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Saul Marquez:
Hey, everybody. It’s Saul Marquez with the HLTH Matters podcast. We record all of these interviews straight from the show floor in Las Vegas where we had the conference, and it is a pleasure to introduce you to another amazing leader. I have Dr. Kevin Larsen here and he’s the senior vice president for clinical innovation and translation at Optum. Kevin’s role is to provide clinical leadership and clinical voice to Optum Center for Advanced Clinical Solutions. He leads the clinical team in building and deploying provider enablement solutions, including clinical decision support, integrated through electronic health records. Previously, he was at Optum Labs, where he supported the design and implementation of innovative research, analytics, and evidence-based translation programs in diverse areas across the Optum portfolio. And he was designated as a primary clinical lead in support of the Optum Enterprise strategy. I’m really privileged to have him here on the podcast today with his diverse experience from medical informaticist at Hennepin County, all the way to the work that he did prior to Optum at the US Department of Health and Human Services, where he most recently was as senior health IT advisory at the office of the Chief Technology Officer. We’re going to be diving into health equity and how we could level the playing field of access to many that need it in this country. So without further ado, Kevin, I want to welcome you to the podcast. Thanks for being here with me today!
Kevin Larsen:
Great to be here.
Saul Marquez:
So, Kevin, there’s so many things that are impacting health and there’s a lot of technology being layered in, we’re going to be focused around some of those things today. But before we do, talk to us a little bit about what inspires your work in healthcare.
Kevin Larsen:
A lot of inspiration has come from my family, actually. When I was a young child, my brother was diagnosed with type one diabetes, and ever since then I’ve watched how he’s interacted with healthcare with the chronic disease. And when I went into medicine, it was with the idea that I would help people live with their chronic disease. Through that, I’ve also seen an incredible transformation and a shift in locus of control from the provider to self-managed care by my brother. And that shift, I think, is ahead in type one diabetes, but is coming in lots of other parts of medicine. The more we have the technology, the more we have self-monitoring. And the more we have support for people, the more they can take charge and manage their life around their condition. Instead of managing their condition around their life, they’re managing their life around their condition. So they’re able to, he’s able to do things now he couldn’t do as a child, change time zones, do all sorts of things that were really difficult with a very strict schedule of healthcare.
Saul Marquez:
Yeah. You know, Kevin, thank you for sharing that. It’s always a personal story, ut seems that that becomes the driver. For your brother, it’s the time zone thing. I’ve heard things like vacations, you know, our vacation to France in a castle gone wrong, just so many things, right? And so the opportunity for consumers to live their life.
Kevin Larsen:
Yeah.
Saul Marquez:
In the way that they want to.
Kevin Larsen:
Yeah. I’m a big fan of what’s called minimally disruptive medicine. How can we help people really be healthy, live how they want to be, but not think about their health as much? How do we minimize the number of touchpoints, minimize the amount of chaos, minimize the work of being a patient, and really use technology to support them in managing their health.
Saul Marquez:
Yeah, and so technology is key. Talk to us about how Optum is adding value to the healthcare ecosystem.
Kevin Larsen:
Well, we’re big, so we do it in a lot of different ways. I’ll start with the place that I work, which is called the Center for Advanced Clinical Solutions. Our work is focused on bringing evidence right into the doctor’s office and making that very personalized so that the doctor doesn’t have to sift through lots and lots of information. So we take the important contextual information from an electronic health record, patient’s health history, their medications, their allergies, their blood tests, and we combine that with a computerized version of best practice clinical guidelines to give a very personalized recommendation for that, each and every patient and each patient will be different. We’re very excited about this work. It’s based on the latest technology. I’ve been at this for a long time. It’s what we call clinical decision support.
Saul Marquez:
Yes.
Kevin Larsen:
How do we really help clinicians be able to make good choices using best evidence? The evidence is changing so quickly. There’s so much good evidence out there, but it’s really hard to keep it all in your head and it’s very hard to personalize it too, for this particular person today what is the best choice? And so we’re excited about our work to be able to do that. More broadly, we’re looking to really, again, support patients through a whole series of patient apps of new value based care management. Another project that we’re working on is how do we give more people access to behavioral health services that they need. We know there’s a huge shortage in behavioral health, and so we’re working with digital therapeutics and again, trying to personalize to say for you today with your background, your likes and desires and your mental health symptoms, what kind of mental health app would be the best fit for you? We’re very excited about that work as well. And it again combines this clinical decision support where we can understand components of a patient and also understand what tools are available and really match the tool to the patient.
Saul Marquez:
That’s fantastic. Thanks for sharing those very specific examples, Kevin. Just incredible to know that you guys are working for both the provider, helping them have a more stress free, insightful experience as well as the patient giving them what they need. How might leaders, think about local community groups and best identify those organizations that are going to make them the strongest partners on this pathway to health equity?
Kevin Larsen:
It’s a very interesting question. So I have a long history working in health equity. I started my career at an urban safety net hospital and ran a health equity research institute.
Saul Marquez:
Where was the hospital?
Saul Marquez:
Minneapolis.
Saul Marquez:
In Minneapolis.
Kevin Larsen:
Hennepin County Medical Center.
Saul Marquez:
Oh, yeah, yeah. I’m familiar with it.
Kevin Larsen:
And what I learned there through wonderful teaching from community members was how much strength in creativity there was already in the community. Often we look and say there are all these problems. How is healthcare? How are we, smart people, can lean in and solve the problems for these people, when really it was the other way around? How is the community already have solutions that haven’t scaled? How do they, where is there community knowledge? Where are the bright spots and how can we as healthcare support that work? So it spreads. That work, I think means that we have to be humble, we have to build relationships and we have to build trust with these community organizations. But it’s all local. That’s the nice thing about it, is we can actually build those local connections. We can look around, who’s here, who’s interested, who’s doing something cool, how can I bring them in and hear what they do and how can I go watch what they do and figure out how we can do it better together? So there’s no one answer. Sometimes it’s the YMCA, sometimes it’s a religious organization, sometimes it’s a not for profit organization. It can be any number of those groups, but they often already have the relationships and already have a number of solutions. I think our job in healthcare is to partner and support and lift those up.
Saul Marquez:
Kevin, I’m so glad that you went there because we could be guilty of inward thinking, right? And it’s like, okay, let us think about solutions for them. But the truth is, the answers are there, we just have to get out there and listen.
Kevin Larsen:
Yeah, and scale.
Saul Marquez:
And scale.
Kevin Larsen:
Often what they’re faced with is a lack of resources to scale, a lack of support. And so that’s where I think we can really help is with sometimes implementation science. Here’s how to scale, here’s what we know from science, but you have the solution. We will come in and help you figure out the scale. Sometimes it’s just plain old money, like that organization, if they could hire five more community health workers could do ten times as much work. It’s any number of those combinations.
Saul Marquez:
Yeah, thank you for that, Kevin. And so a big part of establishing these relationships, getting these organizations, the resources that they need, and you mentioned scalability, it’s data. So what kinds of data are shared across these community organizations? How is it shared and how can it be used in new ways?
Kevin Larsen:
So it’s a fascinating question. Data, there’s a lot of data around. Often it’s the wrong data. Often it’s data that we have the same piece of data at 15 times rather than the one piece of data that would really help. I remember when I was building a program at Hennepin County and we were looking at what was driving some high utilization. And we had lots of data, but when we actually read the records, many of the people that were driving utilization were homeless and the homelessness wasn’t actually in the record. You had to read through and kind of sift through and scan notes to figure that out. Now, the community knew who was homeless, the public health system knew who is homeless, the homeless shelter knew who was homeless. So some of this was a matter of actually connecting data from different sectors in a thoughtful way. Again, not being so healthcare-centric, but saying, okay, healthcare is part of a community, we are part of an ecosystem, how can we build the right relationships, build the trust, and then figure out, we have this utilization, what does the rest of the community know and how do we match that up? Some programs have actually worked to intentionally collect data from these various partnership institutions in a more of a community centric way that requires, again, some investment to be able to be sure there’s interoperability between all these different components of the system. And it involves a fair bit of trust, both kind of cybersecurity trust, but also trust in behalf of the members of that community. But we’ve seen amazing things happen when that works.
Saul Marquez:
Yeah. You know, thank you for that. And so Optum is partnering with these community organizations. And so tell us a little bit more about that. Are you guys giving them money? Are you like, how do you operationalize this partnership? Yeah, we’re just curious.
Kevin Larsen:
Yeah, any number of ways. There are, some times when, when, through our foundation, we give money to community groups. We have a big partnership with the YMCA in which the YMCA actually supports a lot of youth health programs, and that’s both financial support, but also leadership support. Many of our members serve on the boards of YMCAs, but we also work with social determinants of health or what we like to call social needs. We don’t really think that those social needs determine health, but they are definitely critical factors. So we’ve invested a lot of money in partnering with these community groups to being sure that the patients or the members that we serve can have access to food, can have access to transportation, and then that has to be local. So it’s local investment in food, it’s local investment in transportation. We’ve invested in housing, and often that’s through these community organizations that already do this work. So it’s actually much more cost effective for the whole system to use a system that’s already there, that already has a distribution, that already has a channel. So again, often through our foundation, but sometimes actually through various health plans, especially Medicaid health plans. There are payments made for things like transportation for people that need it.
Saul Marquez:
That’s wonderful because half the battle is some of the basics.
Kevin Larsen:
Yeah.
Saul Marquez:
You know, it’s just an incredible amount of people that are faced with these challenges.
Kevin Larsen:
That’s absolutely correct. And you can imagine that if you’re a young mother with children and don’t have child care, how difficult it could be to take the bus to get into a clinic, to have your regular care done or have your well-child visit. So if there is transportation that’s available to you, you can imagine how that could really save downstream costs. Save, really an ounce of prevention is worth a pound of cure. So that kind of investment in something that’s not very expensive, like transportation, can have huge impact.
Saul Marquez:
I love that. Thank you, Kevin. So, you know, folks, you’re thinking about ways to tackle this, certainly some of the ideas that Kevin and the team and Optum are running with are fantastic, both for the provider as well as the communities and the patients that they serve. Kevin, how can organizations build the data-driven map of the ways that social determinants, health literacy, bias, and other inequities impact health outcomes? Because we’ve got to measure it to improve it?
Kevin Larsen:
It’s a great question. So first of all, you have to, want to do it, you have to invest, and then you have to say, who are we going to ask and when are we going to ask them? It turns out that most of the time people are very comfortable giving those answers. But what’s very important is not to guess, to just ask people, ask people what their race is, ask people what their ethnicity is, ask people what language they prefer, ask people what their sexual orientation and gender identity are. These are questions that actually are standardized across the country. There are standards put out by the Department of Health and Human Services for how to ask these particular kinds of questions with unique identifiers that can be attached to them. So this data can move around with the appropriate permission by patients. So you first need to ask. As far as the social factors that impact health, those are also standardized and structured, not all of them necessarily, but many of them are. And a lot of organizations, even a number here, the HLTH conference, a number of these organizations already do ask these questions as a way to gather that information, understand who really needs transportation, who really needs food, who really needs housing, and this lets us build that knowledge base to prioritize our investments and to prioritize our referrals for that kind of support.
Saul Marquez:
Thank you for that. Yeah, it’s the, ask the question, you know?
Kevin Larsen:
Ask the question.
Saul Marquez:
And, you know, as you’re telling me that, Kevin, I’m like a patient, a person is probably relieved when you ask them because they’re like, oh, they know me, they accept me, they can take care of me.
Kevin Larsen:
That’s exactly right. When we did focus groups with patients and said, hey, is it okay to share this, they said, you mean you’re not already sharing it? I just assume that you were. This is an important part of who I am, and I would want that to be shared with other parts of my care team.
Saul Marquez:
Wow. You know, sometimes the easiest things that can make the biggest difference is just doing them, it’s executing.
Kevin Larsen:
That’s correct.
Saul Marquez:
Well, Kevin, this has been insightful. You know, one last thing here. As leaders are thinking about prioritizing for health equity, what are really the best ways that they can do this and make a business case? Because oftentimes that’s what we run into, right? I mean, when rubber meets the road, how do we make a business case for this?
Kevin Larsen:
So we’re a very diverse country and we have a number of domains of diversity. We have racial diversity, ethnic diversity, language diversity. And that diversity often isn’t reflected in our products and our services. So I was a long … researcher in the world of language access. So many Americans don’t speak English. Many more people who have a native language other than English don’t read English very well, even if they speak it. We often don’t provide products in languages other than English, and so a very straightforward thing to do is understand what are the languages spoken by the community you hope to sell to or the area that you serve, and be sure that you actually have your products aligned to communicating with them. I’ve heard stories of call centers that don’t know what language people speak and they call them up and suddenly the person on the other end hangs up because they don’t understand anything that’s happening at the call center. It’s pretty straightforward to say, what’s your language? Oh, I speak Mandarin. Okay, we’re going to be sure that we have a mandarin speaker who is part of that call center outreach. So that’s one way that we can do it. Another way we can do it is to really look at different dimensions of diversity. So, for example, urban and rural. I worked for a while for the Indian Health Service and the Indian Health Service, if you think about it, the map of where their cell phone coverage in the US, it’s all red, except there are some white spots. Those white spots are where the American Indian reservations are. So all sorts of solutions that you think about an app and a text message and they don’t work in all the white spot spaces where there’s actually no cell phone coverage.
Saul Marquez:
I mean, Kevin and I, I’m just like, why? Why do they not have coverage there?
Kevin Larsen:
Because it’s expensive, because it’s low population density, a long ways away from somewhere. So, for example, one of the American Indian tribal clinics is in the base of the Grand Canyon. The only way to get there is by mule, but they have a clinic. And so you have to, if you’re thinking about, yeah, if you’re thinking about solutions for a diverse population, you have to like think about these different kinds of diversity. How am I going to deliver this to a very rural area? What are their needs and what are their ways of communicating? And how is that different than delivering it to an urban population that has broadband access? If I’m going to work with a group with a newly arrived immigrant population that doesn’t speak English, do my products actually meet their needs? Do they understand them? Are they in a language that works for that group? All of this is well known from a lot of kind of consumer work. We’re often late to the game in healthcare to think about how do we reach all of those different dimensions of American consumer.
Saul Marquez:
Kevin, thank you for your insights today. I mean, they are just, as far as business case, folks, I mean, there’s no clearer business case than increasing the access of your products and services.
Kevin Larsen:
Correct. That is absolutely correct.
Saul Marquez:
So people, the business case is clear for health equity.
Kevin Larsen:
Yes. And if you look at where our demographics are going as a country, we’re getting more and more and more diversity, more and more languages spoken, more and more people from other countries. This is increasing, not decreasing.
Saul Marquez:
Wow. Kevin, I’ve really enjoyed this conversation with you. The nuances in equity, you make them so easy to understand. So thank you. And I’m sure the listeners are also thanking you as well for the insights. We’re here at the end, I wish we could keep chatting, but I’d love to wrap it up by asking you just for a closing thought. You know, give us a closing thought and then where is the best place that the listeners could learn more about you and the work that you do?
Kevin Larsen:
My closing thought is really that serving everybody is a good business case. I was also a student of health literacy, and what I learned studying health literacy was that if you make things easily readable for people with low literacy, that actually makes them more easy to read for everybody else. The example is the instructions you get with technology. Nobody pulls out the whole manual. Everyone uses the one page start guide, if they use anything. And so all of us, if we think about how do we build things that are easy to understand, they actually it supports a kind of diversity and inclusion approach. If people want to learn more about me and what I do, we have a website at Optum, as you might imagine, optumhealth. And my email is Kevin.Larsen@Optum.com. Feel free to connect with me and happy to connect you with our new Center for Advanced Clinical Solutions, Optum Clinical Decision Support Products.
Saul Marquez:
Kevin, can’t thank you enough. And folks, what a great opportunity to take it to the next level. I hope that you’re not just listening to this and saying, wow, that was a great idea. The whole point of this is for you to take action and so make sure you take action, reach out to Kevin, go to the Optum website, figure something out, and of course, subscribe to this podcast at the very least. But certainly the opportunity that Kevin has presented to us to drive equity, it could be a lot easier than you think in the business case is there. So Kevin, thank you so much. Really appreciate the opportunity to be with you today.
Kevin Larsen:
Thank you, Saul. This has been wonderful.
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