In the third episode of our three-part deep dive into A Path Forward, Dr. Carolyn Brooks, Vice President of Quality, Strategy, Innovation, and Experience at UnitedHealthcare Medicare and Retirement, and Dr. Wyatt Decker, CEO of Optum Health discuss ways to address health disparities and improve the health care experience.
Technology has transformed and streamlined the way Americans access the care they need. However, for many Americans – especially those in historically underserved communities – the health system feels fragmented and disjointed.
In the final episode of our three-part podcast deep dive into A Path Forward, Dr. Carolyn Brooks, Vice President of Quality, Strategy, Innovation and Experience at UnitedHealthcare Medicare and Retirement, and Dr. Wyatt Decker, CEO of Optum Health, discuss policy solutions that can help address health disparities, advance health equity and improve the health care experience for both consumers and providers.
Click here for more information on A Path Forward.
Evan Sweeney00:06
Hello, and welcome to UnitedHealth Group's three-part series on health care policy, where we're taking a deep dive into a path forward. It's a set of policy solutions released by UnitedHealth Group that offer a refreshed perspective for how to modernize the health system to achieve universal coverage, make health care affordable by accelerating value-based care and reforming prescription drug pricing, and transform the health care experience by focusing on equity and addressing disparities.
You can download the full document at www.uhg.com/apathforward.
In our final episode, we're taking a closer look at how to transform the healthcare experience, in part by advancing health equity to help ensure everyone has access to high quality care.
For many Americans, the current health system feels fragmented and disjointed. Consumers used to making a purchase with a couple of taps on their phone are often frustrated by the complexities of the healthcare system. And for historically underserved communities, those challenges are often exacerbated for any number of reasons, including, for example, lack of diversity within the health workforce.
Here to talk about some of the policy solutions that can help address health disparities, advance health equity and enhance the health care experience is Dr. Carolyn Brooks, Vice President of Quality, Strategy, Innovation and Experience a UnitedHealthcare, Medicare and Retirement and Dr. Wyatt Decker, CEO of Optum Health.
Carolyn Brooks01:31
Thanks for having me.
Wyatt Decker01:32
Thanks, Evan. Great to be here.
Evan Sweeney01:35
Great. Well, let's jump right in…. the COVID 19 pandemic certainly highlighted a lot of things about healthcare in the United States. One of them is pervasive disparities that exist based on race, ethnicity, income level, and even where you live. Dr. Brooks, how have you seen health equity come front and center over the past two plus years of the pandemic?
Carolyn Brooks01:57
Yes, so there has been a lot of talk about health equity lately, so much so that it's become a bit of a buzzword, but it's not a buzzword for us. In fact, I'd say that health equity is nothing short of the measure of our mission, which is to help people live healthier lives, and to make help make the health system work better for everyone. And we've been at this for a long time with a variety of programs and philanthropic efforts to advance health equity over the past 20 years. Though, there's still much more work to do. Health Equity is only achieved when every person has an opportunity to attain their healthiest life without any social, economic or environmental barriers. But today, we all know that there are still far too many barriers to good health that are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. For example, we need to look no farther than the maternal mortality statistics in the US were Black and Native American women are two to three times more likely to die from pregnancy related causes than their white counterparts. We also know that more than half of rural counties do not have a hospital with obstetrics care, causing me to delay or avoid care altogether. And unfortunately, these maternal deaths and related disparities have only increased during the pandemic.
Evan Sweeney03:13
Yeah, I mean, certainly some startling statistics there, I guess, understanding that broader perspective, what can be done from a policy standpoint to address those disparities? And Dr. Brooks, I'll start with you. And then we'd love to hear from you Dr. Decker.
Carolyn Brooks03:27
Yeah, so I would say there are a number of actions that can be taken. First continued investment in and a focus on data driven understanding of health disparities and social determinants of health are necessary to help identify gaps in the system so we can pinpoint those policy and other solutions, and importantly, measure their effectiveness and advancing health equity related to maternal health where the data is clear, racial and geographic inequities and maternal and birth outcomes. Medicaid policy is an important lever, as Medicaid supports nearly half of all births in the US and covers over 65% of Black births, ensuring access to high quality, comprehensive maternity benefits and Medicaid that support both the healthy pregnancy but also extend that care extends care during that critical postpartum period are necessary to reduce and equitable health outcomes. And finally, I know some other guests in the series who have spoken about this, but I believe it's worth emphasizing. We need to be able to serve the health of the whole person. Ensuring behavioral, physical health and social needs are addressed together. So as we think about policy opportunities, integrating behavioral health into Medicaid managed care, along with medical benefits is key. Unfortunately, we've seen that COVID has exacerbated the health mental health crisis in the US especially for our children and adolescents. So ensuring that Medicaid programs provide multiple access points to both behavioral and physical health care for our children and adolescents is another critical policy.
Wyatt Decker05:00
Yeah, Dr. Brooks just underscoring your last comments around behavioral health, it's so important. And it's interesting because most of us as people kind of have an intuitive sense that, that our mental health and well-being is deeply tied to our physical health and well-being. But for a bunch of historical reasons, the payer and provider community years ago began separating the two treating them as if they're completely separate entities. And now we're involved across UnitedHealth Group on both the payer, the provider side on, frankly, a massive effort to bring it back together to what most people intuitively know how it should be, which is the when I or you or our loved ones go to get physical care of some sort, there might be mental health or behavioral health care needs that would hopefully be addressed. And if you have behavioral health care needs, it's going to have a big impact on your medical are, quote, marks physical healthcare. And so as we sometimes like to say, it turns out that for most of us, hopefully, that the head is connected to the body. And we believe deeply in in real tactical ways in bringing the two back together. And that's a big effort for us, particularly is on the provider side in what we're doing in Optum Health, is beginning to get better and better at embedding mental health services with our primary care providers. And sometimes we have the ability to actually have an A, on the team, with the care team mental health expert that can be tapped at when and as needed. Sometimes it's a virtual solution. And to your point, Carolyn around how we're helping, the national epidemic of mental health needs has just skyrocketed. We have to do better at scaling our offerings. And so you'll see us continuing to roll out pretty innovative, but I would say evidence based and validated, virtual and even self paced digital tools that people can leverage.
Evan Sweeney07:12
You know, there is much more focus on social determinants of health, I think over the last several years. And Dr. Brooks, I'm curious, you know, how does that intersect with medical care, and what policies can help connect patients to the resources that they need in that area?
Carolyn Brooks07:29
Yes, so you know, 80%, or more of our health is determined outside of a doctor's office. That means it's determined in our homes, our communities, our schools and in our social networks. There's a saying that your zip code is more important than your genetic code when it comes to health outcomes and life expectancy. This includes factors like poverty, the presence or absence of hospitals and health centers, air quality and the effects of climate change. If you don't have access to nutritious food, or a safe and stable place to call home, that is going to have a significant adverse impact on your health. We have to look at life circumstances more holistically, if we're going to be successful at eliminating health disparities and improving broader health outcomes. We must think outside of our traditional care settings outside of hospitals outside of clinics into real life into homes. It's after decrement virtual and home-based care, for example, where we can better understand the lived experience and environment influencing health outcomes. We know that within healthcare systems across the world, people are adversely impacted every single day, some even by death, not because we lacked the knowledge to treat them, but because of inequities in the healthcare system and beyond that create these challenges and access resources and affordability. So we cannot truly modernize health care without, I would say a relentless focus on equity and these broader social determinants.
Wyatt Decker08:57
You know, Dr. Brooks couldn't agree more with her comments. And I would add that what's really exciting to me is focusing on value-based care because when we have individuals who we care for him value-based care constructs, we're now very interested and able to provide support for inequities and barriers to getting good health care, which are the social determinants. And so we actually use AI enabled analytics to identify individuals with transportation insecurity, food insecurity, housing, insecurity, and loneliness, because those are all big impacts on short term and medium and long term outcomes for health care. And I'm very excited because we're now able to begin the process of applying solutions, like having a van come to somebody's house to pick them up, or having a volunteer bring a cooked meal over to somebody's house. leveraging community resources and our own teams to help address social determinants. And, and in a value-based care construct. We're all aligned to make sure that people get high quality, comprehensive whole person care that helps keep them healthy and well. And sometimes that's care in the home. So I think you'll see us continuing to say, how do we identify and how do we help support individuals who have barriers to high quality health care, great health care and health care outcomes? Yeah, we know
Evan Sweeney10:32
that the health care workforce remains underrepresented by people of color. Our research shows about 16% of the health workforce is Hispanic and less than 12% is black. So, Dr. Brooks, from your perspective, what can be done to improve those statistics?
Carolyn Brooks10:50
Yeah, it's important to note that the reality is the Democrats, the demographic landscape in the US is changing. It is estimated that by around 2042 or so the majority of Americans will be people of color. So we do need a clinical workforce that is more reflective of the people it serves. And this is important so that healthcare providers are able to speak the same language and provide care that is culturally appropriate for their patients. As at the end of the day, we all just want respectful in quality health care. Additionally, you know, I'd say that new research is beginning to show that culturally competent and congruent care may also affect health outcomes. For example, a recent study shows that although black newborns are three times less likely to die as white newborns, their mortality rate is cut in half when they have a black physician. The United Health Foundation, which is the philanthropic foundation of UnitedHealth Group, also recently announced a $100 million commitment over 10 years to help building more racially and ethnically diverse health workforce. This funding is going to provide scholarships support and training for 5000 future clinicians. It's going to provide financial support to upskill 5000 health professionals, professionals. And while 100 million is a lot of money, it is just a start. And we are ramping up other efforts to support our own diverse clinical workforce at UnitedHealth. Group.
Evan Sweeney12:09
You know, there are also projected workforce shortfalls among nurses and doctors. And I'm curious from you, Dr. Decker, you know, how can those gaps be addressed going forward?
Wyatt Decker12:22
Yeah, thanks, Evan, this is a crucial issue for our nation. And for us as providers. There's two factors. One is who's entering the workforce, and Heather's who's leaving. And starting with the second point, we have, essentially another epidemic that's been a little quieter around physician and provider burnout, and the pandemic accelerated that which probably isn't a big surprise to our listeners. Historically, in the past four or five years, most national surveys showed about 45 to 50% of physicians are reporting some degree of burnout. And that leads to early retirements career changes. And sadly, the national rate of suicide among physicians is substantially higher than the base population. So some really tragic consequences. So I think there's an enormous opportunity for us to really helped lead the way in providing an environment where providers and physicians specifically but also nurse practitioners, advanced practitioners, nurses, and others really flourish. And when you talk to providers, and Dr. Park staff spent our careers in these spaces, you rapidly hear about the clerical burdens, about the difficulty of getting the work done. So you know, health care workers actually are quite passionate about the work they provide, and they're not looking typically for less work, what they're looking for, is to have maximum impact of their training and passion around helping others get well and stay well.
Carolyn Brooks13:56
Yeah, I'll reiterate what Dr. Decker said, you know, doctors and clinicians did not enter this field to do paperwork. They enter this field because they felt called to help people. And these inefficiencies in the system negatively impact that provider experience, which we know in turn negatively impacts the patient experience. And I think and just reiterate, this is consistent with our view that the system must be modernized and made simpler for all who seek to deliver and receive care.
Wyatt Decker14:22
And the other point in your earlier question was we also need to think about making health care appealing for young people deciding what they want to do in their career and so we're very interested in supporting early career all the way down to middle school aged individuals. And back to Dr. Brooks comments on diversity in the healthcare workforce that tethers nicely so we were very committed to creating exposure to young people and diverse young people on what healthcare career can look like, even as we work to make it more appealing and more so stainable for those who are in it.
Evan Sweeney15:01
Yeah, absolutely. Well, listen, thank you both for joining today. Really important topic and appreciate both your expertise.
Wyatt Decker15:10
Thank you. Great to be here.
Evan Sweeney15:12
That's our third and final episode on UnitedHealth Group's policy solutions to modernize the health system. Thank you for listening, and thank you to all our guests for providing their expertise. To learn more, download a path forward at www.uhg.com/apathforward.