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The Reality of Social Determinants of Health with Rajib Ghosh, Chief Data Officer & Chief of Transformation at Community Health Center Network
Episode 106

Rajib Ghosh, Chief Data Officer & Chief of Transformation at Community Health Center Network

The Reality of Social Determinants of Healt

The Reality of Social Determinants of Health with Rajib Ghosh, Chief Data Officer & Chief of Transformation at Community Health Center Network

Episode 106

Social Determinants of Health

The Reality of Social Determinants of Health with Rajib Ghosh, Chief Data Officer & Chief of Transformation at Community Health Center Network

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host Saul Marquez

Saul Marquez: [00:00:19] Outcomes Rocket listeners. Welcome back once again to the outcomes rocket podcast where we chat with today’s most inspiring and successful healthcare leaders. I really want to thank you once again for tuning in. And if you love the podcast go to outcomesrocket.health/reviews and leave us a rating and a review on Apple podcasts through that link. I love hearing from you all. It makes my day when I do here so please take the extra minute and leave us a rating review if you enjoyed. I want to introduce an outstanding individual and our guest today. His name is Rajib Ghosh. He is the chief data officer and the chief of transformation at Community Health Center Network in San Leandro California. He’s done a lot in health care. He’s also in O and C health I.T. fellow and I could just go on and on about this amazing person. But what I want to do is just welcome Rajib to the podcast and Rajib if you don’t mind fill in any of the gaps in the introduction.

Rajib Ghosh: [00:01:23] Sure. Thank you very much and appreciate the opportunity to be part of your podcast. My career is almost now about two and a half decades. I’ve been in various places in the last 13 years of those I have spent in health care focused in health IT. So I have done product management product launches working for large organizations small startups providers payers so you name it. I kind of like to cover everything in the healthcare landscape except one thing I haven’t worked on pharmaceutical so yet in my career.

Saul Marquez: [00:02:03] Oh I heard yet.

Rajib Ghosh: [00:02:04] You never know. Right.

Saul Marquez: [00:02:08] That’s true. That’s true. You can’t limit yourself.

Rajib Ghosh: [00:02:10] Yes.

Saul Marquez: [00:02:11] That’s great. Well Rajib thanks for that fill in. You know it’s you’ve done a lot of really interesting things. You’ve worked on the provider side. You’ve worked as a consultant. You’ve been. You started a company. You’ve done so many cool things. And my question to you is why health care why did you decide to get into healthcare.

Rajib Ghosh: [00:02:31] That’s an interesting question. So my career started as a software engineer writing software or telecom industry managing huge data sets and then later I worked as a consultant. As you said in large scale industries like publishing to transportation manufacturing. Thirteen years ago I moved to health care inspired by some work that one of my friends. At that time this company was doing in healthcare. So healthcare technology and opportunity to make this impact in the lives of millions of people in the nation and also worldwide is clearly became quite fascinating to me as I started to learn about the industry. Since then I’ve worked in many technology vendor companies for evil corporate monitoring Twitter Amaar for the Labor and the delivery department in a hospital. Later a move to the chronic disease management space what I learned about the increasing disease management burden the chronic disease burden that the world is facing or will be facing in this century. And that is quite inspiring that some of the work that I did in the Telehealth, telemedicine space can have a major impact in around the road in facing this challenge and this is a worldwide issue. So that also makes a scale very interesting the opportunity to help providers and patients with technology like that. This is quite fascinating. So it’s also the fact that I’m interested in the health policy side I’m really fascinated by helping the clinicians really do what they do best which is really taking care of patients and that is really fulfilling inspiring and then gives a purpose to the work that I do. And I think that is really important. But also I love the intersection of the health policy technology and the care delivery the operational processes because what I understood in my career so far is that if you’re in healthcare you have to understand the implications of this and if we don’t because then we can be in that business because there’s so much dependency on the health policy world. And I think that’s what makes my job really interesting and inspiring every single day.

Saul Marquez: [00:04:51] Rajib. You’re fascinated by health care. You’re intrigued by policy and you’re knee deep in I.T. right now. What do you think should be on the forefront of medical leaders minds and how are you guys addressing that where you’re at today.

Rajib Ghosh: [00:05:07] So there are many things I can think of actually but in a couple of things they wanted to mention as a human race we’re really on the cusp of a new phenomenon which I call is a century of longevity which we have seen as a race ever. So this is going to be our first step into that fight which is exciting. Yeah it is exciting. It is definitely exciting but also because of the fear of the unknown. We don’t just don’t know whether they’re right. Collectively we are going to live longer than the previous generations. And that’s a fact. So this also means that the burden of these chronic diseases will continue to increase worldwide. This puts a lot of stress on the caregivers community both the family caregivers as well as professionals left for missions that is going to increase. And that is going to lead to more caregivers or not. This is already started to happen in the physician’s community where we are seeing major burnouts in there. The rate is actually in wheezing. So this should be on the agenda on all healthy Obama’s hands including the government agencies. There is another aspect which is also making the century quite interesting which is we are waking up to this new reality that social determinants like you know housing situations the crowd station the food the isolation other behavioral aspects are connected with that and then play a big role in determining a person’s health. In fact with the numbers that I’ve seen is like health is 10 percent of the health is really medical. Is everything else. So that is something to ponder. So how do we integrate all those data from those myriad of sources and turn awful analytics on that to continue to be on the agenda that should be on the agenda of the city and the county and the state level and then. So this is this is really a bigger things to tackle. Just to give an example in California there are right now 18 state funded they call a whole person care pilots accrued last year to tell a nice sunset. And you know over a five year period. But I think this is a really good beginning. And that is definitely on my agenda among organizations again that we are deeply integrated with some of one of the county’s pilot programs to really drive some of that. And I think that should be on the agenda of other organizations as well.

Saul Marquez: [00:07:34] Rajib is this a California sponsored program.

Rajib Ghosh: [00:07:37] It is a California sponsored program Yeah yeah.

Saul Marquez: [00:07:40] I love that. I think it’s it’s really interesting right. You mentioned two things here. We have the potential to become centenarians and it’s very real and the comorbidities and chronic diseases that need to be managed are going to increase. And then on the other hand the thought of that goes along with it the social determinants of health. It’s a shame that at this point the incentives are aligned in such a way that we’re not incentivized to tackle those. What are your thoughts there on how your organization is doing it to stay aligned to incentives. At the same time look to where the puck is going.

Rajib Ghosh: [00:08:19] Yeah. So this is something as I said you know payers and providers are kind of beginning to just waking up to this new reality. So it’s going to take a little bit of time and I’m already seeing movements happening in the air war where they are acknowledging that fact that if a patient discharge from hospital can go to the primary care practice because the person didn’t have a transportation to take the person back to the family clinic. That person is going to end up in the E.R. room pretty soon. And so that’s a high cost which can be avoided by just making a twenty dollar override sponsor that is with our patient. Right. And I think this is a conversation that we are having with our peers that we work with and they are listening. They’re not. It’s that they are not listening. I think the key challenge is anything in healthcare we want to see that what is the only the longer term impact. Show me the money. Show me the value first before we adopt it and some of these things you know may sound biting. Tweet it to us when we talk about it when it comes to really paying for it. I think the CFOs of the war they will like to see a bottom line. And I think that is really the challenge. My personal feeling is that we will be sewn into this especially with these pilots which I hope will prove great results which show to the community that this thing should be funded there should not be any debate about that. It is a standoff.

Saul Marquez: [00:09:53] Yeah that’s really interesting and kudos to you guys for getting involved in these pilots. The whole person pilot you called them.

Rajib Ghosh: [00:10:00] It’s called whole person care pilot.

Saul Marquez: [00:10:02] That whole person care pilot will definitely have to take a look at that haven’t heard about those very intrigued. Thank you for sharing that.

Rajib Ghosh: [00:10:10] No problem. And please take a look at it and you will see a very interesting very very interesting program outlines that different counties effort together. And there are some are not counted and some are really building else. But yeah that’s very interesting I’m really excited about that.

Saul Marquez: [00:10:27] Yeah me too. I mean that sounds fascinating. So can you give us an example Rajib of how you guys have used some of these pilots or or maybe in another area that you’ve worked in that you’ve created results are improved outcomes by doing things differently.

Rajib Ghosh: [00:10:44] Sure. I mean there are many examples. I mean we are among this makes me feel proud about privatization that we are quite innovative. We don’t have lots of resources but we try to innovate as possible. So let me be one example which I think actually produce tangible results. So we offer as part of the organizations we do have provided for the delivery centers but we also have a managed business and we manage about 140 thousand manage our lives in one county Alameda County where we are we are based. And we take full probational risks on behalf of our health centers working with two Medicaid health plans that are operational in the county. So what is important for this health plan is that overall performance ratings for the state. And that is determined by some measures called ETUs measures. For those of you and your listeners who don’t know that term it means healthcare effectiveness data and information set is really a quality metrics in a way that was 81 homes and all of those 81 measures are tracked by the state and the planes get their star ratings based on that. So healthplan Pushto organizations provider organizations to help them improve those costs by delivering better and timely preventive care for example cervical cancer screening or immunization a time when they zation are the appropriate level of HIV and control and stuff like that. So the better scores allow what health centers to be set up a focused health center that the plans would make to do work with a business with help us from the managed care standpoint to really negotiate better contract rates for different services. Two three years ago our county and our health centers didn’t do very well in fact we are at the bottom in terms of the state level for the last one to one and a half years. We relentlessly stayed focused on conducting better analytics to identify the gaps in care for all the patients that are seen around centers so that allowed our health centers to do timely outreach bringing patients to the clinics for the necessary preventive procedures and then really address the possibility for any kind of a disease exacerbation of passion and what you’re seeing is that over this time we have made significant improvement in the ratings and we are now among probably ninetieth percentile still some way to go I think. But you know obviously we can do better. But it’s actually a significant improvement. And that is also possible because we change the approach. You know we look at the data we look at the analytics. We took the action plans we implemented them followed up on them and those things.

Saul Marquez: [00:13:38] Well congratulations. I mean a year and a half and now you’re in the 19th percentile.

Saul Marquez: [00:13:43] That’s awesome.

Rajib Ghosh: [00:13:44] Yeah. And a proud moment for us.

Saul Marquez: [00:13:47] Absolutely and you know those kinds of things don’t get down overnight. And you said relentless focus. You know that relentless focus listeners is is really what is necessary to create better outcomes and better results. There’s so many things that you can focus on and how do you decide which ones you’re going to pick and which ones are going to give you the results you’re looking for the improved outcomes once you decide on those focused relentlessly like Rajib did and his team and you’ll create those results. Rajib Can you share one of your setbacks in healthcare and what you learned from it.

Rajib Ghosh: [00:14:27] Yeah and I think you know I personally feel like that you learn more from said.

Saul Marquez: [00:14:33] Totally agree.

Rajib Ghosh: [00:14:35] And also it’s an innovative organization. The other philosophy that they follow that it’s better to fail often and fast enough and lean start up sort of a model because the fear of failure isn’t really a big barrier to make advances right. So with that said there are a couple of situations they can think of where sort of. You know I think the judgment that we’ve made that I’ve made failed to produce the desired outcome in a timely fashion which could be disappointing but there’s a learnings there. So when I started my current job when I came into organizations I felt the need to really develop a very robust data analytics infrastructure because I feel like that is really the recipe to provide better care and efficiency and stuff like that. So in absence of that our data analyst that we have no organization felt that a lot of time is being spent on mundane stuff. And that access know cleansing that have been building it for analysis was just really doing it quickly and giving actual plans to the health centers or the frontline staff. So being passionate about that about data analytics I thought this should be sort of a slam dunk or our health centers to really they will buy into this. And my organization. We can all work together. Start in again. Structurally my organization is a network of musicians. That means that all the health centers are independent entities but they are midcourt with us. And then we set up the next level. So I crafted a big vision of building interfaces a lot of infrastructure using it and let its program and that iPod that you know health centers will come with these cases right. And then we can show that hey you know what for. This is why this is and generates quite easily for you. But to my surprise it didn’t turn out to be that way. As you know health centers werent had many pinpoints that they were aware of that where they could see that that infrastructure investment and deeper analytics could be savvier for it just like you know the payment reform was on kind of on the brink of happening didn’t happen yet and a lot of fee for service going on an incentive driven payment models are sort of discussed being discussed but not so much tangible. And also the sharing data to centralize analyzed data was was also a contentious issue. This is the reason why they cherry model is is also pretty difficult and you know not enough just on the public sector or even on a private public relationship. So the key lesson learned. I mean it took us a while to really bring all the parties together and that didn’t meet the sort of the timeline that I had. And so in a way that vision really didn’t want the way I wanted to. But the key lesson learned is that not this kind of a scenario takes a lot of persuasion before even beginning to execute such an initiative. And that is the reality of today that it takes a lot of persuasion because a lot of stakeholders involved and all those stakeholders have their own reasons not that they are just playing politics but they have their own reason and we have to build this cohesion and this collective work together collaboration model you know pluralism is difficult to say. So you know the general tendency of human beings and organization is to be tribal and autonomous and then so that’s a lesson learned that it takes a lot of work that needs to go in before we can start building a model of even if it’s for improvement. But it takes a lot to do that.

Saul Marquez: [00:18:24] Now that you and I appreciate you sharing that story Rajiv So now that you fast forward to today. What would you say the best way to do that is how do you prime the environment that you’re in to accept a change.

Rajib Ghosh: [00:18:38] I think the change needs to be introduced in depending also on the organization. But in healthcare change needs to be introduced slowly and thoughtfully. That’s one of the things that I often talk about to my industry peers and startups and all of that is we talk about many times we talk about especially in the Silicon Valley that we wanted to disrupt disrupting healthcare is not necessarily the best thing that we can do. I think we can work together to make it better. And there are many ways to do that. So this is example with he said that if we wanted to disrupt a model where things are being done very very differently and they are not used to it. I wanted to enforce something from outside just because I have an experience of doing it somewhere else outside. Outside of healthcare Sadly the chances are it’s not going to be embraced. It’s not a war it’s going to fail. So health care is a very strange animal. And that’s the reality and we need to work these changes through with managing change every step of the way and really building this cohesive relationships and trust which will eventually produce results.

Saul Marquez: [00:19:52] Yeah that’s a great feedback there. And so Raghib tell us a little bit about an exciting project our focus that you’re working on today.

Rajib Ghosh: [00:20:00] Yeah so one of the very exciting projects that we are at the moment working on is we wanted to see how we can bring all our health centers which are on different ph our system into a common electronic system because what that will do us is that then we can launch various other services which are more of a virtual care services. We take it as a virtual care like telehealth telemedicine in a very consistent and cohesive way. So that’s how you started how the finished where you captured information. How do you get a break here. How do you identify the patients who Hofstetter would be amenable for a virtual care delivery model. How do you integrate behavioral health into primary care. So all those things can be achieved in a scalable way. If we can’t have a single system across all overheads so that’s really one of the projects that is actually a big initiative a very strategic initiative at the same time but it’s ongoing and you know lots of challenges. Again same thing that I mentioned before building this trust building this cohesion building this common vision. But I think when one storm I think this is going to give us some tremendous hit Tippee believe me to do things in a scalable way in a quick and easy way. It’s good for the community overall.

Saul Marquez: [00:21:24] Now that’s really interesting. Yeah and what type of timeframe are you guys slotting out to get this done.

Rajib Ghosh: [00:21:29] You know a product like this takes a minimum couple of years to really lifted off the ground and make it operational. I think the key thing is building a sort of a common strategy common vision and that is what we’re focused on right now and why didn’t you find some partners who wouldn’t be the real players and also the sense of identifying the funding sources and I think that’s as critical as crafting provision.

Saul Marquez: [00:21:56] I love it. That’s awesome. All right. So right now you and I are going to pretend we’re building a medical leadership course and what it takes to be successful in healthcare I.T. today is the 101 course or the ABC of a Rajibo Ghosh And so we’re going to write out the syllabus and ask you for questions is going to be lightning round so we’re going to get some quick responses from you. And then you’ll recommend a book to the listeners at the end of the syllabus. You ready. Yeah. All right. What’s the best way to improve healthcare I.T. outcomes.

Rajib Ghosh: [00:22:32] The best way to improve healthcare I.T. outcome is to make all the data interoperable which is the big barrier right now and actually drive the outcome.

Saul Marquez: [00:22:44] What is the biggest mistake or pitfall to avoid.

Rajib Ghosh: [00:22:47] The biggest pitfall to avoid is for from a medical standpoint is not focusing on prevention as a best way to prevent chronic disease onset of diseases that could be prevented or delayed.

Saul Marquez: [00:23:02] How do you stay relevant as an organization. Despite constant change.

Rajib Ghosh: [00:23:07] Our entire focus in our organization is to help our patients for all their needs whether it’s behavioural medical social. And that is the mission that drives us. And I think as long as we stay focused our health I.T. initiatives and technologies not all of them are going that direction. And we have relevant communities that pay.

Saul Marquez: [00:23:28] And what’s one area of focus should drive all else in your organization.

Rajib Ghosh: [00:23:33] I think the main focus area right now is how do we integrate social and medical together into a common framework and demonstrate outcome for managing that.

Saul Marquez: [00:23:45] What book would you recommend to the listeners Raje.

Rajib Ghosh: [00:23:48] Okay so the book that I will recommend it’s not a medical book but it is a very good book that I had recently it is a book by Tom Friedman the famous author of The World Is Flat. It’s called Thank You For Being Late. The thing that I like about it is it’s an excellent reflection of what is happening around us and that’s it for us in health I.T. medical professionals to really understand the Good the Bad and The Ugly that’s shaped by these exponential rate of change in technology business model human interactions and bondman or ethical changes. Pretty much everything. And the author has asked us to take a moment to ponder how nature has designed the eco system that are intricately dependent on one another through meaningful interactions and that’s how we have sustained ourselves against the force of change for millions of years. And I think there are some lessons that we can take from that and how we can work together collaborate. Technology medical clinical social come together for one single thing just to really achieve Sapyta out or all of the.

Saul Marquez: [00:24:55] And that’s a great recommendation. Rajiv and listeners if you want to go get a download of all of our show notes as well as the syllabus to this course that we just constructed for you and the book a link to the book linked to Rajib’s organization. Just go to outcomesrocket.health/Rajib. That’s our RAJIB and you’ll be able to find it there. But before we conclude I just want to ask you to share a closing thought. And then the best place where the listeners could get in touch with you.

Rajib Ghosh: [00:25:27] Sure. As I mentioned before that we are living in a very exciting time in the age of technological exploration advances in technology are happening in leaps and bounds which are impacting everything every industry including healthcare. We are also going through a period when our physician community are experiencing increased rate of bore outs. So those are two key things. While we in healthcare we focus on patient satisfaction cost and quality of care. We can’t forget that we need physicians strategically for that care. So despite having all kinds of technologies and all the apps platforms Wardle’s machine learning artificial intelligence and now block chain. But at the end physicians still play the role of the Mealer so that empathy of a physician towards the patient often is this the real elixir. So in certain disrupting healthcare we shouldn’t forget that we should strive for quadruple aim that is physician satisfaction as well. So that’s closing thought.

Saul Marquez: [00:26:27] I love it. Rajib where kinda listeners get ahold of you if they wish.

Rajib Ghosh: [00:26:31] I have a Twitter account. I know the handle is @ghosh_r. My last name is ghosh sh underscore are your listeners can also send me a connection invite on LinkedIn and you can look me up on the link above with my name and also I write a regular column on health care analytics on a publication called www.analytics-magazine.org which is published by monthly so I request soullessness to follow my thoughts there if they want to and if their interesting ideas. They said that they would like to share with me and I’m always interested in hearing that if they can use better sounding board or needs more advice if they want to. And at no cost and they can reach out to me they are linked in first and then I’ll provide for information as there are.

Saul Marquez: [00:27:23] Awesome Rajib, listeners they have an invitation from hajib to collaborate to check him out on his blog posts and just get in touch in general Rajib. I just want to say thanks so much once again. It was really fun having a conversation with you and looking forward to staying in touch.

Rajib Ghosh: [00:27:41] Thank you so much. And once again thank you for having me on your show.

: [00:27:48] Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Thank You for Being Late: An Optimist’s Guide to Thriving in the Age of Accelerations

The Best Way To Contact Rajib:

@ghosh_r

Rajib Ghosh

Mentioned Link/s:

Blog – http://analytics-magazine.org/

Episode Sponsors:

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Social Determinants of Health