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Saul Marquez:
Hey everybody! Saul Marquez, and welcome back to the HLTH Matters podcast. Listen, we’re covering some great topics here and I want to thank you all for continuing to tune in to the series. For those of you that haven’t hit subscribe, hit subscribe, because you don’t want to miss these interviews. Today, I’m joined with two amazing healthcare leaders, creating some major moves in the Medicare Advantage space. I want to introduce Andrew Toy. He is the president of Clover Health, where he’s responsible for driving the vision for how technology and analytics can improve the lives of Clover’s members and rejoin Clover from Google, where he coordinated enterprise activities from the Android team and ran machine learning enterprise search and analytics for the G Suite team. Before that, he was the CEO and co-founder of Divide, a company focused on creating a split between work and personal data on mobile devices, which was acquired by Google in 2014. He earned his BS and MS in Computer Science from Stanford University. And I’m also joined by the amazing Dr. Carladenise Armbrister Edwards. She is the executive vice president and chief strategy Officer, Henry Ford Health, and she’s a board member at Clover Health. Dr. Carladenise Armbrister has served as the chief strategy officer at Henry Ford Health, a $6 billion private nonprofit health system in southeast Michigan; Providence, a 26 billion Catholic health system with over 50 hospitals across seven Western states; Alameda Health System, a public hospital authority located in Oakland, California, and as the principal advisor to the CEO and executive team, she has led system-wide strategic planning, M&A, and other partnership ventures, business development, clinical and operation transformation initiatives, government affairs, marketing communications, population health, and managed care contracting. Well, she is an expert in her field and she joined Clover Health’s Board of Directors in July of 2022, she holds her PhD in medical sociology from the University of Florida Master’s degree in Educational and Psychological Services. I’m excited to have her join us here. And with that introduction, I want to welcome both of you to the podcast. Carladenise, and Andrew, welcome.
Carladenise Edwards:
Awesome. Thank you for having us.
Saul Marquez:
Oh, it’s such a pleasure. So here at the HLTH conference, we’re covering so many topics from health equity to healthcare in the home to interoperability, and I’m super excited to really touch on some of the work that Clover Health is up to. Before we do, though, I’d love to just take a sneak peek into you guys. And so tell us a little bit about what inspires your work in healthcare.
Carladenise Edwards:
Wow, you want to go first or?
Andrew Toy:
Go ahead.
Carladenise Edwards:
It’s interesting because I think this question is something that I think about every single day, and I just experienced it. What inspires my work in healthcare is finding solutions that enable folks to live long and live well. I, just, totally motivated by that. I met two young people just now who have started companies that are laser-focused on improving the well-being, like improving health and how people live. That’s what inspires me, is inspiring other people to create really cool things.
Saul Marquez:
I love that, Carladenise. Thank you.
Andrew Toy:
And I’ll just jump off that, it’s like, in terms of like healthcare, which is inherent to, like the human experience is inherent to all of us, something which actually really inspired me is I carry, personally, I have a genetic condition where if it’s caught early, which it was with me, and managed early, you live a completely normal lifespan. Fortunately for me, with medical technology, but if it’s not caught early, which it often isn’t, you often die before you’re 50, which unfortunately happened to my father, which is how we actually caught it for me was, I think like my father had to pass away in order for it to be caught. But literally, I take a probably 25-cent, not even like a five-cent pill a day is what it takes, and I’m good for my life. And so what I’m really obsessed with is we’re building technology and capabilities to like make that true for everyone. It sounds very clear for me, but if we all have conditions where if you catch them earlier, you manage them earlier, sometimes it doesn’t cost more than $0.05 a day, but we can live longer, healthier, happier lives, all of us, actually.
Carladenise Edwards:
We absolutely can. We absolutely can. I love that.
Saul Marquez:
Wow, thank you for sharing that story, and thanks for sharing your vision and why you do it. Now, there are several things that I want to dig into with you all, but before that, one last question is Clover Health. Tell us about the value that Clover Health is adding to the healthcare ecosystem.
Carladenise Edwards:
I want Andrew to answer that question. I have an opinion, but he has the facts.
Andrew Toy:
She’s on the board, so she gets to say what she likes here. So Clover Health, like what we’re thinking about is we’re a Medicare Advantage company. What that means is we look after a sicker population, the 65 and older and the disabled. But the way we think about it is they’re sicker because, again, human condition, we are all going to get older, we are all going to get sicker. It’s just part of life, right? So we were inspired to look after that population. But even within that population, the difference we’re trying to make is kind of what we said earlier. It doesn’t mean that you’re already sick at 65 and you’re done. You know, like lifespans are much longer now, so you have a lot of life to look forward to when you’re at that age. And with our technology, we’re looking at saying, how do we bring technology, personalized approaches, personalized medicine together to have every single person we look after live that longer, healthier, happier life. And we were talking about this earlier, called this to myself, but from a health equity perspective, which you mentioned, we mean everybody. So like not like an insurance company. We are an insurance company, but most insurance companies, you kind of think about, well, riskier people, maybe not for me, right? I want those safer people. But when we get older, we’re all going to get some kind of sick, right? What we need to think about from our perspective is how do we look after everybody and then bring that early detection, better management leading to healthier lives.
Saul Marquez:
I love that.
Carladenise Edwards:
And I’m going to answer that question from a completely different perspective. As somebody who studied healthcare economics and who is adamant about changing the way in which healthcare is financed and accessed in this country, I actually believe Medicare Advantage is the perfect example of being able to provide healthcare to all, because what we’re doing is we’re saying here’s enough money and resources that we can prevent illness and treat illness and then wrap a bow around the whole person, right? And in that pot, you have a diversity of people who then spread out the risk. And so unlike traditional insurance, where you cherry-pick the people who are exceptionally healthy and well, and then you ignore the people who are not, through Medicare Advantage, what we’re saying is let’s put everybody in the pot and then let’s distribute those resources based on the needs and in of one to the people who need it the way they need it, when and where they need it. Clover Health is exceptional in making sure that they not only have services that folks ask for and request, but they actually deliver services that people need even in their home and in community. That’s the difference between Medicare Advantage and all the other products and services that are available through Medicaid, Medicare, commercial, fee-for-service.
Saul Marquez:
Yeah, thank you for that, that distinction. And it’s a great example, you know, why can’t we extrapolate the way that we deliver care through Medicare Advantage to the larger population, you know? Very good. Now, you got me thinking here, Carladenise, I really love that. Were you going to comment, Andrew?
Andrew Toy:
Just on your point, I think that, that hybridization where we have a model where we can actually target care and manage care more closely, that’s the Medicare Advantage versus traditional Medicare. And then, but the approach of extending beyond Medicare to other areas, the real difference is and the reason why I think we focus on Medicare Advantage and Medicare, in general, is that’s the population that can use a lot of help. Basically, like we said, like, you know, fortunately, most people, when they’re younger, most people, like generally healthier, more reactive care in that case. But still, there are a lot of people who are younger, who are chronically ill and younger, and multiple comorbid. So I think the way that we think about it is we’re building tools and technologies that help with people who are in that situation, which we will all become as we get older, and some folks who are younger also need that kind of care.
Saul Marquez:
That’s fantastic. And Carladenise, you mentioned where. And so the topic of hybrid care models has been omnipresent at this conference, caring for people virtually in the home brick and mortar. Are you guys able to provide all of those solutions?
Andrew Toy:
Yeah, so definitely just jumping in there is we have a lot of solutions for what we call distributed care, a distributed care model. We want to decentralize care out of the brick-and-mortar hospitals, certainly, Carladenise and I talk about this all the time. The hospital isn’t meant to be the place you go for all of your healthcare. Certainly a lot of some part of it, but not all of it, right? That’s not the mentality we need. So when we decentralize out of the hospital environment, and then we go into the home, that’s one area. Telehealth provides a capability anywhere with Internet, with 5G and technologies that are coming in over there, and then we layer on more and more capabilities. And I’m going to say one thing there, I think that sometimes is really missed in the conversation, like when there’s the sites of care that are in there, but also we don’t have enough doctors and clinicians in the country. There’s a nursing shortage right now, for example, we don’t have enough PCPs and MDs. When we decentralize that care, we make our clinicians more efficient, actually, because we can actually route and have everyone performing at their top of license, and when we do that, we extend the precious sort of like clinical resources we have far more than if we try to sort of like schedule everyone coming in and out of like a physical location. So that’s kind of the way I’d like to frame it.
Saul Marquez:
No, that’s a good frame.
Carladenise Edwards:
And not all conditions require a medical doctor, and so to the extent that you can extend the care, you also can extend the service providers on the care team to do what Andrew described, which is function at the top of their license. Someone with a chronic condition may need a care manager, somebody who’s struggling to actually comply with the medical regime that their provider prescribed might need a community health worker. And so when we have the technology and the analytics that allow us to target or pinpoint what that end of one needs, right, then we’re not dependent on folks showing up at a hospital when they’re acutely ill. We’ve got them and we’re providing care to them preventively or preemptively. And that’s why I think it’s …, now, I’m going to say, because, you know, I have been in the hospital business, I don’t believe hospitals are going away, right? There’s this myth that digital and virtual is going to take over, Walmarts and Amazons are going to eliminate hospitals. No, the hospital is not going anywhere. But how many of you actually want to go to a hospital? Nobody. It’s inefficient, it’s scary, so let’s fix it. So the hospital does what the hospital does exceptionally well and it’s not so scary and it’s not so inefficient.
Saul Marquez:
I love that. Thank you both, and I appreciate the fashion that both of you guys have for this topic. You make it very, very interesting and exciting. So during your fireside chat at HLTH, our conference, you cover themes about including all as a mission of health equity. Let’s expand a little more on that.
Carladenise Edwards:
Yes, Andrew and I talk about this all the time and we’re often afraid to talk about it outside of the kitchen table because we’re never sure if people really agree with us. There’s a perception that when we talk about diversity, we’re only talking about those people. When we talk about the social determinants of health, we’re only talking about people who don’t have access to food or transportation. But all of us in this little room have social, economic, and environmental factors that influence our well-being. It doesn’t matter if you’re brown, if you’re gay, if you’re straight, if you’re disabled, if you’re whatever, right? There’s something that’s influencing whether or not you’re healthy or you’re sick. And so Andrew and I talk about this all the time because we believe that it is the obligation of organizations like Clover to make sure everybody gets access to what they need so that we actually are providing care to the diversity of people who are in our responsibility, that’s all.
Saul Marquez:
Yeah, we all have social determinants.
Andrew Toy:
Yes, by definition, right?
Saul Marquez:
We’re all social, right? I mean, so, yeah, that’s a really great point. Most of the time you talk about the remote urban setting or the rural setting.
Carladenise Edwards:
As if those, I’m using air quotes for people who can’t see, those people are different or special. No, they’re human beings, and they live in a very different circumstance than maybe the one I live in, and what makes them different is the people who are making the decisions actually are living away from the people who actually need the majority of the care. But if we can see ourselves as one, as humans, as all, and it makes it so much easier to make decisions that benefit humanity.
Saul Marquez:
Everyone. I love that. Thank you, Carladenise. And so I’m so glad that we’re having this discussion, it is about creating equity and getting rid of those disparities. And so what are the most significant barriers to achieving health equity?
Andrew Toy:
There’s lots of barriers, right? I think, and I think part of what we’re doing, and we talked about this in our talk, is, just because things are hard doesn’t mean they have to be scary, it doesn’t mean that, we just talk about them, and say they’re hard, right? Health equity is hard. That’s why we’re going to work on it, right? And so, there’s many, many particular barriers that are in there. One is, and I briefly mentioned this in … earlier, is when we talk about health insurance, insurance, by definition, historically has structurally said, why would you want risk? You want to try and make as much money as possible by taking as little risk as possible. Your job is to take risk, but you are trying to take as little risk as possible. And certainly, if you’re going to take a risk, you’re going to charge those people more money in order to take that risk. You know, in regular insurance, that kind of makes sense, right? But would you extend that to healthcare is, makes significantly less sense, right? And it creates then the structural, I use that word carefully, the structure inside insurance, because you take the structure of insurance, you put healthcare in that box and suddenly it doesn’t combine in a way that doesn’t feel super right anymore. That’s no one’s fault. Like we understand why in the insurance system, right? It’s no one’s fault, but we have to look at that and say, look, that’s not working as intended. We were trying to help everybody. The fact that we think about insurance in certain way, and I think Medicare Advantage goes a long way to try to fix this, it’s not perfect. Then we can look at that and say, well, the financial incentives, how do we align those better to actually reward people for looking after everybody? And if those financial incentives are not lined up properly, then we have created a structural disincentive to actually solving the problem. And we should again just say, look, I’m not blaming anyone. That’s just what we did, let’s fix it.
Saul Marquez:
Just call it out and let’s fix it.
Andrew Toy:
That’s right, and people are scared to call it out, right? If you are just like, no, it’s perfect, right? Or like, if we had Medicare for All, that’d be perfect. Right now, nothing’s perfect and we just call it out, like you said.
Carladenise Edwards:
And then actually fix it. I think the structural barriers that Andrew described are probably the most significant, right? The perverse incentives preclude us from actually providing health. And so I think the challenge and the barrier to health equity is that. It’ll add another layer to it. I think another barrier here in the continental US are our values. I’m not confident that our nation, our country collectively values health. There’s a direct correlation between our capitalist economy and our values, and everybody makes a lot of money on all these things that are not healthy. We haven’t quite figured out the value problem associated with health. And so what Andrew talked about, those structural barriers, I think are consistent with values that match the economics of our country. We’ve got to figure that part out, and as our country gets more and more diverse in terms of people coming into it and people growing into it, I think we’re going to come to a values collision that has to be addressed.
Andrew Toy:
I just want to quickly jump in there to say, as a reminder, I, just because I always think is, I think that statement we’re making is without judgment, right?
Carladenise Edwards:
Correct.
Andrew Toy:
This is just calling out what’s going on.
Carladenise Edwards:
Look, I have a Porsche, Ferragamo, and a Gucci purse. Okay.
Andrew Toy:
Capitalism works.
Carladenise Edwards:
But we’re calling it out.
Andrew Toy:
Yeah, we’re calling it out because, like again, we said this earlier, right, but we’re having a conversation, just happened to come out. But I was like, I love French fries. And Carladenise was like, I love French fries, too. And I also, like, I’ll stop eating French fries if my doctor tells me they’re going to kill me, but until then, I choose to eat the French fries, right?
Carladenise Edwards:
And me, if he says it’s going to kill me, I’m like, oh, well, I’m going to keep eating them. But if he tells me, it’s going to lead to my inability to do the things that I love while I’m alive, I’m going to stop. So you see, we have different values, right? For some of us, living well might be more important than living long, right? And so my husband is like, do not unplug me under any circumstances. I’m like, the minute.
Saul Marquez:
I say unplug me.
Carladenise Edwards:
See? There you go. The minute I can’t do what I love, unplug me. But very different, and it’s okay, it’s absolutely okay. But it goes back to Clover, one of the reasons I chose this particular board to be a part of, and this corporation to be a part of, is that its core value is that in of one and using data analytics, technology, and science and knowledge, and truth to try to help as many people as they possibly can with their tools and their services, that’s what attracted me to being a part of Clover Health.
Saul Marquez:
You know, what I really love about this conversation is that it’s philosophical in nature, but it needs to be, right? So I can tell that Carladenise, Andrew, both of you guys are deep thinkers and you’re tackling the issues at a very deep level and I think we need to do more of that. So thank you for being thoughtful.
Andrew Toy:
Thank you.
Saul Marquez:
Absolutely. So now that we’ve identified those barriers, what are the ways that healthcare systems can address them?
Andrew Toy:
So I think, thinking broadly meaning systems being payers, providers, like everything versus, specifically health systems. I think one thing, and we’ve already kind of called it out, let’s call it out again, right, is to be just conscious and thoughtful about the problem that you’re solving. And just like if it’s hard, it’s hard, if it’s a little awkward to talk about, that’s okay. We talk about awkward stuff, especially in healthcare, right? Like, that’s what happens. I’d be like, are we actually solving this problem? Is this a priority right now? I was just discussing this to somebody else earlier, Carladenise. But if I asked anybody, is health equity a priority right now? I think they would feel compelled to say, yes. That person is going to say yes no matter what. Even if actually health equity is actually like their 27th priority.
Carladenise Edwards:
They’re going to say yes.
Andrew Toy:
Without judgment, again, I’m not judging them for that. There are important things going on, but they’re going to say yes.
Carladenise Edwards:
They’re going to say yes.
Andrew Toy:
And I think that’s an initial barrier to having even the discussion about health equity. I’m like, look, I’m not going to judge you as your number 27 on your list, right? Like, that’s okay, right? But if you say it’s your number one priority.
Carladenise Edwards:
Then do something about it.
Andrew Toy:
And you don’t do anything about it, then it’s going to be very confusing to people, right? So now everyone’s saying it’s a priority.
Carladenise Edwards:
But still, nothing’s happening.
Andrew Toy:
Nothing’s happening.
Carladenise Edwards:
So we shouldn’t have a problem. If everybody was actually doing something, guess what? That problem would go away. So I want to answer, Andrew, the question. Andrew almost said what I was going to say, but he went a little bit in a different direction. I believe one of the barriers or challenges that health systems have is trying to be all things to all people. And so I think about this living in Detroit, and even before I moved to Detroit, I would use auto industry as my example because I love cars, but it took a while for the Ford Company and other companies in the Continental US to realize that they couldn’t own, create, manufacture, operate, manage every aspect of putting a car together. And it took the industry failing to realize that, right? Because it takes cows to produce leather to make the seats. You can’t own the farm with the cows, right? You need minds to create the rubber for the tires and the batteries, you can’t own and operate all that. So once they realized because of the scale, right, and the speed by which cars were now being demanded, that they couldn’t do that, and unfortunately, in the United States, it was too late. They started to say, oh, let’s compartmentalize. It’s okay to buy the glass from the Japanese for the windshield. It’s okay to get the leather from the Italians. It’s okay for us to compartmentalize and then function on what we, Ford, Chevrolet, Porsche can do exceptionally well, and that’s our brand. So now take this to healthcare. Health systems have felt compelled to own, operate, manage, control every aspect of the healthcare ecosystem, and we’re not doing, and I use a collective we, we’re not doing any of it well. Go back to the hospital. How many of you have had a horrific hospital experience, right? Because we’re trying to do all these things instead of being the emergency department, right? Instead of being the birthing center, instead of being the cancer infusion center, we’re trying to do all these things. So my future is for us to figure out a way to do what we do well and then to let somebody else do the rest. I think that will fix healthcare.
Saul Marquez:
Love that, and the analogy was great as well, Carladenise, just lay it out, there it is. We’re trying to do too much and it’s not working, so let’s do it simpler. So how can we build health equity into every aspect of what a company does?
Carladenise Edwards:
We do that by each individual person making a commitment to being kind and to being just to the human beings they interact with every single day.
Andrew Toy:
Including themselves.
Carladenise Edwards:
Exactly.
Andrew Toy:
Starting with themselves.
Carladenise Edwards:
Starting with yourself.
Saul Marquez:
I love that.
Carladenise Edwards:
I just don’t even understand how someone can say, I’m working on health equity, and then they go and they do something that abysmal to their neighbor, or they deny somebody access to care, or they tell somebody they can’t do something or have something, and then say they’re working on health equity. I’m going to share a short story and this one should really hit home. My husband went to the doctor a couple of weeks ago, and when he got there, they said his insurance had been canceled, and so they said he couldn’t see the doctor. He has a chronic condition, he goes to the doctor once a month, this particular doctor once a month. They said he can’t see you because your insurance been canceled. He’s like, no, my insurance is perfectly fine. They didn’t bother to do anything other than tell him he needed to go away and figure it out. So he calls me, I act like my normal crazy person, and I say, I said, that’s the wrong answer. First, you would say, Let’s say it’s true, can you pay another way? It doesn’t really matter, you’re seeing the doctor today, Mr. Edwards. We’ll figure out the payment part on the end. Same people say they’re focused on health equity, but they’re going to send somebody who actually had enough money in his pocket to probably pay for him and three people behind him, but they didn’t even ask.
Saul Marquez:
Yeah, it’s just such a knee-jerk reaction, right? I mean.
Carladenise Edwards:
That is not health equity.
Saul Marquez:
Right.
Carladenise Edwards:
So you can’t have health equity on your wall and in your mission statement, and then somebody shows up and you tell them to go away because their insurance card’s not working.
Saul Marquez:
I agree.
Carladenise Edwards:
So to answer your question, be kind and be just and start with yourself.
Saul Marquez:
Wow, you know, I didn’t expect that answer, but I really love that answer because it does begin with us. And so, folks, you’re listening to this interview straight from the HLTH conference floor in Las Vegas here at the Venetian.
Saul Marquez:
Be kind and be just because it starts with us. I really appreciate that, Carladenise. Andrew, what would you add to that as a closing thought?
Andrew Toy:
Well, I mean, that was perfect.
Carladenise Edwards:
It was a combination of the two.
Andrew Toy:
I …, but I just want to add to that part. Like the, it’s easy to always add that the self part of the end, but I mean, you have to start with that part. Carladenise said this, really important earlier, which was, you got to make sure you put your mask on before helping others, right, like in that regard. You’ve got to look at that and then you could be in good shape because again, we’re all human, and if you’re tired, then it’s easy to just be like, snap at somebody or be like, I don’t, I can’t do this. It happens to everyone, it happens to me. So like health equity, I think we both like, invite everyone to be part of health equity, but not by saying, look, you go save someone else. The reason why everyone can be part of health equity is because you can always at least do yourself.
Saul Marquez:
Totally.
Andrew Toy:
Right? That’s why we can all do it.
Saul Marquez:
And what I hear both of you saying is that health equity starts with human equity.
Carladenise Edwards:
Yes.
Andrew Toy:
Nice.
Carladenise Edwards:
It really does.
Andrew Toy:
Yeah, absolutely.
Carladenise Edwards:
It really does.
Saul Marquez:
Wow, well, listen, thank you both so much. I’ve really enjoyed this podcast. It’s a great way to close the day. And this is, we’ve got Ludacris a little bit later.
Andrew Toy:
Amazing.
Saul Marquez:
But certainly appreciate both of you. If people want to learn more about you or about Clover Health, where do they go?
Andrew Toy:
I would love that. People, if you can follow me, you can find me, Andrew Toy, T O Y. I’m Clover Health’s President and I’m the incoming CEO, on LinkedIn, and you can follow me there. I write regularly and share thoughts like this.
Carladenise Edwards:
And I also am a pretty avid LinkedIn user, so it’s Carladenise, one word, Edwards.
Saul Marquez:
Love it. And folks, we’ll go ahead and put all of the links and profile to both Carladenise and Andrew in the show notes, so you could just click, reach out and connect. Be sure to do that, and as today, they mentioned, don’t just listen, take action on what you do. If you’re saying you’re going to do it, just do it.
Andrew Toy:
Just do it.
Carladenise Edwards:
Just do it.
Saul Marquez:
Thank you, both.
Andrew Toy:
Easier than you think.
Saul Marquez:
All right? Thank you so much.
Carladenise Edwards:
Thank you, thank you.
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