift going on right now in healthcare, which states that I just do not want to cure this person right now. I have to make sure that we have a good and healthier population in next five years. So this is the mindset change going on. What do you think about it? speaker-1: Yeah, you're absolutely right. ⁓ you know, there's a concept called ⁓ whole person care. Yes. ⁓ which has existed ⁓ in the ac academia for a number of years and is slowly becoming ⁓ the model of care for the future. Mm-hmm. And I think ⁓ it's really important to recognize and understand that we need to first address structural needs gaps. Yeah. Food, housing, transportation. If I don't have a roof over my head, I can't show up in the doctor's office. Exactly. If I can't have transportation, I still can't show up for my appointment. And so even before you address the person's health condition from a clinical perspective, you need to address their health from a structural barriers perspective. And so ⁓ where I work at, we have an approach and a process to ⁓ capture that information. across our community and across our patient population. In addition to that, we've always been invested in our community health. And so one of the other sources of funding for FQHCs is through grants. Again, you know, it's not a steady state, but grants can be extremely instrumental, not just in the way of ⁓ giving us that buffer from a revenue perspective, but also allowing us to ⁓ build capabilities that otherwise we don't have the resources to. And so on the community health side, ⁓ you know, I had ⁓ an opportunity about almost three years ago to stand up a community health group ⁓ where I work at. And so it's been a very fulfilling and ⁓ the most satisfying journey to see the outcomes and the impact that we've been able to create in the community. speaker-0: More about it, what exactly you built, and how you are ⁓ putting this whole person care into your ⁓ day-to-day practice. speaker-1: practices. Yeah, absolutely. So we had to one of the issues that I saw in the industry and across the population is knowing that every third or every other patient has some gap around structural need and that they require a warm touch, whether it's in the form of an outreach call or someone who's able to talk to them and ask them, hey, do you need help? Can we connect you to the set of resources? So we were able to establish that across a smaller population in the community, but starting with our most vulnerable patients. Patients coming out of the rehab center, patients coming out of the carceral facility, and patients coming from inpatient settings. So some of these patients that ⁓ we started out with, ⁓ or the individuals that we started out with were not people. Who are set up to live independently and live healthy independently. So they needed someone like a case manager, a community health worker to go and get in touch with them and understand what their needs are and what kind of resources they need to be able to establish and get better so that they could live independently in the future. And so the community health workers would go and meet these people where they are at. Sometimes it's in a coffee shop. Sometimes it's in the rehab center. Sometimes it's in a jail. Sometimes it's ⁓ in the hospital. And so ⁓ we would get referrals from a variety of sources in the community. And the nature of the community health work is one of those wherein you need to build a network of community-based resources in those settings that you're offering this. And so as It was the journey involved not only building a set of community health workers who are comfortable and who had that experience and lived experiences to go and serve these individuals in the community who are very vulnerable, but also being very systematic about how we approach these community based organizations, some of who were also offering similar services to us, but in some cases unique services. Whether it's food stamps, ⁓ whether it is temporary housing and sometimes it's just peer support. Right. So ⁓ it took ⁓ almost two years to build that network in the zip codes that we were servicing. Yeah. And we are it is absolutely not easy. And ⁓ the type of work can be extremely you talk about burnout, this is a very different kind of burnout because speaker-0: It's it's a big thing. speaker-1: Some of these patients, you know, they don't have a phone number that you can consistently reach out to. So when you have numbers that are changed and people that don't pick up the phones, you can you have to keep on calling. So we have to establish some guardrails around, you know, what should be that outreach approach and where all can we be going to. And what kind of safety can I, as the employer, as the leader, enable my community health team to feel safe and to be able to go out and meet these people, right? And then how do we bring all these community organizations together so that we are all marching towards a common goal and a common mission? So oftentimes when you have these common areas of or common goals and vision of what you're trying to accomplish, you're going to see better buy-in. So I think it was important for us to understand from their perspective what it is that they are marching towards, share our objectives and goals, and then find where that common and middle ground is and then get the support. So, you know, I'm probably simplifying it by saying what I'm saying, but it's a number of little things. That's going yeah. And ⁓ it's like a team play, right? You need ⁓ every individual and every entity to be doing their best for this to make the biggest impact that it can have. And ⁓ you know, like with anything, you know, that you're gonna have churn, people come and go, but then how do you still keep that work going? ⁓ so those challenges are obviously real and ⁓ something that you have to always keep at the back of your mind and then figure out how you're going to overcome it. But ⁓ I do think ⁓ community health workers are a very important ⁓ entity in in the landscape of healthcare, especially when it comes to addressing structural need and social needs gaps. Because like you said, you know, more than eighty percent of a person's health is attributed to non clinical related ⁓ factors. speaker-0: Explain a little bit more on the community which you formed. So you have your volunteers or your workers, they visit the patients and they check whether everything is good with them or not in case they do not have any food or they do not have any mode of transportation or even if they just want emotional touch or emotional thing to be shared with ⁓ your community ⁓ workers do that. My question is what if they do not have Food, do you supply food or you are connected with different other vendors who go ahead and get this charity work together? speaker-1: Think so the community health workers are like case managers. Yeah. They can't provide all kinds of services because sometimes it's a lack of skill set or you know we need to be certified. So when it comes to things like addressing mental health and behavioral health issues, ⁓ we are primarily a medical shop ⁓ and we have one payer. So if someone is eligible for medical, we'll get them enrolled and we'll get them an appointment. And that's how anything related to health and mental health is taken care of. When it comes to things like food, yes, there are a number of community based organizations who can offer some support. So we try to get them in touch with that. It's by no means I would say I think ⁓ the word volunteer, we are not volunteers. ⁓ this is a paid service. ⁓ so they're just ⁓ another set of employees in our organization. The case management services itself is something that ⁓ ⁓ California State ⁓ recognizes as being an important health care service. And so we do get reimbursed for certain type of case management services called enhanced care management and then community health services. So anytime we engage with a patient, whether it's through a phone call or through ⁓ you know, we are having them come to the clinic and assess their needs and draw up a treatment plan or a care plan, ⁓ all of that is ⁓ recognized as a billable service. ⁓ and so we are able to establish it's really important to do that because that allows us to scale, take something small and then make it big. The format of support is a combination of ⁓ getting them connected to the right resources. speaker-0: Do you think this job is very fulfilling? Do you feel satisfied? Do you feel happy about what you do? speaker-1: I yeah, absolutely enjoy. I think ⁓ you know, ⁓ it's been sixteen plus years since I've been in healthcare. Mm-hmm. I started out working on the payer side and then I moved on to health tech and now I'm on the ⁓ provider side and community care organizations are very special. ⁓ and I I I I wouldn't know what they did until I started working there. So I've I feel very grateful. ⁓ I think ⁓ The fulfillment comes from the impact that I'm able to see. And also, ⁓ you know, it's a mission driven organization, so we all work well with each other, we all care for the greater good. And when it comes to helping someone, you know, it's all hands on deck. ⁓ no one says, Okay, I'm busy or I have to go somewhere when we have a patient in need and some sometimes they don't have a transportation. We try and figure out how to get them the support that they need. speaker-0: A great, great work. We have been building a lot of innovations from decades in that 20% slab. We have got a lot of automations, a lot of AI implementations are being done just to make sure that that 20% is extraordinary. And also, when I go to conferences, there is another version of AI in healthcare versus what is actually happening in the clinic where there is no room for any faulty. pilots because and also there is budget crunch and of course no no room or no experimentation mode is there. So tell me how you feel about it. Tell me what are the latest developments you have seen happening or you have seen ⁓ getting implemented in your current organization. speaker-1: Yeah. I think when it comes to technology, ⁓ we are an organization and I've been grateful to have been the leader that has helped build ⁓ I would say, infrastructure capabilities as well as ⁓ work with teams that have enabled ⁓ you know, easier documentation, ⁓ better optimization of patient care activities, as well as giving us visibility to our workflows. And where we have gaps, whether it's in revenue cycle or some other areas. So what I'm trying to say is that in the horizontal layer, you know, the business doesn't run if you don't have a solid system of record, which is our EHR, and then all the technologies that enable it. But I think when you think about where technology has made some market ⁓ impact and improvement, ⁓ in our case, and I think for the gr if you look at the healthcare landscape itself, you know, how do you reduce clinic clinician burnout? Right? So as a clinician, I didn't go to medical school to know how to document in the EHR. Exactly. So if if you were to take that seriously, how can we make it easier, better, less stressful for the clinician so that they're able to spend more time talking to the patient and learning about their problems and delivering care? So we implemented ⁓ an ambient scribe ⁓ capability. ⁓ it's been more than a year and a half and we continue to ⁓ scale it and drive adoption. I think one of the nuances in healthcare is that you can't have big scale launches like you would in other industries. Makes sense. ⁓ because it has to be extremely systematic, methodical, and ⁓ at no point can you enable something where you are not hundred percent sure it's going to work well and deliver the outcome that you're expecting because the adverse event can be extremely costly ⁓ both from a patient care and patient life perspective or or ⁓ you know when you look at other things in terms of cost and revenue. So it's really, really really important that ⁓ you have ⁓ well wetted technologies that are HIPAA compliant, taking care of all things related to a patient's ⁓ condition, ⁓ their ⁓ privacy, ⁓ as well as that it's really allowing the clinician to do something that they really are intending to do. ⁓ so we have slowly, you know, ⁓ we started with a small pilot of ⁓ early adopters and ⁓ a lot of word of mouth And then constant ⁓ reinforcement of the benefits of those capabilities ⁓ w is really important because then it allows us to draw more ⁓ other, you know, others to really scale these kinds of technologies, right? So that that I think has been one of the biggest areas of ⁓ improvement. I think aside from that, you know, we are always looking to enhance our infrastructure, whether it's in the way of enabling ease of use or enabling us to look at have a better visibility of our data. One of the other areas that I've been very fortunate to lead and drive for the organization has been in the area of driving and implementing some solid data infrastructure. We do have access to data that sits within our system of record, but it's extremely opaque. ⁓ It requires a lot of technical expertise for someone to feel comfortable to pull it out. And so I ⁓ I've been ⁓ able to sort of ⁓ unpack that and then build a data warehouse ⁓ internally. ⁓ and today, you know, we've enabled and built some dashboards that allow folks to who have no idea what they're looking for to come out and look at you know business performance metrics, clinical quality performance metrics, our ⁓ patient population mix. How does it look by ⁓ demographics and race, ethnicity? ⁓ income, age groups, as well as also language preferences, and at the same time also looking at you know their payer constitution, you know, the payer mix across the board. Because it does vary by ⁓ service line. And I think ⁓ this has been extremely important because it is allowing us to understand ⁓ our business better, understand what's working well and where we see some gaps. So instead of Taking a wild guess and looking at anecdotal information to drive improvement and changes, we have real data. So we have facts. And we can also prioritize where we want to go first and second and third. And it's easier to get alignment and buy in when you're operating with facts and data versus when it's only anecdotes and someone's perception and speaker-0: Yes. Data can make everybody feel comfortable or show them the reality. Exactly. But that is the best way to go ahead with. I'm wondering how do you do such transformations with ⁓ limited resources? What are your best practices? speaker-1: Yeah. Yeah. I think ⁓ it's funny you were ask you asking that. I was thinking about it this morning. I think it's you know, just being open to change. ⁓ in a small organization, ⁓ I'm sure you can relate to it. ⁓ you wear many hats at any time. Mm-hmm. ⁓ I think it's ⁓ teamwork is dream work. It sounds very cliche, but it is absolutely the secret ingredient. ⁓ you know, the ability to lean in. Stretch, be curious. ⁓ I've been very fortunate to be working alongside some extremely talented and creative people and some exceptional leaders too. So I think ⁓ the at the heart of it, ⁓ you know, I care about what I'm giving back to the community. ⁓ and I'm also at a point in my ⁓ career where I want to pay it forward. ⁓ I feel fortunate to have had the opportunity to do many things. And experience ⁓ many areas, whether it's ⁓ in the domain of healthcare or some other industries. So I feel it's now time to give that back, ⁓ whether it's sharing knowledge or expertise or mentoring people. So I enjoy that a lot. ⁓ but yeah, I think staying humble is also extremely important. Yeah. ⁓ because ⁓ You know, I although it feels like I've been in this industry for a very long time, I still feel like I don't know much. And every day I learn something new. And I discover. Yeah. speaker-0: Yeah, it's like yeah, but I completely agree with you. ⁓ if you're not humble, if you're not ready to give back to the community, this industry is not meant for you. These are some of the things you need to deeply have embedded in you. That is what I believe. ⁓ what are some of the barriers you see and you think should be ⁓ overcomed in upcoming years? speaker-1: Yeah, I think ⁓ healthcare has become a bit of a luxury good or a luxury service, especially here. And so I hope and pray that we can somehow find a way to make it a little more accessible and hence affordable to many. ⁓ cost of healthcare is a huge barrier. And so that if if costs are going to be as high as they are, it's going to keep sick people away from getting the care that they deserve and need. I think healthcare needs to be ⁓ accessible to more people than it is today. ⁓ So whether it's ⁓ easing up on some of the regulatory pressures and then finding ways where more people can look at this whole industry not as a for-profit industry, I think ⁓ is probably ⁓ going to enable us to drive towards that. I think the second thing is the recognition of the fact that There are structural barriers before you can address a person's healthcare, I think is going to ⁓ be extremely important. And we have to find ways to build systems and capabilities and resources to enable that. Not just from an individual entity perspective, but more from a, you know, it requires the intervention of ⁓ many, many different entities, including the government, public health, private entities, ⁓ and so. It takes a village to make it happen and so this is something that is a village speaker-0: To take knowledge to happen in I I'm not sure, maybe ⁓ a good number of ⁓ years because if you see the healthcare industry and the established community centers or any private or public healthcare centers, they are established from decades, and the kind of data they are having, the kind of establishment, the mindset it needs to slowly move on to another level of giving more. speaker-1: For giving. speaker-0: back more to the community. ⁓ Given a chance, what would be one thing you would like to change in this FQSC model? speaker-1: I think there's a lack of awareness of the FQHC model of care and who we serve and that we keep our doors open to anyone. And so if I had an opportunity to change anything and something, it would be around just driving awareness and ⁓ also mm, you know, ⁓ communicating the kind of model of care that I think if it were to be scaled and made more broader in terms of scope. can really also help in not only driving access but also that whole affordability because like I said, we don't say no to anyone. ⁓ so that probably is the only thing I can think of. ⁓ but I I mean I think ⁓ from the bigger perspective of things happening in the industry, you know, we face the same amount of pressures that others are facing in a different way. ⁓ I think in our case resources are very skinny and limited. And so I have to always be scrappy and a little more creative and trying to figure out how can I enable something to happen but with a lot limited number of resources and budget that is available. So every place I think has its nuances and so does ⁓ so do FQHCs. speaker-0: Given chance to rebuild US healthcare where FQSC is the blueprint, what would be the one thing you would make sure getting right? speaker-1: I think you know, in in a perfect world I wish I can be doing a lot more and sometimes I I'm constrained and I have to prioritize because I just don't have the resources. So I think ⁓ more support for FQHCs, ⁓ because ⁓ you know, yes we are a safety net, ⁓ we are in these rather rural areas or not so rural area areas sometimes serving underserved populations. But I think the mission and the impact that we deliver is so far reaching that we can be just doing a lot more with a little more support. speaker-0: So you're saying resource. Great. Thank you so much, Malika, for the insightful discussion. speaker-1: Thank you so much. I appreciate the opportunity and it's been a pleasure.