Episode Transcript:
Talya Schwartz, MD
My mission here is not just to make sure that people have great access to quality care, but that their experience accessing it is dignified, is timely, is appropriate, and they are receiving what they're entitled to expect to receive, an excellent experience.
Robert Traynham
So, I'd love to start the conversation with just an icebreaker. Dr. Schwartz, tell us, what you wanted to be when you were growing up?
Schwartz
I always, as far as I can remember myself, wanted to be a physician. I remember being a five-year-old, really not knowing much about anything but knowing I wanted to be a physician. I don't know where it came from, because nobody in my immediate family is a physician, but I guess it was the sense of taking care of other people, really making a difference in somebody's life. It was just innate to me. So, yeah, before I knew what it meant being a doctor, I wanted to be one.
Traynham
Part of your DNA, literally and figuratively. You just knew this in your heart of hearts.
Schwartz
Yes.
Traynham
And so, based on that, how have you applied your experience as a physician throughout all of your leadership roles?
Schwartz
It's really been helpful, actually, because I naturally think about the person, right? Whenever we make a decision, whenever we make a plan, whatever initiatives we're planning, I always gravitate towards thinking about the person. What does it mean to them? What does it mean to them from a clinical perspective, what does it mean to them from an experience perspective? What does it mean to their caregivers? But also, because I'm a physician myself, what does it mean for the physicians, right? The decisions that we're making that are impacting the full equation, right, of the health care stakeholders. It's really important for me to make sure that we are aligned with the physicians and we're supporting them, we're complementing them, because so much of the care that they are providing is not just limited to the office visits, right, it goes way beyond. Obviously, physicians can't necessarily go way beyond, and it's critical to go way beyond, so how do we complement whatever they're doing with our support? So, being a physician, being in their shoes, experiencing what they're experiencing, it's very natural for me to consider those stakeholders anytime we make a crucial decision.
Traynham
Here at AHIP, we call it guiding greater health, meeting somewhere where they are and literally walking on the journey with them.
Schwartz
Exactly.
Traynham
Not just prescribing and says, "Go out and do it," but let's just walk on this journey together at your pace. Sometimes that's running, sometimes that's jogging, sometimes that's barely walking.
Schwartz
Absolutely. It's interesting, you know, I'll just take this one step further, something that we do all the time is introducing peers, that we're matching to various cohorts of members, and it's exactly this concept. They walked in our member's shoes, they had those experiences, they really know what it means to deal with HIV, they really know what it means to deal with a substance abuse, they really know what it means when your diabetes is out of control. And putting those people who have those lived experiences in front of other people who are still struggling really makes a significant connection, and finally also makes a real dent in how they're progressing through their condition towards better outcomes.
Traynham
Empathy, having a conversation, whatever you want to call that, right?
Schwartz
Yes, absolutely.
Traynham
Dr. Schwartz, you are a leader at MetroPlusHealth, what does that mean to you specifically?
Schwartz
So, I really feel a true affinity to the people we serve. I also truly believe that the fact that somebody can't afford their coverage doesn't mean that they get a subpar coverage. Actually, quite the opposite. We want to provide those people the concierge service they need because they don't know how, necessarily, to advocate for themselves. They don't necessarily know how to navigate the system. They don't necessarily even speak the language. These are the people that I really want to invest in, because that concierge service is truly, truly critical for them to stay healthy or be as healthy as they possibly can.
Traynham
And as a follow up to your answer, Dr. Schwartz, is that how you measure success? The dignity, the equality, the equity, making sure that that individual or individuals that you're speaking of get, have the access to the best-quality care?
Schwartz
Absolutely, yes, and doing all of that through a great experience. We are all used to having a somewhat subpar experience when we interface with health care, right? We don't tolerate it in other places at this point in our lives, but we accept it when we interface with health care. My mission here is not just to make sure that people have great access to quality care, but that their experience accessing it is dignified, is timely, is appropriate, and they are receiving what they're entitled to expect to receive, an excellent experience. And I will tell you, I'm so proud that we were able to close quality gaps for our Medicaid population, and essentially bring those gaps to the same level as the commercial population. That's what I'm talking about, not just talk about equity, not just kind of communicate about equity, but showing the outcomes, showing that we were able, through a lot of hard work, a lot of innovation, a lot of flexibility, to match the quality outcomes for this population to our commercial population.
Traynham
Yeah, there's a saying in my family called “doing the stuff,” and that is not talking about it but just doing it, and doing it, quite frankly, when no one else is watching, because that's not why you're doing it.
Schwartz
Absolutely.
Traynham
You're doing it because you're walking on that journey with that individual.
Schwartz
Exactly.
Traynham
You are a provider-owned plan. Walk us through how that shapes the way you provide services.
Talya Schwartz
Yeah, this is really our special sauce – one of many, we have a bunch. But we really view ourselves as an integrated system, and so people who are covered with us and receive services with our provider organization have a completely seamless experience.
Traynham
I see, it's – my words – one-stop shopping?
Schwartz
One-stop shopping, no administrative headaches, no calling, no paperwork. It's completely seamless as long as you're covered by us and get the services with our provider organization. What it also means is we join forces when we see gaps in care. If we do not see in a certain area that women are getting their mammograms, if we do not see kids coming for their appointments, getting their immunizations, we join forces, we identify the area, we organize the intervention, and we have the providers coming in to help us make that intervention.
When it comes to case management for our really complex, complex patients, we're able, again, to bring our care managers together with the providers and address whatever the issues are. And one of the things that I'm really proud of is what we have done around mental health. So, we embedded mental health clinicians into psychiatric wards, into substance abuse facilities, and so we're working together with the providers on site at the most vulnerable phase of our member/patients, but then we handhold them through the transition back into the community. So, we meet them when they're really vulnerable, when they're open to, to get the help, and we stay plugged in as they transition, and we've seen tremendous, tremendous improvements.
Traynham
So, it sounds like these are really good examples of you being proactive, you having this seamless experience on behalf of the patient for dignity, for empathy, and, again, meeting them where they are.
Schwartz
Exactly, exactly. And I think frequently the plans are seen as adversaries to the provider system. I think we're able to overcome, we're able to plug ourselves in a place where we're helpful. And even with our parent organization, we have 11 different hospitals, not, it is not one-size-fits-all. We understand what are the needs, what are the gaps in each of the wards, and we plug ourselves in into those needs.
Traynham
So, what I hear you say, to be really clear, each of these wards is hyperlocal, very community-focused to your earlier point?
Schwartz
Exactly, and we're not coming with preconceived notions, we come to them and we say, "What do you need? How can we be here, how can we be helpful to you? How can we complement what you're already doing?" And it's different for each of the hospitals, and so we're able to customize our support for them.
Traynham
Any examples with respect to peers?
Schwartz
Yeah, there are two examples that come to mind. One of our peers was working with an HIV member, and a significant storm was happening in New York City and it flooded the member's apartment. We wouldn't have known about this, but this member was connected to one of our peers, elevated this to us saying, "His apartment is flooded," and we were able to secure a placement for this member while his apartment was renovated. The other one is really heartbreaking. It was a member, a female, who lost all of her hair and she was so embarrassed about her appearance that she refused to go and seek medical care that she truly needed. Again, the peer elevated this to us, we were able to secure a wig for this member so she will regain her confidence and will be able to seek the care that she really needs.
Traynham
Thanks for sharing both of those.
Schwartz
Absolutely.
Traynham
You alluded to this a few moments ago, and that's the uniqueness of New York City, which I believe, I think, is the uniqueness of your plan. Tell us more about that.
Schwartz
Yes. Well, you know, New York City is the largest city in the U.S., it has a population that is larger than many countries in the world, and sometimes it feels that there are many countries in New York City.
Traynham
In many ways, it is, and New York City is a microcosm of the world in many ways.
Schwartz
It truly is, and what's unique to us, we are a New York City plan, so we understand that New York City's not one-size-fits-all. You say New York City, I don't know what that means. There are different boroughs, there are different neighborhoods, and there are very different communities. We operate out of New York City, our employees are, a lot of them are, either live in New York City or immigrated into New York City. We reflect New York City in our employees, and we really understand this is not one-size-fits-all. You really have to be hyperlocal, hyper-focused in New York City truly to understand the different needs of the various communities, and tailor your solution, your communication, your approach to those communities.
Several years ago, we looked at how our members are behaving in terms of utilizing services, and to nobody's surprise, we saw that the homeless population was truly, truly struggling, in and out, in and out, out of the hospital or out of detox facilities. And so, it became very, very clear that unless we helped to address the homelessness situation, this trend will continue. Now, because we operate under the auspices of New York City, we were able to work very closely with other government agencies, other city agencies, specifically with Department of Homeless Services. And so, we were able to contract with that and collaborate with them in a way that we actually could take our members who are eligible for supportive housing and walk them through a pretty significant maze of getting into supportive housing, meaning we supported them through the clinical evaluation, the mental health evaluation, we helped them find the supportive housing, we helped them with the interviews, we helped them with the landlords, and finally, when they actually moved into their new homes, we helped them to settle into their new homes, find the supermarket, find the pharmacy, find a new doctor if you moved away from where you used to live. All of that came together, and this is how we were able to make a real impact.
Traynham
There are quite a bit of barriers when it comes to the physical and social barriers, towards health in this country, accessibility, affordability, the list goes on and on and on. Any ideas with respect to how we can tackle this?
Schwartz
Yeah. So, in terms of physical accessibility, telemedicine is something that everybody is aware of and plays it. Here's the issue: telemedicine is now available, right? A lot of providers are offering it, and almost all the health plans offer a vendor, right, for 24/7 coverage. Only that having telemedicine is not enough, because what we are seeing is that the commercial population jumped on this solution and knows how to access it, and there's a significant, uptake there. When we look at the government-sponsored eligible, they're not using it as much or hardly using it at all.
Traynham
Why is that?
Schwartz
I think there is, to some extent there's a trust issue. To some extent the communication that we are sharing, is received better in certain populations, and so we need to adjust how we're communicating, and I think the last piece is we need to offer it at the right time, right? Sending a letter to someone saying, "Telemedicine services are available to you whenever you need it," doesn't work. When somebody's looking for service, they need it now, and it is something that can be addressed through telemedicine, this is when you jump in and connect them, right, at the right time and you show them how. Then there's a chance they will use it.
Traynham
Yeah. And throwing a little bit of a curveball, I have a cousin, when I mentioned telehealth to her and she said, "I have to remind you, Robert, I don't live in privacy. I share this apartment with four other people, so for my own dignity, for my own privacy, I don't feel comfortable, you know, using this, service, and we don't have high-speed internet." And I just had this aha moment. I'm like, "Oh my goodness, thank you for reminding me of your shoes." Because here I come in saying, "Oh, just use this," but she had to gently remind me, "That's not my lived experience, that is not my lived experience."
Schwartz
It's true. I mean, luckily it's not the, the connectivity's not necessarily an issue in most of New York City, but even in New York City we still have spots where it is an issue and it does preclude people from utilizing telemedicine. And the other thought is there are actually a lot of people in the community – aides, nurses, social workers, community health care workers. How can they be eyes and ears, ultimately communicating potentially to a provider, to a nurse practitioner, to a social worker, right? Using kind of the presence with technology and connecting the dots where needed, those people are already there. How can we utilize them better?
Traynham
Let's talk more about technology, we're, we are sitting at the intersection of technology and health equity, and the promise of that, there's some pitfalls, but the promise of that. Can we talk a little bit about both, the promise but also maybe some pitfalls?
Schwartz
Yes. So, we're all aware of the wearable devices. You can transmit whatever you're doing, right, at any given time. That's amazing. It's back to your question about accessibility, right? They may not need to go see the doctor as frequently, “I can transmit my information, that's great.” Technology helps us connect the dots. There is a lot of input, right, at this point, good and bad, right? It's incredible that we're able to collect all of those data points. It's also overwhelming. What are you going to do with all of those data points? At a certain time, they actually can be more alarming than helpful. Technology can certainly help us get to people we wouldn't have gotten to otherwise, right? I mean, all of this ability by incredibly talented surgeons, right, to control different procedures from afar and really contributing their talent from afar, there's just so much that is available to us right now.
Traynham
Is it also a bit overwhelming? Can it be a little overwhelming?
Schwartz
I mean, recent events are showing us that while the advances can be tremendously helpful, they also make us vulnerable, right? The more technology, that's been interwoven into what we're doing. And as I mentioned before, it is not equitable, so we are seeing technology being more adopted by, people who are more educated, people who are more comfortable with, with advances, and less so with people who could really benefit from it. We need protections, and we need to make sure that technology helps equality, doesn't make it worse, and I'm not sure we're there at this point.
Traynham
In your mind, what is the next big thing in health?
Schwartz
I was thinking about this question, and so much came to mind, right, from personalized medicine to gene therapy curing conditions that we thought were incurable, right? To aging population and really trying to figure out how to deal with common conditions in the aging population, Parkinson's, Alzheimer's, social isolation that goes hand in hand frequently with aging population. Really women's health that is also kind of suffering from inequality, right? Less research is done for women, especially women kind of in their midlife phase, right, menopause. All of this now is coming to light, but still far behind. But as I was thinking about it, of course AI, how can we talk about the next big thing without AI, but as I was thinking about the evolution of medicine, when we started with medicine, there was this one doctor that knew everything, right? Not only about you but about your entire family and maybe your entire village or... Right? They took care of everything. We've then evolved from there to specialties, right, but you still had the primary care provider functioning as the quarterback, right, and still coordinating your care. But now, there's so much specialty, there's such amazing amount of knowledge out there that a primary care provider is struggling to coordinate all of this, to become the quarterback, and so what's happening is that the patient is left with all of those data points to make decisions for themselves. And so, for me, we're at a point where technology, possibly AI with some service support, will help connect all of those multiple dots and support the patient and support the primary care provider in coordinating and making the right decisions for themselves.
Traynham
Thank you for sharing.
Schwartz
Thank you.
Traynham
Thank you.
