HLTH_Judith Kulich: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
Hey everybody! Saul Marquez with the HLTH Matters podcast. Welcome back to another great episode. These interviews are all recorded at the HLTH event in Las Vegas this year and just incredible conversations that will help you take your business and thoughts to the next level. Today I’ve got an amazing interview that I had with Judith Kulich. She serves as ZS Consulting’s lead for Patient Health and Equity, focused on partnering with clients across the healthcare industry to drive meaningful progress in health equity. She’s also an elected member of ZS’s Shareholders Council, where she serves as the chair of the ESG committee and leads the ZS Practice Council. Judith has spent much of her 20-plus years in healthcare, focused on drug development, and brings medicines to the market globally. In recent years, she has expanded her work to healthcare payers and providers, bringing sectors together around a common aim of addressing disparities in care and global health inequities. She has led industry collaborations and ZS’s investments and actively contributed to global health equity partnerships. I’m excited to have her here on the podcast and as you could guess, we’re going to be talking about health equity and access. And with that introduction, Judith, I want to welcome you to the podcast. Thanks for joining me.
Judith Kulich:
Thank you, Saul, very happy to be here.
Saul Marquez:
It’s a pleasure to have you here. So we’re really covering a lot of things around health equity at this conference. It’s at the core of what we’re trying to tackle and I’m excited to hear what you as well as ZS has done on the topic of health equity. But before we go there, I’d love to learn more about you. What inspires your work in healthcare?
Judith Kulich:
It’s a great question. I’ve been working in healthcare for over 20 years now, so I think back about the evolution over that time, and it’s probably evolved since I came into healthcare. Today, I do think this really extreme focus on individual patient experience and specifically on health outcomes and addressing disparities in care and health equity gaps to help everyone really achieve their most healthy lives. It’s become increasingly clear to me how, while we’ve made so much headway in terms of innovation, particularly in life sciences, so many Americans and individuals across the globe don’t have access to basic healthcare. So it’s really closing that gap and raising the collective bar that really motivates me today.
Saul Marquez:
Thank you for that. And so, Judith, we are sort of in this realm right where we do have to close that gap. How would you summarize ZS’s value to the healthcare ecosystem? What are you guys up to?
Judith Kulich:
Yeah, you know, one important position that we have the opportunity to be in is that we work across so many players in the healthcare industry. Our bread and butter is in life sciences, but increasingly working with payers, with providers, with health technology, with digital health. We’ve recently had the opportunity to work on engagement with the healthcare Leadership Council, really tapping into and kind of enabling and activating this 50-plus member community across the healthcare kind of ecosystem. So one really compelling value proposition I think we have is that purview and that ability to see across and increasingly the opportunity to share across. I think health equity is a topic that many, many organizations are eager to collaborate and kind of collectively cooperate, even in this pre-competitive kind of manner toward achieving common objectives. And so sharing what we see as best practices from one organization to the next, or elevating things like data standardization, learning about partnerships that are working that then we can replicate with other organizations in the healthcare industry. I think it puts us in a unique position to really be able to, again, kind of look across healthcare and show these connections and share best practices and elevate our collective game on this topic.
Saul Marquez:
Yeah, for sure, and that exposure that you guys have across different sectors and different stakeholders really offers perspective, so I really appreciate you sharing that. Addressing health equity, it’s often framed in moral terms for good reason, that every individual has a basic human right to equitable access to healthcare. Can you speak to the impact of health equity disparities to both individuals and more broadly to society as a whole?
Judith Kulich:
Yeah, the impact to individuals is increasingly clear. We saw COVID brought to light a lot of health disparities and health inequities. We see data with regard to death rates that were 2X, if not more, among minority communities within the United States versus comparable kind of white populations. But COVID definitely wasn’t new, it just brought it into focus. We see rates like black women are 42% more likely to die of breast cancer. We see other studies that more than a third of cancer deaths could be avoided if we can address these social determinants of health. So at an individual level, the outcome is clear. I think we also see this scale. So studies show that 74,000 Black Americans die every year in the United States due to inequities. Clearly, the individual impact is clear. I think from a societal perspective, going beyond moral terms, which are enough to motivate many of us, but really from a societal perspective, also understanding that these disparities, unless we really actively address them, aren’t going away, and in fact, we’ll even have more and more of a profound effect on our society as a whole. The US population is projected to be a majority non-white by the 2040s, and so these inequities that we see today will just continue to grow and grow. We also share, and I know there’s many studies out there, but the Robert Wood Johnson Foundation showed that the economic costs of health inequities are over $300 billion per year on the US alone. These disparities in care, the delayed diagnosis and screening, and in non-optimal treatment that many individuals across the United States face.
Saul Marquez:
Yeah, it’s apparent, and thank you for those examples. They’re fantastic examples that illustrate that it starts at the individual, but in essence, it’s a societal problem that will only get worse if we do not do something about it. So if everybody agrees that eliminating inequities in healthcare is a worthy problem to solve, why is it so hard to make progress?
Judith Kulich:
I think it’s so hard because it is such a massive, kind of seemingly immovable, daunting, overwhelming task, short of feeling kind of hopeless. I think what we’re seeing is individual organizations finding what is their hook, what is the specific area where they can drive progress individually, and then also again, where can they form partnerships or look to others to lead in other areas and they can move into more of a supporting role. There are significant challenges, again, with just kind of the kind of massive nature of the dilemma that we’re in, and we do see progress in some cases of organizations making strides there. I think other barriers that get in the way are inconsistency of data, if there is even data at all. So lack of data collection, sharing, and outcomes measurement standards really are limiting us to speak a common language within our organization, but particularly as we look across organizations, lack of clear ownership, some of these drivers of health are so kind of deeply rooted, whether it comes to food insecurity or loneliness as drivers of disease incidents and diabetic patients, for instance. Who takes responsibility for that? We see organizations really do the best they can within their four walls, for instance, but some of these drivers are just so foundational and yet so hard to move. We see lack of training and incentives to adopt behaviors that bolster health equity. There’s challenges with regard to how to collect data, how to talk to our patients, how to approach patients in a culturally appropriate way. And even beyond that, training and bias, frankly, just lack of representation among minority groups across healthcare. Efforts being made in some cases now, but really for many of our patients, kind of those that they interface with within the healthcare system don’t resemble them, and there are significant trust barriers and even significant bias barriers that continue to exist.
Saul Marquez:
Thank you for that. Yeah, it’s certainly a daunting challenge, but there are solutions. And you talked about data, Judith, and I know ZS has done a lot of work with analyzing claims data and other trends. What are some of the things that you found that have been surprising about some of the research you’ve done in that area?
Judith Kulich:
Yeah, you know, I think a couple of things that stand out. We think about kind of the patient funnel, if you will, so how are individuals engaging with healthcare and where are they frankly kind of dropping out or not continuing to engage, right? Or maybe not even getting that chance, not even feeding the top of the funnel. What we see is if we look into data, if we look at individual disease areas and we look at individual steps in this patient funnel, in this kind of patient journey and kind of ongoing engagement, we see different drivers affecting different steps in that process and again, really emerging differently for different disease areas. So what I guess what, the point of all this is that you really do need to look at a very focused, targeted, through a very focused targeted lens to figure out where can you drive the most meaningful change. In COPD, those drivers will be different than they are in breast cancer. In HIV, maybe they’ll be different than they are in diabetes. What really is driving those gaps and how can you most meaningfully address them? And I think what we’re talking about here isn’t, isn’t frankly, it’s not rocket science. We’re talking about trying to get the whole US population up to a bar more in line with what the 75th percentile might be receiving in terms of optimal care. There’s significant kind of, again, leakage in the funnel that we’re really just talking about getting more patients and more individuals up to a common level of care. One thing I think also that’s quite interesting, there often is an assumption or I don’t, you know, maybe excuse is a strong word, but a bit of an assumption that those patients that are dropping out, frankly, can’t pay and are going to be a burden on the healthcare system. But our data, when we dig into the claims, suggests that actually only about a third of those patients that we see dropping out because of other drivers of health will require additional either partial or full financial support. The other two-thirds really need help with awareness, with support with on-the-ground care coordination. They have other reasons for dropping out of the kind of healthcare engagement and blaming it on finances alone, it really doesn’t tell the full story. So I think that’s interesting to consider as we think about these programs and what really needs to be done to address these patients.
Saul Marquez:
Yeah, so there’s a lot of knee-jerk reactions as to why, but if we take a step back, there’s more to it than what we think.
Judith Kulich:
Yeah, absolutely.
Saul Marquez:
Got it, thank you for that, Judith. And so ZS works with clients across healthcare, not just pharma you mentioned and med-devices, but payers, large hospital systems, and your piece for us, you recommended steps each sector can take to start making real progress on health equity. What are one or two for each sector?
Judith Kulich:
Again, I think in any sector that, where you can lead versus where you can support and follow is really interesting. Both are needed and these collaborations are needed, but where can you really lead? For payers, driving reimbursement reform to incentivize nonclinical interventions is really critical. Again, providers are doing, taking many steps to improve care within their four walls, but how can we support things like transportation, things like food, things like housing in many cases? How can we support these more preventative care efforts and improve health outcomes for all outside of clinical interventions? In life sciences, life science is really, you know, owns or really leads in the product development, the medicine development, the pharmaceutical development side of things. So developing medicines that benefit a broader population, you know, being more inclusive in clinical trials, focusing on infections and populations that have had historical underinvestment. There’s many things that life sciences can do in terms of what medicines they’re pursuing, as well as how they’re developing those medicines and who they’re engaging with in their clinical trials to make sure that they really have a robust patient population when those drugs are approved. We see healthcare providers and health systems, there’s so much to be done in terms of harmonizing data sources and data collection, more systematically collecting information to really understand your patients at a much more targeted level and then really be able to come up with that common language to bridge across healthcare providers as patients are moving between health systems, making sure that we can kind of speak across a common language and have some consistency in that. We also see the providers having opportunities to expand sites of care, to reach patient populations, maybe with lower utilization of traditional channels and options, scaling interventions, and partnerships with community-based organizations, and even going back to, again, the representation of the healthcare providers as a whole, working toward greater diversity and equity and inclusion within the staff itself, but also training and reducing biases where maybe there’s still work to be done in terms of the actual diversity, but being sure to make sure that we’re kind of removing those biases along the way.
Saul Marquez:
Thank you, Judith. A lot of really great ideas here that, if implemented, could make a big, big difference in health inequities. And folks, as you’re listening to this, I would say it’s worth rewinding because Judith covered a lot here. We also have a transcript and the summary show notes, so make sure you take a look at those because there’s an opportunity for us to make a difference, and it’s just picking those one or two things that you can do in your sector to make a difference. Making sure everyone has equal opportunity to be healthy, it could feel overwhelming, but you’ve written about bright spots, Judith, things that are already happening to others that we can learn from and take inspiration from. Can you talk about some of those examples?
Judith Kulich:
Yeah, I love recognizing the bright spots because it can feel like a somewhat daunting task. One of these elements that we talked about was focus, right, and kind of defining a problem coming up with a target that you can actually move and see progress in. One, I’ll call out, actually Amgen shares quite publicly their areas of focus, and it’s interesting because again, you think with such a broad biotech organization working across so many disease areas, you know, where to start and where to focus, it feels like it would be very hard to define, but they really talk specifically about reducing biomarker testing disparities in black populations in Georgia, or CV disparities in black populations in Florida, or asthma disparities in Hispanic populations in New York. So they’re targeting specific disease areas, specific communities, specific geographies. You know, and if they can make meaningful change there, they will learn, they will see real tangible impact, and of course, they can grow in scale over time, but I think that’s really just really interesting, kind of a prioritization, you know, to figure out where to start. Another example, I spoke with Tim Tarbet from SCAN earlier today, but they’ve really taken a very, again, laser-focused view on disparities and medication adherence across races and ethnicities, and she shared so much about what they’ve been doing, but really to be able to meaningfully close that disparity gap, they were aiming for a 25% reduction in disparities among their patient populations and adherence, and they achieved a 35% progress within 18 months. So again, they just really focused in there and had all kinds of programs to really laser focus on adherence across their populations. And finally, one other I’m particularly inspired by is a pre-competitive collaboration referred to as Beacon of Hope. Novartis started it out as a partnership with historically black colleges and universities, and since then, Novartis led the way, but Merck has joined in, Sanofi has joined, in really working toward collectively addressing the root causes of disparities in health and education. It’s a ten-year commitment, some of these changes are not going to be quick, right, but they’re making the investment today to focus on expanding diversity among healthcare professionals again, expanding diversity in terms of clinical trials and in terms of clinical trial investigators. So, again, really kind of locking arms, if you will, across the industry to achieve and strive together toward this common aim. So those are just a few examples, again, some focused efforts, collaborative efforts, lots of partnerships to speak to, but I think it’s these highlights and these examples that make it an exciting area to be in, an exciting area to focus and to feel like, yes, it’s big and overwhelming and daunting, but if we can each do our part, we can collectively make progress.
Saul Marquez:
That’s fantastic, Judith, and it’s about a ruthless focus, right, and executing, just getting it done. And the examples you shared are certainly examples of we are moving the needle, slowly, but we’re starting to move the needle and that’s what matters.
Judith Kulich:
Yeah, absolutely.
Saul Marquez:
So I want to thank you so much for spending time with me today. It’s certainly been a stimulating discussion. And just to close things off, Judith, I’d love to ask any closing thoughts that you’d love to leave the listeners with.
Judith Kulich:
It’s really exciting at HLTH this week to again see the level of focus on health equity. I really hope and I’m personally inspired to ensure that this isn’t just a buzzword, right, but we are committing for the long term, that we are working together in a collaborative way and also learning from specific interventions that we’re trying to run, that then we can improve on and build on and change and adjust to address populations over time. This won’t be an easy needle to move, but I think it’s a very worthwhile effort, again, both in terms of individual lives, first and foremost, you know, society as a whole, and also in terms of value for the organizations that we serve in that are active in this industry.
Saul Marquez:
Fantastic. Thank you for that, for your closing remarks. And what’s the best place that listeners could get in touch and learn more about ZS and yourself?
Judith Kulich:
Well, I can be reached on LinkedIn, Judith Kulich. I’m a principal with ZS in Patient Health and Equity Lead, or ZS.com, obviously, to learn more about our company overall.
Saul Marquez:
Fantastic, Judith, thank you so much. And listeners, make sure you check out the show notes on today’s episode. Make sure you subscribe to continue listening to these amazing health leaders like Judith Kulich. Judith, thanks for being with me today.
Judith Kulich:
Thank you, Saul.
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