Episode Transcript:
Darrell Gray
One of the misconceptions, when we talk about health equity, is that it's only about one population or one race. No. When we talk about advancing health equity it’s ensuring that everyone regardless of race, ethnicity, sexual orientation, gender identity, religion, disability, the list goes on...
Robert Traynham
Income, geography…
Gray
Exactly! That they can attain their highest level of health possible.
Traynham
So, I think the first question that is burning, at least for me, okay, and that is: How do you decompress? What does that look like for you?
Gray
Oh, my goodness. Well, I have to tell you first that I have four little kids. All right? So, they range in age from 15 months to eight years – three girls, one boy. And so, we have a busy household. It's not a lot of decompression that happens. But when I do decompress it is usually watching movies. I actually really enjoy movies. That, and if I can sneak a date night in with my wife, that's it.
Traynham
What kind of movies?
Gray
A little bit everything. I might surprise you with my favorite movie. I'm gonna take you back with this one.
Traynham
Let's go back.
Gray
"The NeverEnding Story."
Traynham
Never heard of it.
Gray
That is a classic! How have you never heard of it? So now when you leave AHIP 2023, I've got to give you some homework. You’ve got to go see NeverEnding Story.
Traynham
This 1980s?
Gray
I mean, the 70s? Maybe, very early 80s?
Traynham
Okay, yeah. And it's funny because I'm a big movie buff, but I've not heard of this movie.
Gray
Classic. Never heard of Atreyu? Like struggling? Oh, my gosh, come on now. The imagery of it all.
Traynham
Okay, yeah. Well, I think I can relate to this, though not this movie. For me, a movie is about like, just getting lost. And it's everything from the writing to the acting, but of course, the story plot, right? And so, for a good — I don't know — hour, two hours, maybe even three hours, you are just taken to another place. And especially if the movie is like so riveting that it's like you're not looking at your phone. You know, you're barely picking the popcorn up because it's almost like you in the movie become one.
So, let's keep this metaphor going.
I want to write a script for you. And the script is, and the story plot is that there is this big world out there, where there's a lot of inequity when it comes to health. There's a lot of inequity when it comes to people feeling empowered to talk to their doctor to have a relationship with them, feeling empowered, to really you know, understand their benefits from a health insurance perspective. People feeling empowered just about saying, “Hey, listen, I'm not feeling okay. But I'm not sure who to talk to.”
So here we have now this Chief Health Equity officer, and he or she comes onto the screen and does what?
Gray
Well, first, they have to first listen. So, you know, what's incredibly important is you come into an organization or come into a new role is you need to know who the stakeholders are, what their priorities are, and who they serve, and what those people they serve, what their priorities are.
Certainly, in the role of a Chief Health Equity officer, your ear has to be to the ground. And I say that lovingly meaning your ear has to be towards those who are closest to the inequities. Your ear also has to be towards other stakeholders within the business. And certainly, as a peer, I think about, you know, within our business, who our internal stakeholders are, who our strategic partners are, that help us to be effective in our partnership and serving people of all walks of life. So, the first I think when someone comes into the role, it's about listening, and but not stopping there. It's about learning. So, learning from what you hear from all different stakeholders in the communities in which you serve, and then doing. So, listening, learning, and then acting on what you hear. Creating change and trying to find the most effective and efficient way of doing that — that is business aligned.
Traynham
Can you, if I may, Darrell. You are Dr. Gray, and for the benefit of the folks that are watching, you are a trained doctor, an M.D.
Gray
Yes.
Traynham
That's important for us to put into the conversation.
Can you give us an example of showing up listening, understanding the stakeholders, and then saying, this is a right, I'm sorry, “This is a wrong that I need to right.” Can you give us an example of that?
Gray
Yeah, well, I think, you know, I don't know if it's fair to say a wrong that needs to be a right because even if it's not wrong, there's always opportunity to improve. And I think, for example, when I came into the role, you know, Elevance Health had been doing work in identifying and addressing disparities for decades. What I think the opportunity was, was how can we as an organization, be one band, one sound? How can we be unified in our approach to advancing health equity?
I think in many ways, we have been very disparities focused, you know, identifying what the data tells us about disparities. How can we prioritize certain areas. But it's different to kind of focus on the disparity as opposed to focusing on how you can get to equity. And I think as we started to frame again, listening to stakeholders, leveraging that to develop strategy, which, in what we do at Elevance Health is health equity by design. That was the opportunity. It wasn't necessarily making a wrong, right. But it was doing business better. And through a very strategic focus.
Traynham
I see. You touched on some examples a few moments ago. Can you elaborate?
Gray
Yeah, a couple of stories, if I may, I want to share with you, as a part of our pharmacy business pharmacy benefit manager called Carelon, CarelonRx. We have about 400 clinical pharmacists and pharmacy technicians. Well, one of our pharmacists, Tia, was reaching out to a member because this is a member who had chronic disease takes several medications. Matter of fact, there were seven medication that this particular member did not fill. So, Tia reached out to the member to, to basically see what was going on, she was going through her typical check in “Hey, how you doing, I noticed you hadn't filled seven of your medications. Can you tell me what's going on?”
Now this goes back to what we talked about earlier, trust, right. So, in this case, the member told Tia “Well, you know, I haven't filled these medications because I don't have stable housing.”
She was floating between temporary housing situations, didn't have a stable address. And so, filling the medication wasn't a priority. And so based on that, Tia did some other screening, social risk screening and social determinants of health screening, but didn't stop there. So didn't just stop at asking the question, identifying the problem, but then connected the member to a solution. So connected the member to resource to ultimately have more stable housing.
So, as we talk about, you know, I go back to what I was saying earlier, listening, right, learning and then doing — that's exactly what Tia did. And not only just addressing that clinical need fill those seven medications to, you know, take for your chronic disease, but addressed something that influences why she has some of those chronic diseases, whether it be hypertension or otherwise. And that is getting stable housing. Right?
I think about another situation we have, and this is for our Kentucky plan, they have community care navigators. And again, trust. So, there was a member who had touched base with one of our community navigators and called them, basically, and I'm paraphrasing, but very matter of fact, “Look, I know you can’t help me with the situation, but I figured it's a long shot. I just want to tell you what's going on. I got an eviction notice.”
And so again, this goes back, another housing story, right? And it just so happened that the community navigator, again, had that relationship and said “No, there is something we can do.” And so, through a series of calls to the landlord, they worked out what she did not have to pay. She had stable housing. The eviction notice was revoked. And now she has her home. And I wish I could show you this visual, there's a picture I have on my computer of the card that the lady wrote, talking about how thankful she was she actually wrote a little poem, but how thankful she was to that community navigator for the service that she provided and allowing her to keep her home.
Those are the kinds of stories we get each and every day. And, it's because of people in our organization who are building relationships. And that's quite impactful.
Traynham
Yeah, you know, in my mind, these are like pieces to a puzzle that create a larger picture.
Gray
That’s right.
Traynham
And part of that picture is a story. And a story always begins with a beginning and a middle and an end. But I'm not comfortable sharing my story with you until there's a level of trust. And I think, or at least you're giving off the vibes, that you're listening.
Gray
That's right.
Traynham
And guess what? If you're listening, it's like, “I think I can help you.” So, you're tying it back to helping that person which, thus in a process, reinforces what a strong relationship is. So, it's almost like a 360 in so many different ways.
Gray
That’s right. You hit it right on the head. Yeah, absolutely.
Traynham
It appears, Darrell, that this is now a national conversation. It feels like this isn't a conversation that's happening in silos around the country. It seems more uniform. Is that fair to say?
Gray
That's fair to say.
Traynham
And so, what is the next step in your work? What does that look like for you and for the industry?
Gray
Well, I think, for me, for anyone who's in a similar role, it's about creating systems so that when I or that person in whichever company is not in that role, that the work continues, when the word health equity is not a buzzword or not Vogue, the work continues. Regardless of what happens, kind of in the health ecosystem, the policy ecosystem, the work continues. So, as I think about what we are building toward, it's creating systems that are designed to achieve what we want it to, which is advancing health equity.
So, ensuring that we are centering people from all walks of life again, you know, one of the misconceptions — I may go off on a tangent, so you may have to stop me.
One of the misconceptions, when we talk about health equity, is that it's only about one population or one race. No. When we talk about advancing health equity it’s ensuring that everyone regardless of race, ethnicity, sexual orientation, gender identity, religion, disability, the list goes on....
Robert Traynham
Income, geography….
Gray
Exactly! That they can attain their highest level of health possible.
Now, it does require that we prioritize those who have been minoritized or made vulnerable. But a misconception is that it's only about one group, and it's at the expense of other groups. That's not what we're doing. That's not what we're building. We're trying to improve health for all.
And certainly, in accordance with our purpose of improving the health of humanity, there is no way to get to the point of improving humanity without going through advancing health equity.
Traynham
I want to talk about technology — the good, the bad and the ugly. How can it help you and your work? Are there any guardrails that need to be put in place? And then lastly, are there any, frankly, potholes, things that you should avoid?
Gray
Yeah, I think one of the benefits of technology is it can make interactions, connections easier and more efficient. So as opposed to and I'll put myself in this, I'll put myself in the hot seat. I was a practicing gastroenterologist prior to joining Elevance Health and unfortunately because of the lack of gastroenterologists in the area I was in and lack of diversity there you know, I was one of very few African-American gastroenterologists in the area. And because that created within the community, a preference for me to be a gastroenterologist for many patients, the wait time used to be very long — months for people to get into see me. And that's even with me, overbooking my clinic, etc, etc.
Well, technology made it a little bit easier for me to see people quicker. Now, whether that was through telehealth, whether that's through portals that allow me to interact with patients — but that's just an example. It can make connections a lot more easy.
The downside is that not all technology is catered to everyone. So, as I think about it, let's go back in our memory banks to the start of the pandemic, when we were — everyone was — thrust into a telehealth revolution. Now I'll stay on this topic of telehealth. And, you know, for some, they didn't have a device through which to interact with their care provider meaningfully. For others, they had the device but they didn't know how to leverage it in a way that that made sense. They just weren't used to the technology. For others who, for example, had limited English proficiency and couldn't necessarily hop on a video and they had to do a telephone call, which you're not getting the face to face. Now you have a third party, translator, or interpreter, excuse me, who's guiding the discussion as opposed to kind of face to face, as well. And so, you know, in some ways, when we designed technologies without having certain populations in mind, they fall through the cracks.
Traynham
One hundred percent. And I'm going to throw another, a little bit more salt into this, this wrench here. Let's assume you have bandwidth. Let's assume that you have a high-speed internet connection. You know it’s interesting, a cousin of mine, we were having a family Thanksgiving dinner — this is during COVID. And I sent the email out in a text message to all the family and my family member replied back and says, “Well, I don't have the internet.” And I just said, “Wow, shoot. I should have known that. But I just assumed that everyone within my family group had access to the internet. But this one person said, “This is great, but what about me?” And so that's just another assumption that I made that I'm sure some others will make to… ”let's just telehealth.” And by the way, there also could be a barrier in terms of the speed of the bandwidth. So, for example, I might have whatever I have through my internet provider at the highest level, you may not. And so there might be a barrier there in terms of how I communicate with my doctor, or practitioner in terms of the connectivity.
Gray
That's right. And, and the other thing is, let's say you have the bandwidth, you have the technology, you're able to engage, but you may be less likely to engage, if you don't find features that represent you.
Traynham
That's right. Or even, if I go one step further, you might not have the privacy, you know. You might literally be in a home with five or six other people where you might not have the grace, to be able to share your personal information.
Gray
That is, right.
Traynham
It's little things like that, that sometimes we don't think about.
Gray
That's exactly right. And so, I think about, you know, there are brilliant people who are creating fantastic solutions. And as I think about those who are involved in the technology landscape, very well-meaning people. Sometimes I think they can be limited, however, by who's in the room at the time that they're designing the solution. And so that's why it's so important that we elevate the voices of consumers, as well, to inform where we go as we design technology.
Traynham
Yeah. What's the next step in your field? What does that look like in terms of the conversation?
Gray
You know, at Elevance Health, we're keenly focused on, I would say, really four areas. One is ensuring that we are delivering exceptional consumer experiences. So, that starts with knowing who our members are. Building trust in a way that allows us to have meaningful connections and ultimately move the needle on improving their health outcomes, because they trust us.
I would say also digital platform for health. So, we were just talking about technology. How are we leveraging technology in a way that people trust, and then use, to impact health outcomes?
The other thing is care provider enablement. So, for us, you know, our provider partners are key. We cannot do this work without our provider partners. So how can we create, again, meaningful relationships with providers, incentivize them to replicate the behaviors that improve outcomes and advance health equity, and shift towards more value over volume. And then lastly, I'll say, which is kind of the thread throughout all of it, is advancing whole health and health equity.
So, we think about it. You know, health is not just what happens in the clinic. And in the emergency department and in the hospital. It's largely what happens in homes and neighborhoods. So how are we thinking about behavioral health and social wellbeing? How are we addressing the pharmacy needs of those whom we get to serve, but also centering? Well, I should even say centering. The bedrock of that being how we are advancing health equity, ensuring that everyone has a fair and just opportunity to be as healthy as possible.
Traynham
You said something about 30 seconds ago that I'm going to I'm going to go back to which is incredibly important: meaningful relationships. So, it's one thing to have a relationship. But it's another thing to have a meaningful relationship, where, in my view, there's a level of trust. There is this authenticity in the relationship where it's like, “Hey, I'm not feeling okay.” Or, “I'm feeling a certain way, how can you help?” And vice versa, on the other end of that relationship is, “I hear you, here are some of the resources that we can perhaps maybe give you, and you're not alone.”
So, it's a journey, in this relationship, where you're not alone.
Gray
That's right. That's right. And oftentimes, I'll tell you, you know, navigating the healthcare system, and I say that just broadly, is not easy.
Traynham
No!
Gray
Even for a seasoned physician. It's not easy. So, imagine that person who lives in rural America, who needs to, maybe they have to see a specialist. And so, they have to go to the big academic hospital. It is a huge undertaking. And that can be overwhelming.
Traynham
And that's working under the assumption that you're feeling okay. That you are, you know, that you could you imagine. I can't even imagine the anxiety. In fact, I know how, because I've been in a situation where you just feel overwhelmed by all the information. You have to make a decision, right? It's about your health, but in some instances, it could be a financial decision. Yeah. And so that's a lot. That's a that's a big, big burden for people to carry.
Gray
It's a lot. And think about, so, let's say you're going through this tough situation, a new diagnosis, a new hospital, a new doctor, a new landscape, right. But also, you're thinking about, “Well, how am I going to pay for this? How am I going to navigate my benefits? You know, is this adequate coverage for me?” And so, having a trusted partner, a meaningful relationship, right, not only only with your doctor, but with your payer, your insurer, is incredibly key, I think in what we are trying to do.
Traynham
I think you just answered it, but I'm going to ask the question a bit differently. What's next for you? I heard you say that you were seeing patients.
Gray
Not now, currently.
Traynham
Not now?
Gray
Not now. I was. I do miss my patients dearly, too. If they were happening to watch, I love you patients! I miss you. But yeah, not currently practicing.
Traynham
I gotcha. What's next for you?
Gray
I think for me, it's continuing to challenge our organization, our industry — in partnership with so many others — to do the right thing, to make the right choices, the easy choices, and in advancing health equity, I think. And that comes in a multitude of ways. So, for one, you know, challenging us to continue to invest in health equity.
And, you know, what's been so exciting for me is to see our organization, certainly led by our CEO, supported by our board, but so many others across every dimension of our enterprise, to do that, from business planning to what they're doing on the ground in communities to how we even do grant giving through our foundation, to community partners, to the stories that we get from our members, I see it happening. So it's challenging us to do more, to be better, to be more intentional.
Traynham
So, it sounds like you see the impact every single day.
Gray
I think it'd be a stretch to say every day. And that's just me, I'm gonna be honest, I think that we are continuing to push. We get stories every day of victories from our members on successes in their health journey. But when I think of impact every day, I'm thinking of we serve 47 million members. When I think of impact, I want us to get closer, more away from the individual to the masses of people that we get to serve, I want to see that kind of impact every single day. We're working to get there. We're working to get there.
Traynham
So the progress is not by inches, you want to in feet, you want it much, much bigger.
Gray
Yes, because we can do it. And it's not us alone. It's working in partnership with those within our industry outside of our industry, partners, such as AHIP, to get there. It's been far too long that we've been, that it's been a game of inches. We need to push this out to the to the feet and yards.
Traynham
Understood. Last question. Think bold. Think really, really bold. The next big thing in health is?
Gray
Hmm, give me a minute to think about that.
Traynham
Innovation and Technology, or perhaps maybe something a little bit more, you know, closer, closer to home.
Gray
I think what we're going to start to see, and this is, I think I'm thinking longer term — so five years or more. We've traditionally thought of providers, as physicians, nurses, nurse practitioners, you know, the clinicians. But I think we're going to shift to seeing community-based organizations as providers, and I'm looking forward to that day because they are integral partners on health in health care delivery. So, I'm looking forward to them being recognized as care providers, more I think that's part of the next big thing.
But also, you know, technology is continuing to evolve. Certainly, you can’t have any conversation about what's next in health and health care without talking about technology. I think what we're seeing with AI, we're just seeing the early parts of it. There's a lot more evolution to happen in AI. And I think that is part of what's next. I think what we need to do also is — and this goes back to a word, I think a word that you mentioned earlier — either was safe or privacy. But certainly, as we talked about AI, it’s safety and the safety of those when we get to serve in our health care ecosystem.
Traynham
It’s part of that relationship, the meaningful relationship. It’s about trust.
Gray
That's right. That's right.
Traynham
Thank you very much for joining us.
Gray
Thank you for having me. This was a pleasure. Thank you.
