--- title: Why It’s Important to ‘Meet People Where They Are’ When Improving U.S. Healthcare | TIME description: The Covid-19 pandemic made issues with access to medical care apparent. At the Time100 Summit on Wednesday, three healthcare officials discussed how the concept of meeting people where they are could help improve the whole industry. canonical: https://time.com/video/A25Agc7x/ og:title: Why It’s Important to ‘Meet People Where They Are’ When Improving U.S. Healthcare og:description: The Covid-19 pandemic made issues with access to medical care apparent. At the Time100 Summit on Wednesday, three healthcare officials discussed how the concept of meeting people where they are could help improve the whole industry. og:url: https://time.com/video/A25Agc7x/ og:image: https://cdn.jwplayer.com/v2/media/A25Agc7x/poster.jpg?width=720 og:type: video.other twitter:card: summary_large_image twitter:title: Why It’s Important to ‘Meet People Where They Are’ When Improving U.S. Healthcare twitter:description: The Covid-19 pandemic made issues with access to medical care apparent. At the Time100 Summit on Wednesday, three healthcare officials discussed how the concept of meeting people where they are could help improve the whole industry. twitter:image: https://cdn.jwplayer.com/v2/media/A25Agc7x/poster.jpg?width=720 --- * World # Why It’s Important to ‘Meet People Where They Are’ When Improving U.S. Healthcare > Sponsored content. Supplied in partnership with TIME. 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They are at time.com/newsletters and are separate from a paid subscription. ## Video: Why It’s Important to ‘Meet People Where They Are’ When Improving U.S. Healthcare [Watch (HLS stream): Why It’s Important to ‘Meet People Where They Are’ When Improving U.S. Healthcare](https://cdn.jwplayer.com/manifests/A25Agc7x.m3u8) (25:08)  _Published 2024-04-24. The Covid-19 pandemic made issues with access to medical care apparent. At the Time100 Summit on Wednesday, three healthcare officials discussed how the concept of meeting people where they are could help improve the whole industry._ --- Apr 29, 2024 2:00 PM UTC --- ## More From This Series [All Videos](https://time.com/video/) [TIME100 Talks with U.S. Senator Tammy Duckworth](/video/uHpA66nB/) ### TIME100 Talks with U.S. Senator Tammy Duckworth [U.S. Air Quality Slips After Decades of Improvement](/video/bFYJAorO/) ### U.S. Air Quality Slips After Decades of Improvement [Big Tech Tackles U.S. Healthcare](/video/3McU2m7a/) ### Big Tech Tackles U.S. Healthcare --- ## Transcript Hello everyone and thank you for sticking with us. We have a fantastic panel. So I promise you they will make it worth while we are here to talk about future-proofing Healthcare. And I think all of us can agree that health care right now is facing quite a few challenges drug prices are skyrocketing there in equities and access the quality of care that people received and that's just routine health care when it comes to a public health threat, whether it's natural like we saw with covid-19 Channel with the potential buyer and terror attack most countries. I think we'd all agree are pretty unprepared to respond Contra note who was on stage earlier today spoke at a previous time 100 and he said complex problems like these they don't have one solution and no one person or one company or one group is going to have the answer. So that's why I'm thrilled to have our panel. Here because I think we're tackling these problems from very different levels. So Tony and let's start with you. You created cityblock Health, which is really kind of working from the Grassroots up tell us what motivated you to create cityblock health. And what need did you see that needed to be fulfilled? Thank you so much. It's a real honor to be here. Like so many folks here. I have had first-hand experience trying to navigate to healthcare system. And we all know how fragmented how complicated how scary it can be. Even for those of us with Resources with education with access with great Insurance. What is also true? No surprise is that if you lock any of those things if you were living in poverty if English is not your first language, if you're struggling with multiple chronic condition and perhaps your challenge is a mental health challenge that do tend to stigmatize that all of these problems become even more complex. I'm a physician Did my career and medicine I'm in Boston practicing and community health centers and safety-net hospitals and all I saw over and over and over again with people coming into the hospital with increases with medical psychiatric and Social Challenges that we put a Band-Aid over and send them back out into the world for and no surprise in the day that what we see is that there are massive disparities in Access and outcomes were seeing the same population people of color immigrants to this country people in poverty people with disabilities and mental health challenges having just unbelievably worse outcomes and the Healthcare System mortality got morbidity got some real challenges that are frankly I think a real indictment on our system and how many resources we have in this country as we built this business to try to address that to prove that we can and should care for the folks who need it the most the most of marginalizing. Population better that we can treat people with respect with dignity. We can provide them access to high-quality Services. We can meet their names on their own terms and in so doing we can change their outcomes and give them access to the best possible opportunities for house and we can do this in sustainable economic model. There's a business to be built here because we waste so much money on the Band-Aid solutions that don't solve the real problem since that's what we've been doing that soon as my motivation for doing this work. I'm going to get back to that economic model cook is critical, you know to to this whole idea of saying we can't just twiddle our thumbs but we really need to have some Concrete Solutions. I'm going to come back to that. But Luther you are executive director of patient Innovation and engagement and work directly with patients. And I'm sure you hear from a lot of them about drugs and NY drug prices are so high and clearly as part of the development drugs. There's research and development which about clinical trials, you know, very expensive to test these drugs and But it seems that if the home R&D process can be streamlined made more efficient, then you know, the ultimate price that consumers see could also come down. What are some of the ways that we should be Yer are rethinking how to develop drugs and particularly how to test them to kind of bring that whole price structure down. Great. Will thank you to be a part of this panel. Well, I'm not a part of the commercial organization, but I am involved in or Indy I'll wear out focuses on developing new therapies that improved I am save lives and one of the areas of focus is really bringing the voice of patients into the work that we do some work like other biopharmaceutical companies really I have recognized that the incorporating the voice of patients into the work that we do is critically important because these insights are really are so of valuable in What they offer and patience as you mention of course are the beneficiaries of any new medicines are new medical interventions. So that involving them in those decisions involving and bringing their insights and perspectives. What's important to them to a work is critically important not only because we didn't take a count of what importance of patience but it helps us in developing therapies that am or what I should say patient-centered a patient friendly. I research and our development and a focus of the work that we're doing is really been around making this process of developing new therapies, both representative and Equitable. So they getting insights from the patients in the communities for the therapies. I will in fact I be used and this has been extremely valuable in terms of our efforts to overcome barriers to Dissipation mean it with your well-known such as. You know mistrust, you know understanding of what it takes to develop a new therapy the looking at the logistics know the lack of research sites and somebody on the represented communities, but also just being asked to participate so these are inside that a critically important to our decision-making both in terms of how we do business. But also I'm making the work and the therapy is better and more efficient friendly and potentially more efficient write the whole process and and and and more efficiently because when we want me to speak about representative and Equitable development of medicines which recruiting and enrolling patients in our research and one of the lessons that we learned from the the covid-19 pandemic was not only that, you know the spot like that was shine on long-standing disparities, but that Was critically important to involve impact the communities in the development of the healthcare Solutions so that when you bring patients into this process, they not only contribute to advancing the science but also to developing Healthcare Associates that improve Healthcare that ultimately May Advance equity and there's also the the confidence and Trust in those therapies, if patients in the communities where they are being used I have been apart of the development program. That Rice you have a unique perspective because you your career spans both at working at the Grassroots level for healthcare delivery as well as most recently as special assistant to the president seeing the perspective from the federal land and National side. So, let's start with covid-19 because I think you know, it's it's the thing now to kind of look at the ark experience in the pandemic, which was so unprecedented and really see are there lessons that we learn there because the vaccination program, for example, we never most people here have never seen anything like that in terms of a mass vaccination program in terms of a shot being made available by the government. So what were some of the lessons do you think that we learn from covid that we could, you know, continue and keep in order to address issues of access quality and price even will. Thanks. Historian folks I thought I've finished up at the White House in the fall of 2023 sign now a recovering public servant as my therapist wife likes to tease me about I had the you may remember that the former president President Trump had disbanded in office at the National Security Council in the white house that was focused on pandemic preparedness. He did that in about 20 in the year 2018 couple years later something called covid happened, which I think folks will remember and he was quite unprepared. There were statements being made including that the disease will go away. It'll be a it'll be a miracle yesterday marked the For your anniversary of the president President Trump saying that you we should look at injecting bleach into people's veins to stop covid. There's a reason a president could be unprepared when you disband such an office. So I say that to let you know that was the office than that President Biden restored and I was eventually asked to lead and we work closely with the covid-19 on this vaccination campaign when when President came into office his number one goal was to get shots and arms and to put cash in people's pockets who were out of work because of the the the disruptions to the business and the economy from from covid part of ship between pharmaceutical companies Community pharmacies Community organizations academic medical centers doctors nurses community health workers in the 40 shifts that I think are relevant for Health Care access today. The first shift was shifting. From having Staffing of healthcare from being doctors to being Community nurses that are part of that team and even community members Outreach workers that were part of the community extended the medical team the healthcare itself. The vaccinations weren't delivered in hostile space has Warren clinics only many of you probably got your vaccines out at Community sites or even in Community Pharmacy. So we shifted the space closer to the patient the stuff of healthcare. You'll have to forgive me cuz my wife also doesn't like my habit of alliteration, but that's the only way I remember things a medical school so staff space the stuff of healthcare the test the treatments we mailed those two people. We mailed Testa folks. We brought treatments in the community pharmacies in the systems. We decentralized Healthcare by going more virtual allowing telemedicine to happen in more places that that approach of High-Tech high touch Community Healthcare. Really is not only key to ensuring vaccines get out to people. It helps ensure the missing half of healthcare is built in this country where they were dealing with the maternal Health crisis. We could have home visits happening to mothers that would help reduce maternal mortality with naloxone and the opioid crisis. We have an over the counter medicine. Now that people who have overdose affected neighbors can use that's shifting all of the stuff of medicine closer to patients. So this approach of High-Tech high touch Community Health Care is important that building missing half of healthcare. It's also higher standard of care and this Mantra that got really emerged during the covid pandemic meet people where they are was responsible for helping ensure that hundreds of millions of shots went into the Americans arms 3 million deaths were averted a trillion dollars of economic losses were prevented 13 billion of those shots. Around the world the United States supported many low and middle-income countries to get that done 20 million lives were saved and you had the kinds of Pelt vision of health care where you had vaccines people educating folks about vaccines in barbershops and in rickshaws in India in the Town Square in Massachusetts where I was involved in some of the vaccination Outreach and in the Himalayas of Nepal, but it was that shift to bring chair to people to meet people where they are that mantra for the vaccination campaign meet people where they are should be the mantra for all of healthcare. I think that's what you're doing right now. Thank we all agree with that with with City Block because meet people where they are that worked with covid because the government pay for the shots because you know, there were at the government paid for like these Mass vaccination campaigns, like you said, there was like some unusual an unprecedented Going on at that time in the absence of that and I wonder if you could have dressed like how do we meet people where they are and you're successfully doing that and how do you change specifically the financial model which right now means like when we've gone back now to the way that we do in a traditional vaccination we've seen vaccination rates go down, you know people don't get the shots. They need specially childhood vaccinations. So tell us a little bit about how we take that Mantra of you know me people where they are and make it work with the current system that we have absolutely think there's a there's a physical at Saint of temporal a component to that what you really talked about Rogers. There you go out to see people you meet them in their homes. You send the medications to their homes you go away from those Darkly medicine Family Medicine. I was trained in its you come to me you get what I can give you when I have time for you and your welcome, right and that's kind of have to pay for it. I have to pay for it. If you're not if you're we do when we take care of folks who received their health insurance through Medicaid, so they typically don't take cash out of pocket. But if you are, you know, working two or three jobs and you got four kids and your time is your is your currency and so we we ask people to take the day off work at the cash out of your pocket. We asked me to pay for transportation at cash it if we ask him to wait for us and then we give them 10 minutes of something that typically doesn't feel like it's met their needs and we say you're welcome to go by and so so physically going to people as a complete transformation, I clinically fell in love with home visits. I'm very early in my career similar to rise to a lot of work overseas where this is the norm, but imagine the feeling as a as a clinician or even in your role today and whatever job you have if you just completely flip a dime right? I'm waiting. I'm going to someone's home. I'm knocking on their door. I have that little rush of adrenaline. I don't know what's inside. They let me in there sitting in their comfortable chair. I take off my shoes if if that's the norm for them there. The clothes they wish to where I addressed them how they want to be addressed completely flipped the dynamic and the respect that you infuse in that relationship is really powerful. But the other component to meeting people where they are is actually much more there is a spiritual but there's a component to it. It is about understanding where people are in their beliefs their practices their values and and earning their trust because part of what we have done and learn I think in healthcare is it if you just build it they don't always come because if it makes them feel bad if it does not feel respect for dignifying if we deliver Karen away that feels hierarchical we missed the opportunity to meet people where they are and you know, we've been talking so much about how we address disparities and Care outcomes. The first thing we have to do is earn back the trust that we not are in from these populations with people whom we seek to serve and that means saying look, hey, I went to medical school. I believe that you know of vaccination this vaccination I've been tested it has been proven to be efficacious. It's a good thing for you. But what do you believe if you don't believe that to be true then I need to meet you where you are. And we need to start to figure out how we built together a basis of information and knowledge over time and it may take five visits. It may take one until we've been building a city block has an ecosystem and a and a business model that allows us to take the time to physically go to meet people to earn their trust over multiple encounters. And then when they are ready to deliver the type of care that we know will help transform outcomes and we can do this in a different business models and most clinical practices get paid what we call fee-for-service which means you come to see me I write a prescription. I do a procedure I counsel you. I bill the insurance I get paid now that prescription may not make you feel any better. In fact, you couldn't feel worse to have side effects. You may not even fill the prescription the advice I give you may not be the right advice. It doesn't actually matter. I still got paid. We don't think that's a good way to run. Healthcare System, I would like my incentive to be tied to do you feel better. Did you get the services that you need? Did we change your outcomes? Are we giving you more time in the community in your home with your family? Are you able to participate in society differently? And so we built a business around a business model that allows us to be incentivized around those outcomes so I can justify doing home visits even though I could probably see seven patients in the time. It takes me to see one is that one home visit resulted in a transformational experience for a patient that allowed them to stay away from the hospital allow them to stay in the community 11 to achieve better outcomes and we believe by doing that we can build a sustainable business model that allows everyone frankly to have access to the type of care that we all deserve it would benefit from but starting with a population that has the most to lose in the most to gain frankly from have broken. Our system is today and I'm focusing on the field with the most complex being and the most challenging needs to address in the biggest barriers to care today. The buzzword of course. Yes. I think we all agree with that the buzzword for that value-based can't write right and this is something that a lot of major health systems are also in are trying to adopt at spies are being one of them and what makes it work for them though is that they are the insurers as well for their members. So they're able to say we have decided we're going to reimburse for this more for this, you know, because it resulted in better outcome. How are you working with the current system? That isn't completely shifted to a value-based care model, but it's still primarily fee-for-service. How are you making cityblock Health work financially the reality is this solar system that feels unsatisfying is also incredibly expensive. It is way more expensive than it should be and it is incredibly costly particularly for folks at the furthest extreme of medical complexity people who we care for have fizzy. Full House challenges mental health challenges and Social Challenges on by definition. There are folks on Medicaid. So they they live at or around the poverty line and they're also people with lots of medical stuff going on in and then then Austin psychiatric things going on these folks tend to the hospital a lot as a usual source of care because the reality is with all that I just described we built a system where if I'm at home at 10 at night on the kids are finally gone to bed. I've been feeling unwell for 3 4 5 days. I haven't been able to take a day off work cuz I can't afford another day without pay and I call my doctor's office. They will tell me come in in three weeks or 6 weeks make an appointment tomorrow. What am I going to do? I'm going to go to the emergency room. We created a scenario where the emergency room is. The only place where if I am Lonesome cold tired hungry or feeling unwell that I can go reliably 24 hours a day and expect to be treated. Like a human and to be fully evaluated and maybe have some of my material needs mat that is so inefficient and so costly and see what we've done is we've partnered with health insurance to say, let's take them the money we would have spent otherwise on all of its reactive Band-Aid slapping on on problems and let's invested and community-based care that's invested in building trust engaging folks on providing them with high-quality care in their homes on their own terms in a way that allows us to save money cuz they're not making that 10:00 at night visit to the emergency room for something we could have taken care of for weeks ago in their home on their own terms. If I may add on Alice, you know the kind of work cityblock health is doing should be scaled up and it's 90 toyin's hard at it that hard at work on it. And one thing said that the in the white house that we would try to create the right incentives around business models. Like this one was to you know, try to get the what work with the centers for Medicare services to enable them to pay community-based health workers reimburse community health workers for the first time that you're Central to models like cityblock Health. These are folks who are hired trying to quit from their own Community instead of talking to you about diabetes and high blood pressure at the exam table and a clinic like your doctor might to they're coming to your home and talkin to you about it in counting your pills at the coffee table in your living room. That's that kind of Reform is critical to scaling this and that needs to go along with the kind of We need to keep moving forward the Affordable Care Act has helped enroll 21 million Americans just in the last year the lowest number record number of uninsured rates ever. We are there any president in in in in history in that coupled with these kind of reforms expanding the Medicaid Program which now 45 million Americans including ACA than Marketplace those two together about 45 million Americans depend on and those are some of the folks who need health care the most but don't either wise get it. And I know that often when we talk about issues like value-based care and and you know, the the kind of gaps in the Healthcare System. It's at 30,000 ft. So I wonder if we could very quickly we've got very little time left. Just turn to one big issue that's been getting a lot of headlines lately which is maternal mortality and although it's declined since 2000 it still not at the rate. It needs to be to reach the sustainable development goal of 70 deaths per 100,000 live births where it were quite far from that and I think it was surprised a lot of people here than in the US 33 mothers die for every 100,000 live births even here in the United States. So Luther I know Mark has been involved with addressing maternal mortality around the world. So tell us how we can apply some of these ideas about addressing inequities about addressing access and how your company is working to fill some of those gaps. But thank you Alice. That's actually a great way to end this session so that into to look at you know, what the cause of these that these deaths are in these young healthy women and I would say to that is really terrific that there is such a spotlight on this issue. Now, I'm work for mother's which is a global program that was developed by Merck in 2011 are with the gold really of creating a world where no mother had to die while giving lice and our role in this has been focusing on the research that will understand. I'm eternally health and while you steps for the disparities among different groups, but also the developing of actionable solutions and currently no mark from others. I have about 60 program and almost 50 countries around the globe and the focus is really on prenatal care postnatal care, but also that. All of the above Around the mother is so making sure that you're listening to the people who are involved as I was saying early the women, you know who are impacted and developing solutions that are not only actionable but that will change and continue to improve. You know, this really are quite deadly disorder. Luther Toyota in and Raj. Thank you so much. I know we could continue talking about this, but our time is unfortunately up and thank you for sharing your perspectives on how we can really make Healthcare more impactful for everyone. Thank you. ```json {"@context":"https://schema.org","@type":"VideoObject","name":"Why It’s Important to ‘Meet People Where They Are’ When Improving U.S. Healthcare","description":"The Covid-19 pandemic made issues with access to medical care apparent. 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