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Jim Jordan:
Welcome to the Chalk Talk Jim Podcast, where we explore insights into healthcare that help uncover new opportunities for growth and success. I’m your host, Jim Jordan.

Jim Jordan:
I don’t normally record the introduction after the podcast, but today we have a very special guest, Nisha Maharaja. And what makes this particular guest special for me is because Nisha is my first podcast with a former student. She attained her undergraduate degree at Carnegie Mellon University and her master’s from Carnegie Mellon’s Heinz College of Information Systems and Public Policy. Now, to my knowledge, Heinz College is one of the only master’s colleges in the country that houses both information management and public policy. Now, the school’s goal has always been to prepare men and women for intelligent action. And I prerecorded this introduction because I realized how seamlessly Nisha weaves public policy, law, technology, and a sense of service into her intelligent action. I hope you enjoy this interview as much as I did. So, Nisha, my first question is, tell us a little bit about your background.

Nisha Maharaja:
I have been in healthcare pretty much since I left Heinz. So my backstory is, really, I started out at Carnegie Mellon in undergrad, thought I was going to go into pre-med and take the clinical route, be a doctor. Midway through my undergraduate, I wasn’t sure that was the path for me, and a pivotal moment was I was actually working in Geneva at the World Health Organization working on tobacco-free initiative work within the WHO. And that summer sort of established for me that I could be really good at the policy, maybe even the business side of healthcare, and that maybe my interest in healthcare didn’t necessarily always have to sit in the clinical route. So from then on, it sort of changed my path, ended up switching out of pre-med, decided to come to Heinz into the Healthcare Policy and Management degree at Heinz, and actually stayed within the UN system because I thought that international health was really where I was going to sit. And coming out of Heinz, I decided, I needed to think a little bit broader and get some more hard skills, so I went into consulting, worked for Accenture for five and a half years, stayed in the healthcare realm, touched everything from technology to policy to clinical optimization, care management, utilization management, you name it, I did it, in five and a half years within the healthcare system, but ultimately transition out of there and went to Lyft for two years.

Jim Jordan:
That’s the one I wanted. That was a surprise. So tell me about why and what did you do there.

Nisha Maharaja:
Yeah, so Lyft was pretty cool. When I was trying to come out of consulting, I was definitely thinking more in the startup, maybe mid-sized company. I wasn’t really trying to go back to another big corporation, and I wasn’t trying to go into the payer industry or the provider industry, and Lyft came up, and it was a role in Lyft Healthcare. And so what Lyft Healthcare was doing was essentially non-emergency medical transportation. So the transportation that, for example, your grandparents or someone you know who may be on Medicaid is receiving. Those benefits are actually, particularly for Medicaid, are mandatory benefits paid for by Medicaid, where someone can get transportation to and from their medical appointments. And Lyft was building their NEMT, their healthcare program. They had already established the program but were looking to really build out the Medicaid side, and as all of us healthcare experts know, Medicaid is a wild, wild West. If healthcare wasn’t already messy enough, then you go and tell every single state across the US to build their own Medicaid program. It is not one size fits all, and they were looking for people who had policy expertise as well as business savvy and understood the industry, but understood how to work for a company and hustle, and that’s how I decided to transition to Lyft. And it was the perfect fit because it was sort of this startup mentality. When I joined was, I think not even four years old, and they had not even put a dent in the Medicaid piece.

Jim Jordan:
I do want to stop on this because this might be news to our audience, this transportation issue. So my daughter had worked for Medicaid practice in Boston, and as you know, we also did a Medicaid project at Carnegie Mellon University while I was there, and there’s some interesting things that came up from the details of transportation. And what we learned from my daughter’s experience and from the CMU project is that as cities gentrify, they tend to push the economically challenged out of the cities in pursuit of more affordable housing, and sadly, when this happens, when they arrive out there, they no longer have access to public transportation, nonprofit daycare solutions, or public health services. And particularly, with perhaps single mothers coordinating care for themselves and maybe multiple children, their health deteriorates when they move outside of the support systems from these cities. And so I didn’t think there was a program like this. Did Lyft recognize this, or is this a Medicare Medicaid program?

Nisha Maharaja:
Yeah, that’s a great question. So NEMT, non-emergency medical transportation, I will probably say that as acronym a lot. But NEMT has been an established benefit for decades. And the way it’s traditionally run, every Medicaid program has their own way of managing their medical transportation, but when you think of a medical transportation provider, traditionally, those are potentially ambulances or more non-ambulatory car fleets or maybe even fleets that are taxis that are accredited. So transportation network company is a short way of saying the Lyfts, the Ubers of the world. With the way the laws work in Medicaid, there are very specific to the types of providers. Our goal was to come in, in every state, into every Medicaid program, and go change those guidelines to allow for a TNC to be an eligible transportation provider, and that’s really where I think the game shifted. So it’s not that the benefit wasn’t there to begin with. It’s been there for decades, but the classifications of who could provide that transportation were very, very limited, and they needed policy experts, people who understood the market and could go in and literally help change the laws, talk to government leaders, and explain what’s the value proposition that Lyft has for their members, for their Medicaid agencies.

Jim Jordan:
One of the things that this podcast is about is the business of healthcare, and when you think about the best customer service you’ve ever had, it’s the processes behind it. And I think the challenge of Medicaid as a program is each state can run it their own way, and so, for a national firm like Lyft, it makes it very difficult when you have to change models. And, you know, we’re here in Pittsburgh, we can be in Ohio in two minutes, we can be in West Virginia. Those rules change. So did you make it to the point where I could use my phone and maybe have a special code on the phone that would allow it to register? How did someone call a patient?

Nisha Maharaja:
Yeah, great question. So the way an EMT traditionally works is actually a broker traditionally will call for transportation or order transportation, set it up on behalf of a Medicaid member. So traditionally, when a Medicaid member needs a set transportation for a doctor’s appointment, it can work in various number of ways. The member may call a set number, a call center who, and that call center will then go ahead and set up the transportation. Now, that call center has a list of transportation providers that can be used. Lyft isn’t right for every single Medicaid member in every single situation. So Lyft isn’t really appropriate for those who are physically and mentally able to get themselves in and out of a car by themselves. So if, for example, it’s a simple appointment, let’s say for a typical primary care appointment, that person will call the call center, the call center will establish that that member is able to get themselves in and out of the car. It’s a very simple getting them to and from the appointment, nothing more, nothing less, and will go ahead, and actually, that call center has the capability of a desktop link. And think of it literally like what you see on the app, you and I see, that’s what, these call agencies, and they go ahead, just with the simple name and number, they go ahead and put in the member’s name number, address, the pickup and drop off address, and set the appointment, and they can do it on demand, they can set a scheduled ride, they can set up an on-demand ride, which is a type of ride where the call center is still sending out and managing the ride, but the member themselves gets a link to their phone. And to your point of what you’re saying, the member can actually, from their own phone, then go and dispatch the ride whenever they want.

Jim Jordan:
What an important service. I mean, is it something like this for Medicare?

Nisha Maharaja:
So it can work for Medicare as well, because Medicare is a nationalized system and supplementary benefits, and the supplementary plans are traditionally where you’re going to find those extra transportation benefits. And it’s not again, just like Medicaid, it’s not standard, so that plan has to elect to provide transportation as a service, and there are definitely Medicaid plans that have been engaging more and more to get this for their Medicare members because they understand, you know, a lot of those Medicare members are over a certain age, are right now relying on their kids, family members, friends, neighbors versus if they can just get a quick pick up and drop off, They’re starting to bring in these types of programs more and more. And even hospitals, when you’re thinking about ED discharge, and Lord knows, I think all of us who have worked in the health system know there are so many people when you’re ready to leave the ER, if you don’t have transportation, you’re stuck there. So many people are beginning to stay, have to end up staying for an extra night, simply because they can’t find the transportation to get themselves home. It is much cheaper for a hospital or an ER, for example, to pay for a, let’s say, $30 Lyft ride versus an extra night in the hospital.

Jim Jordan:
It makes perfect sense. So the dynamics are changing, too. I did a podcast a few weeks ago with someone in the long-term care industry. They were talking about the various programs that were out there that were subtle support networks like this, and one of the things we were talking about is, 50 years ago, families didn’t move around the country like we all do today. And now, in a lot of these settings, these people don’t have family around them, and these programs become even more critical to help with cost structures. Well, that’s only one-third of your story. I just thought that was the most interesting thing. So tell us about when you left Lyft and what you’re doing now.

Nisha Maharaja:
Yeah, I joined Lyft right before the pandemic, so it was a very wild situation for me. I was living in DC for about four years, and then right before the pandemic, moved to New York. And what a time to move to New York, but stuck around here and ended up with Lyft for a little bit over almost two years and nine months, and I was hired with maybe somewhere between 4 and 7 states. And by the time I left, we had changed from a policy to, I think, 20 states. And I was like, you know, I’ve done this, and I was good, and I decided it was time to look and maybe jump into more of a startup, decided to join a startup in digital mental health company. We really care about the holistic full journey, so our products include communities of care, our products include digital therapeutics, and we’re not thinking of mental health just from the perspective of mental health in general. We also are really diving into and thinking about it from a specific condition standpoint as well. So while we do mental health in general, we also are focusing in building products that focus on mental health for pregnancy, mental health for psoriasis, mental health for MS, all of these different components and ways of addressing how to support an improved wellbeing as it relates to mental health and all of these other specific conditions.

Jim Jordan:
There’s a silver lining to COVID, it opened up some policy changes and reimbursement codes that have been proposed for years. It sounds like it motivated at least some states to change the way they do Medicaid, and it has availed the necessity of taking mental health issues as seriously as we take organ health issues. So tell me more about your journey into mental health and more about your company.

Nisha Maharaja:
So the company is at ten years old. It started as Happify Health. Our founders were in the gaming space and were building products for gamification and realized, why don’t you apply the concept of gamification to healthcare to help better solve and treat health issues? And that was the origin story of Happify, and we just rebranded right before I joined in July of 2022. With the rebrand, we established products that we are providing and that we are serving, which are what we call Sequences. Sequences are not just one facet but multifaceted. So again, there’s communities of care where, for example, if you’re utilizing the pregnancy sequence, the maternal health sequence, it is a place where pregnant women, moms, can check into tracks and ask questions with expert content as well as experts that are also monitoring and providing feedback within the communities. They can engage with other moms, with other pregnant women, and the questions that you see in these communities of care are pretty astounding. It’s as simple as, how do you know if you’re pregnant, right? But some people are really afraid to ask those questions.

Jim Jordan:
So, … of stories to provide some evidence of the importance of what you’re doing. I have a daughter that works in the after-baby care unit, that serves an economically challenged community. And part of what they are trying to do is educate these mothers while they have them in the hospital. And it’s always shocking to me some of the stories she tells me on the disinformation that these women are working from. They really don’t have a place to go in their community to get this information. And my second story talks about the importance of community. My wife met this group of women online when she was pregnant on a Mothers-to-be chat page. And these women from Scotland, New Zealand, California, have stayed connected for 25 years. They have discussed their pregnancies, childhood development in their kids, and notably, some husband development in there, but they are evidence of the importance of having community. And this is just a small example of the importance of what you’re doing. Can you explain how you fit into the healthcare system?

Nisha Maharaja:
Great question. So there’s the communities of care, and then there’s digital therapeutics. What we do is non-prescription digital therapeutics. There is the direct-to-consumer facing part of it, which is the communities of care, what’s called Twill Care. What we’re trying to do is work with payers to have them bring Twill on as a service so that payers are then providing their members with access to utilize Twill and the full set of services.

Jim Jordan:
I just want to pause for a minute and ask, where can people find your community?

Nisha Maharaja:
If you go on to the iPhone App Store, or the Google Play store for Android, just google Twill, T W I L L, care, C A R E, and you should see the app pop up, and you can download it and go into the app and pick the appropriate community of care that you want to join and you can join today for free. Where we really are working with our payers is for adding on components of digital therapeutics as well as integrating services connected to health plans. So health plans provide a ton of services and a ton of services related to mental health and a ton of services that are full context of your care. So with our digital therapeutic, we’re bringing in tracks and the gamification component of therapy games and non-prescription digital therapeutic therapy, right, for certain conditions to help members better treat their symptoms, right? We’re not helping people solve for the issue, we’re just helping them to better manage and manage their well-being and manage how they’re dealing with their issues.

Jim Jordan:
I think sometimes the benefit also is it helps them package their problem through that education to whoever their provider is. I mean, there is, as you know, one of our famous professors at Heinz College, … Padman, does a lot of work on information management. And one of her data sets that she looks at is the cost of healthcare illiteracy, which is people not knowing how to navigate the system or any information or how to help. Where do you get your models from and how do you source the data? I imagine that you have some strong algorithms, but are you also using artificial intelligence?

Nisha Maharaja:
Yeah, there definitely is an algorithm behind it that’s helping to try and understand. Can’t get too far into it, but I can say that, yes, there is an AI behind it that’s really helping to understand and read what are the habits of a member and helping them better guide how to better manage their symptoms.

Jim Jordan:
I’d be very curious to understand. So this is your second time working with tech?

Nisha Maharaja:
Second time, yeah.

Jim Jordan:
As a healthcare expert, being one of the few people that I know that have had sort of these experiences working with the tech world, what insights do they bring into the party that those of us in healthcare aren’t really thinking of, or those of us in healthcare because of the way we use our systems in healthcare have paradigms that need to be kind of exploded and changed?

Nisha Maharaja:
It is probably from my, from personal experience, my opinion. I would say that what I see tech bringing there is a healthy amount of skepticism in our healthcare system. Our healthcare system in the US is so convoluted and complicated and so expensive. How do we get it back to getting people the care they need? And we used to say this in grad school all the time, like the right care at the right time for the right people. And I think a lot of times that concept is really, really lost. And I think where tech has really come in is trying to almost bring a level of simplification. On the back end, don’t get me wrong, it’s not simple at all. When you were talking about how we’re trying to cater treatment and therapy specifically by reading what people’s activities are, right, and understanding.

Jim Jordan:
To your point is, if focused on the customer and letting the complexity be behind the scenes, not be something that the customer deals with. I mean, even your Lyft story, for example, why do you have to go to an exchange to figure out how to get that Lyft? Obviously, you were in my marketing class, so we would talk about really, in marketing, there’s only three big things you do, right? You create a new category, do something that’s never been done, you collapse the value chain in how long it takes to do something without changing the satisfaction or maybe delivering some more. You just make it cheaper. There’s all sorts of complexity around those three things, but that’s really all we’re doing. I think a lot of these tech people think that way. It’s just, we’re doing something new, we’re collapsing it, and I think that’s what they bring to the party.

Nisha Maharaja:
I think it’s, some people will say, the naivete of someone who’s not healthcare coming into healthcare, but that’s why you have people like us, right, who then are like, okay, we give a healthy dose of reality to the healthy dose of optimism that traditionally, when you’re in healthcare, does not exist. And I think that’s a piece that has been really interesting both in Lyft and here at Twill is, there’s the people who have been in healthcare for a long time, we’re the ones who are like, oh man, you know, all right, we want to do X, Y, Z. And we’re the people in health who have been in healthcare, the ones who are like, all right, well, here’s 40 other considerations that you need to do. Those people who brought the initial suggestion still keep that hope alive. We can do this. And there are ones who will help bring us to the middle ground of what’s a solution to, like we’re saying, simplify something that doesn’t necessarily need to be over complicated. And I’m not saying it works for everything, but it works for many things, probably, in healthcare, that we haven’t really explored before.

Jim Jordan:
So it’s a perfect transition to a question that says, tell me about a time when you’ve had to adapt or shift your strategy. So you’re kind of working with a new group of people.

Nisha Maharaja:
Yeah, it’s new, and it’s different. So I would, say at Lyft, I was a lot more on the policy side of the world. I definitely did some business strategy, definitely was thinking through new ways to help support the business. I wasn’t necessarily focusing on anything tied necessarily to revenue. I was literally going to Medicaid agencies talking about what the policies are on transportation for Medicaid and going to try and change regulations, policies, roles, you name it, like very heavy, almost borderline government relations. Here at Twill, we don’t really need that as much. Transportation was highly regulated, of course, we’re in a space mental health that’s highly regulated, but right now, we’re at a stage where we’re really just trying to bring more customers in to show what we can do, and particularly in the Medicaid space, really bring in the value that we can provide to Medicaid plans supporting their communities. Because, like you said before, at the top, the workforce limitations and the mental health space are tragic right now. This is, not statistically, but probably in one of the worst states it’s been, right? The workforce, the number of mental health support, psychiatrists, psychologists, to the demand is very, very limited. And so I think we’re at a point where we’re trying to pivot and prove that we can help alleviate some of that bottleneck and that stress.

Jim Jordan:
In light of the current working-from-home trend, businesses may not be aware of the challenges employees face when it comes to mental health. While working from home has its benefits, and I’m enjoying it myself, it can be a lonely experience, especially for new employees who lack network and guidance from experienced colleagues. In the past, when you were in the office, you’d simply walk over to a senior colleague, and you ask for help, but now it’s become a bit more difficult. And actually, McKinsey and Company reported in April that workplace relationships account for 39% of employee job satisfaction, and relationships with the managers account for 86% of that. Some companies are starting to address these issues by being more purposeful about creating virtual events and in-office gatherings, and it’s important, I think, for businesses to recognize that this need exists and to take action to support their employees’ mental health. So you’re in a new space. So the other question is, how do you find your resources to keep up to date? So you’ve been in the policy side for a long time, and most people would answer right away, go here, here, and here, but I imagine you’re still in the collecting and forming phase.

Nisha Maharaja:
Yes and no. I think for me, I’ve been in particularly over the past three, four years, I’ve been in spaces that require me to constantly be abreast of the most current situations, most current topics, and they’re all related to what’s going on in the market as it relates to whether it be mental health or transportation. And frankly, I think, even if you’re not working in a very clinical or very, I won’t even say clinical, but a very healthcare-related company or business, you almost always still have to be somewhat understanding of what’s going on in the world. So researching for me has just been a constant since I can remember.

Jim Jordan:
The resources you could share with the audience that you go to. I think we need to slice it a couple of ways, given your background. So for health policy, where would you recommend people go?

Nisha Maharaja:
For policy, a resource that I’ve been engaging with is HMAIS, I think it’s Health Management Associates, I believe is the name of the group, and they are pretty much the gold standard for Medicaid content, Medicaid information, and they have a newsletter that is free to subscribe to. And I think every Wednesday you get an update of, you know, the biggest hits and headlines of the week in the Medicaid space and its policy, the latest RPs, the latest mergers and acquisitions, anything and everything, whatever the federal government is doing from CMS, whatever CMS is putting out, it’s a great summary spot. Even if you’re not trying to think of just specifically Medicaid, it’s great to know because usually there’s talking about Medicaid, you know, more often than not, you probably have something else tied to it. Kaiser Family Foundation is always a great resource, and Fierce Healthcare are also two great resources just for getting to know of the know, what’s going on in the US healthcare industry. I think those are probably the most frequent places. If I’m looking at articles or pulling articles or reading things, those are the three probably top websites or resources that I’m using.

Jim Jordan:
So what about the digital side?

Nisha Maharaja:
Great question. The digital side, I would say honestly, Fierce Health has a really great grasp on that.

Jim Jordan:
So you have done the World Health Organization, you’ve done the consulting for-profit across all the different service areas, you’ve done the Medicare, Medicaid, transportation, and now you’re doing mental health. So what’s the biggest lesson you’ve learned in this journey thus far?

Nisha Maharaja:
Oh, that’s a, that could go on for another hour, probably. I think the biggest lesson I’ve learned is that there’s always something to solve for. I think we haven’t gotten it perfect. I don’t know that we’re ever going to get it perfect. I think there’s a pretty large room for improvement. And I think while I’m optimistic about the state of healthcare, I think the reality is there’s a lot of issues we have going on, and there’s a lot of people that are underserved, and there are a lot of people that don’t have access to healthcare. And there are a lot of ways that we could probably better get people the right care that they need at the right time. And if you’re in healthcare and you’re in this space and why you’re doing it, I hope that’s one of the reasons is that you’re trying to serve the bigger purpose of, particularly living in New York, I see it walking outside all the time where you see people who you know for a fact are underserved and need that help, and in the back of your mind, you know, you want to help them in the best way you can. And I think particularly when you’re thinking about health tech, there’s a lot to be said that tech can be a really quick and easier way to get people at least some level of access and care that they haven’t gotten or help people more easily get the care that they haven’t gotten before and get them to the care that they need.

Jim Jordan:
Someone was commenting that they’ve noticed a lot of the homeless have phones. I was standing there at a bus stop watching this, and the person was not talking to, made a snarky comment about, they’re homeless, and they can afford a phone. And so my friend and I started talking. I said, I guess that person doesn’t realize that that’s their access. That is their access to everything. It may even be in some cities, it’s actually their access to the homeless shelters to schedule a night in the homeless shelter. And so, to your point, think about tech and what it can do to enable things and that it can end up having a bigger impact than we think. But the same question, the biggest lesson or something that you’ve learned, what has that been?

Nisha Maharaja:
For me, I think; personally, I think I made the right decision. I’m glad I stuck in healthcare. I want to grow in this space. I want to continue to help people. I think there’s an altruistic reason to me being there, and I know it’s very cliche, but for me, I think the biggest lesson, you know, I said, I transitioned out of consulting. While they’re doing great work, that’s valuable to keeping the operations running in healthcare payers and hospital systems, it wasn’t for me because I wasn’t ultimately directly benefiting the people who need it the most. I think that was one of the bigger lessons and sort of helped my career in terms of growing as a leader in the healthcare space and growing my career, leaving consulting and understanding while, you know, some people may find their passion in helping transform the EMR systems at a hospital, where my passion lies more is helping transform the systems and the services that really are provided to people and to help get the care that they need the most and better serve them. And to add that to, Jim, your point about the homeless and seeing phones, I would like to remind people it’s not just in the US. This is a global thing. In the world many people who are what, by our standards, we would consider are not as well off, nearly as well off as us, still have cell phones. And so what we’re solving for here in the US can probably be maximized across the world, globally, and I hope we start to think more globally and less locally.

Jim Jordan:
Globally, in some cases, these regions are even more advanced than us. For example, I’ve worked with companies in Nigeria and other parts of Africa, and running telephone wires and internet cables across these vast plains makes zero financial sense. And so they do it with cell towers, and because of the low population density, most access to healthcare is done through their phone.

Nisha Maharaja:
That’s right, I’m sure we’ve all been to healthcare conferences where we think things need to change and we need to move for the better. But man, if you really dig into the policy and into how laws are written and how to get things changed, it’s going to take some lift and some work. I think we need to, from the ground up, rethink how we’re establishing our healthcare system. I would say the status quo is the biggest threat, and it’s also the biggest opportunity. If you go and simply read the laws and the regulations and the rules, just for example, on Medicaid, they’re written from the stone ages.

Jim Jordan:
So the question comes down to who is minding the big picture and what is the big picture? For example, we have two solid policy discussions going on right now that is somewhat mutually exclusive in terms of maximizing each policy. We have a desire for interoperability, and why can’t my Apple Watch send my pulse, my ECG, etc., to my doctor? I mean, that seems so obvious. And then we have cybersecurity policies and large fines for people who aren’t diligent. If this policy were taken to an extreme, you would shut down the goal of interoperability or at least slow it down measurably. And so, who is responsible for setting these policies? Good policy, I think, requires a balance of vision with the practicality of the current state. So I think industry, government, and academia must all be at the table. But Nisha, to your point, that’s hard work, and it takes a collaborative attitude. And true progress is generally done through a series of compromises, but unfortunately, that’s not our current political environment right now. So in its absence, I guess we get the Stone Age.

Nisha Maharaja:
It’s funny, I was having a conversation with my family just this weekend, and this is the point that I was making, is that unfortunately, law, government, has not caught up to innovation and we don’t want to stop innovation for necessarily the sake of law not catching up to it. So how do we get everybody on the same page? How do we get people comfortable with being able to have innovation and quickly and rapidly start? You don’t need to have it all written and be comfortable with, but it’s an evolution. And that’s where healthcare is, it’s always an evolution, it’s the way of life.

Jim Jordan:
So you’ve got 30, 35 years ahead of you before your career is done. At the end of your career, what do you think the healthcare system looks like and what have you helped to change in it?

Nisha Maharaja:
You know, particularly being in a tech space over the past couple of years, we’re starting to catch up. I hope by the time that, you know, I am come time for retirement, I hope EMRs can talk to each other. I hope the sharing of information becomes more fluid. I hope that we are thinking completely holistically about care. One thing that I didn’t really mention too much today, care is not just about the care you get from a doctor. It’s about your access to transportation, your access to housing, your access to employment, access to good food that’s nutritious and will keep you healthy. SDOH has been … over the past ten years or so, but I really do hope that we start to think more holistically.

Jim Jordan:
Can you define SDOH, just for the audience?

Nisha Maharaja:
Social determinants of health.

Jim Jordan:
Thank you.

Nisha Maharaja:
Yeah, working in the transportation industry, I touched everything. I touched how to get people from their doctors to housing, how to get people from a doctor to then go to a grocery store and think about food as medicine. And that all plays. And when we’re talking about mental health, if you are living in a healthy space, if you have access to people on social networks, if you have access to good food, those all are pieces that play into mental health and how you’re living your best life and living your healthiest life from a mind and body standpoint. Everything I feel like I’ve been doing the past three years has been connected. So I really hope that by that point we will think more holistically, every facet of your life that plays into your health. And I hope that the conversations around all of these pieces have become more normalized. I know mental health is a really hard thing for people to open up about and tied into that job insecurity’s hard to talk about, housing insecurity, ability to put food on your table for you or your family, these are all tough topics. I hope we’ve come to a place where we can talk about it more, ask for help more, and found solutions that people can get their help more.

Jim Jordan:
I recall a situation from my time working in Pittsburgh South Side where a piece of mail arrived at our office, it wasn’t meant for us, and it turned out that the intended recipient was an elderly woman who just lived about three blocks away, so I decided to deliver it in person. And when I arrived at her house, I found this woman carrying an oxygen tank and using a walker, and despite her health issues, she welcomed me into her house and offered me a cup of tea. And as we talked, she opened up about her struggles to afford her housing and her health issues. And it turned out that her son, who was studying engineering at college, had to quit school and come home and take care of her, and he was working part-time at the local Burger King to make ends meet. And this experience highlighted to me that healthcare is not only a moral issue, but also an economic one. And this young man left college to care for his mother. He had the potential to contribute much more to the economy had he been able to continue his studies. And it’s a sober reminder that health issues can have a far-reaching implication well beyond the individual affected. Is there anything else you’d like to share with our audience?

Nisha Maharaja:
No, I think that was a lot. But if you’re in the healthcare space, I hope you’re excited to make an impact, as I am, because I think that’s why we’re all doing it, is to make a big impact and help not only ourselves, but somebody else in the process.

Jim Jordan:
Well, thank you for being a guest. I really appreciate it.

Nisha Maharaja:
Thank you for inviting me.

Jim Jordan:
This was a big episode and it’s hard for me not to take some reflection here. We have an upcoming episode on Precision Medicine, and Precision Medicine uses AI to provide personalized therapeutic treatments. And it struck me that these digital mental health models are doing something very similar. It’s so easy to let labels and fancy names confuse us. What we’re trying to do here is use AI to find the health variances before it happens and to intervene so we don’t have an acute event. And in doing so, we’re ultimately going to reduce the overall cost of the healthcare system over time. Now, Nisha also shared some views today that some of you might not agree with. But again, upon reflection, what’s the problem we’re solving for? I’m reminded of an exercise I would run in my classroom when teaching health systems, and I would start with the question, is healthcare a right or a privilege? The classroom would instantly divide as many personal values are built into this question. However, I changed the problem that was solving for. I asked the classroom, if everyone had healthcare and healthcare costs went down and gross domestic product went up, would you support it? And consensus was instantly built, that was a good problem to solve. So the point is not to start a debate at the end of a podcast. The point here is this podcast revealed the importance of knowing what you’re solving for.

Jim Jordan:
Thanks for tuning in to the Chalk Talk Jim Podcast. For resources, show notes, and ways to get in touch, visit us at ChalkTalkJim.com.

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