The COVID-19 pandemic exposed systemic inequities in the quality and safety of the patient care experience—including gaps in interpretation services, telemedicine access, and crisis standards of care. Even today, economic, social, and other injustices continue to create barriers to accessing high-quality health care. As organizations prioritize the importance and necessity of embedding equity into quality and safety operations, there are several strategies that organizations can use to improve services, technology, and partnerships that advance health equity.
Leaders discuss how to:
Komal Bajaj, MD, MS-HPEd, Chief Quality Officer, NYC Health + Hospitals/Jacobi/NCB, Professor of Obstetrics & Gynecology
Pothik Chatterjee, Executive Director of Innovation, LifeBridge Health
Kimberly Noel, MD, MPH, Medical Director, 23andMe
Shu Li, PhD, MPH, Chief Operating Officer, Rendr
Human Side of Change - Improving Services, Technology, and Partnerships that Advance Health Equity Improve the Impact of your Organization’s Health Equity Initiatives
Kimberly Noel: I just wanted to start. I'm not here in official business for 23 and May. I'm here on my own accord and the ideas and questions I ask are my own. But I'm very excited to talk about the human side of change. Particularly as it affects the issues of health equity. And I am very excited to be with such a distinguished panel. We've seen particularly in Covid-19, the ugly face of inequity. Whether it be access to interpretive services, the disparities of telehealth, access among many, you know, and those who've been adversely affected by the pandemic. These issues came to the forefront in a very significant way, as well as arise in the overall issues of justice and health equity.
What's interesting now is that the Joint Commission has recently created this notion of health equity as a patient safety issue and addressing that factor. I would love for you to talk about your respective roles. Introduce yourselves. Talk about, what this means, this notion of health equity as a patient safety measure.
Komal Bajaj: Good afternoon everyone. My name is Komal. I'm an OBGYN geneticist. And after I completed training now almost two decades ago, I joined health and hospitals because, frankly, I was annoyed by how genetic services were delivered. And I'm happy to say we're sort of on par now with the rest of our neighbors.
Shortly after I joined the system was investing heavily in simulation. The use of robots, virtual reality, augmented reality, not really as a training tool, but as a quality and safety tool. Really thinking about the systems and structures of care to solve sort of problems at scale.
And then I was very honored about now, four plus years ago, that the system asked me if I would take on a Chief Quality Officer role for a couple of hospitals that are in the Bronx. And so that sort of frames my commentary as I sit in sort of. The intersection of tech quality and value-based care and really the human side of change.
And so, you know, to your, to your comments specifically You know, it's easy for me perhaps to hide behind mission, right? Work for the municipal health system. It's our mission to take care of, to deliver high quality care without exception. But I think for me, the first in, in sort of my journey has been to look at myself, right?
And to really think about sort of my own. Sort of biases that we all, you know, we all have biases and, and, and limitations, and that's been a really remarkable journey and sort of prompting our healthcare teams to sort of do the same. One of the things that I'm sort of really looking forward to as you mentioned you know, there's a lot of important levers.
Not only did the Joint Commission raise health equity to a patient's safety, which is really remarkable, which comes with, you know, sort of demonstration of leadership buy-in allocation of F T E for that work. You know, health entities are now required to identify a disparity and address it. That's really, really important.
There are also a lot of work being done to stratify data to, to look at outcomes based on sort of different groups. In thinking about sort of those important levers that are coming that have come from a regulatory and payment standpoint, as a Chief Quality officer, one of the things that I'm really interested in is how do we ingrain equity into the work that is already being done, right?
Health entities spend a lot of money, right? There's a lot of people who work on quality and safety. in healthcare. And so from integrating the patient voice into hiring for those roles to, you know, when we're picking projects that we wanna work on, right? Why, why are we choosing certain projects, right?
And how can we really deliberately think about raising care for all. One of the things that I've been really, really interested in is as we're putting in tests of change, are the materials available in all the formats and languages that are necessary? And, you know, our work across the health system, we now have 150 sort of system level PI projects that we're completed sort of really thinking about equity at each step.
And it's remarkable that if we didn't apply an equity lens, 23% of those completed PI projects, which means high fives. We, we made awesome change. There have been gains that have been seen, but if we start to look from an equity lens in 23% of those projects, there was a group that was left behind. So an intervention generated disparity.
And so if you don't go looking for it, right, if you don't plan for it and think about upstream in, in sort of the work that you're planning, you're gonna. And so, you know, from performance improvement to event analysis, you know, I'd encourage this entire group, right, whether you're from, you know, sort of building products or implementing products in the digital space, really thinking about, you know, your own sort of practices.
And then from design to implementation to. Tracking impact. How can you ingrain equity at each step?
Kimberly Noel: That's great. Thank you so much.
Shu Li: Good afternoon everyone. I'm Shu Li. I'm the Chief Operating Officer for a medical group in New York City called Render.
So we were formed about three years ago. First from 17 founding practices that mainly serve Chinese American patients in the China towns or in the three boroughs of New York City. And so. Three years later today we are, we actually, last November, we just joined forces with a similarly sized medical group called Excelsior Integrated Medical Group.
So between render and Excelsior, we're now the new render. And we have about 250 providers, P C P focused, multi-specialty. We have 70 plus locations in Manhattan, Queens, Brooklyn, Staten Island. And in 2022, we had more than a million visites from our patients. Our patient population is about 200,000. So at this scale, really what we're doing is thinking about how already embedded in our operating model and also the, I guess, the philosophy.
Our mission is already the consideration for health inequities because our patients are predominantly, as I said earlier, Asian Americans, especially Chinese a. and there are Medicaid and Medicare also predominantly. And they face day-to-day a lot of health barriers, language barriers, literacy barriers, digital literacy barriers you name it.
And so in our journey over the past three years, the goal has really been to think about change management day and day out, like you were saying, and the human side of it, because not only do we serve this patient population with these characteristics and needs and maybe inequities. In fact, most of our staff members also are from the same community. So our staff members and their family members see the same PCPs that work at Render.
So it's the same community that we're working to take care of. And in certain ways working to transform, how do we help people to get organized and coordinated and maybe mobilize in a way that previously in the format of private practices they were unable to accomplish? So how do we get together?
With the same great PCPs or other providers and the same staff members who have long I think relationships and trust with our patient population. How do we enable them to work in a way or in a company that can scale predictably and scale reliably? I, I think that's our challenge. So it is a change journey.
On that journey and then can share more of what we've been doing on the quality side, patient experience side. I would describe us not so much as a tech-driven or digital company. I think it's more rather lower medium tech but always fact-based, hopefully data-driven evidence-based and innovative problem-solving, and system building.
And so a little bit about myself. I came to render first from management consulting. So I was a consultant with McKinsey for a number of years, working mostly with large health systems in the US and in Asia. And that gave me exposure to, I guess, large health systems, strategies operations, organizational topics.
And then I work also in China on a bunch of topic. That try to bridge US and China healthcare spaces. And then before I came to render, I was also leading the Asian business for New York Presbyterian Hospital and doing innovation work there. So I would say that at Render outpatient community care, it's really a different landscape compared to some of the other organizations or, or industry segments I worked for.
But it is tremendously fulfilling and. And challenging. So I look forward to sharing with everyone.
Pothik Chatterjee: Good afternoon, everyone. My name is Pothik Chatterjee and I have about a decade of experience working in health systems on innovation. Most recently, I was the head of innovation for LifeBridge Health in Baltimore, Maryland, where we set up an incubator program that focused on health equity called 1501 Health.
Which is a joint venture between the health system and Care First Blue Cross Blue Shield of Maryland. So it's a pair and provider incubator program that invests in early stage health technology startups that can really make an impact in the health equity space. So through that program, we invest in minority entre.
That are starting up companies in health technology that can really address gaps in care in the Baltimore community and at a national level as well. And I can talk a little bit about some examples of the startups that have been invested in through the 1501 health program. Before LifeBridge Health, I worked at Brigman Women's Hospital in Boston, also in healthcare innovation.
And it's been remarkable for me over the last eight. To see the differences going from Boston to Baltimore, where there's a 20 year life expectancy difference between different zip codes between wealthier and less wealthier neighborhoods in Baltimore. And the, this topic of health equity is near and dear to my heart.
And we saw during the pandemic how black and brown communities were disproportionately affected by the pandemic. In terms of access to care mistrust around vaccines and at LifeBridge Health, we had to take some really creative approaches from 2020 till now that included partnering with Under Armour in Baltimore to create a P P E manufacturing factory during the early days of the crisis when we couldn't get access to masks and isolation gowns for our staff and our administrative employee.
So we set up a mask making factory in one of our hospital buildings in Baltimore and got the textiles at cost from Under Armor and the innovation department trained staff to create 10,000 masks a day and use sewing machines to sew isolation gowns for our staff. Fortunately, the supply chain disruptions improved after a couple of months, but that's one example of creative collaboration between different industries.
Another example that I'm really proud of is a startup called Live Chair Health in Baltimore, Maryland that started as a mobile app for African American men and women to book their barbershop appointment or their salon appointment. And what Andrew Suggs, the founder of Live Chair Health found is that many of these customers had not had a PCP appointment in over one year.
And they were having conversations with their barbers around their healthcare and about personal topics that they weren't having with a provider. So Andrew came to LifeBridge Health and said, can you help us include P C P information in the live chair mobile app, and train our barbers to conduct blood pressure readings in the barbershop itself?
And I love that example because it shows how doctors and nurses and administrators can't always control the lifestyle and healthcare impact that happens outside the four walls of our hospitals or even our primary care network. So we have to go out into the community and partner with startups like life Chair and having the pair component.
In our 1501 health incubator has been really effective and helpful because it's helping the entrepreneurs figure out the crucial reimbursement piece, right? Once they build these mobile apps and AI and predictive analytic platforms that can make an impact in health equity, how are they gonna scale of that technology?
They have to get data to apply and be eligible for reimbursement through codes, and it's been really helpful to. Care first, blue Cross Blue Shield advisors and mentors. Talk directly to the entrepreneurs to help them figure out what's the roadmap, whether it's remote patient monitoring or other areas, and how can they be successful and grow.
So really happy to be here and talk to you with this wonderful panel.
Kimberly Noel: Thank you so much. I think it's very exciting to see the different facets of healthcare. You're all addressing health equity in very different ways, and what I find unique is that the communities in which you serve are also different demographics with different lived experiences.
So I'm going to go around and kind of pick a little bit so that we could learn more from your expertise in how you've addressed these issues. One of the issues that comes to the forefront of late is the rise of maternal child mortality as an ob gyn in the quality role that you are in. Can you speak to how the challenges of health equity have been unique for this population that you serve and how you have mobilized your leadership to those concerns.
Komal Bajaj: Yeah, absolutely. Thanks for that question. And it honestly is a gut punch as an ob gyn and healthcare quality leader to see the, the rates of maternal morbidity and mortality that we are seeing. And I and I, I wanna talk about some programs that we've implemented in a moment, but I did wanna raise this idea of knowing your community.
Yes. Right. And how crucial that is. And, and you, you raised some sort of you know, amazing examples. Thinking about engaging with the community. One thing that I did wanna share though is as we think about our EHRs and platforms and reimbursement and stratifying data, part of that is having that data shared with us.
And one of the journeys that we're on here in New York is people not trusting us with that information, rightfully so, for a lot of different reasons. And so when you flip on a switch that mandates that we ask about certain social factors or sort of identifying factors, all of a sudden you get like a 40% other rate or unknown rate, right?
And so how can you make. Information more meaningful. And so we've been hosting a whole variety of a forward facing campaign and, and thinking about why are we asking this data? And also you know, working with our community and focus groups to be like, tell us what is the best way. You know why?
Here's why we, we, we need this information. Here's why we want this information. You know, how can we partner with you? What will it take? And I think that's a really important first step in thinking about, well, if we're gonna be addressing disparities, we really need to know more about our communities. And they have to be willing to share.
Right? And. We haven't been very trustworthy and we need to be more trustworthy. As a specifically, sorry, go ahead. No,
Kimberly Noel: I, I was gonna push back a little bit in the sense that, you know, the statistics of maternal child morbidity and mortality have been clarified, right? Yes. Like, and so we understand that there are biases within the system that are not quantifiable.
One aspect of leadership is being able to use that data in a meaningful way. Mm-hmm. , and I feel like the healthcare system has moved the needle to the first part. And when it comes down to getting to the true underlying issue, you know, it's, yeah. How are you tackling?
Komal Bajaj: Well, so I, I, I hear you on that, and I will say that it is absolutely true that.
There is an awareness now that that black and brown birthing persons experience these mor morbidity mortality at increase rates. But I will, I will still say that there's a lot to be done to understand more about our communities. And, and so I think for me, 1 thing that we've done across our health system, and so, you know, we care and deliver 18,000.
Babies a year in New York City. The first is sort of having these conversations honestly, about not just on a national level, here's the data, but here's our data based on this facility, this area, this community. Cuz as you mentioned, right, there are micro local environments even within sort of New York City and Baltimore.
And so first is having these honest conversations and you know, sort of giving people the space to talk about it and not be defensive about it. That takes a lot of psychological safety, right? If we don't have the culture where people can tell us, both staff and patients can tell us where their problems are, we won't be able to fix it.
And so there's a lot of sort of work around culture and conversations, and certainly myself as a healthcare leader in OBGYN talking about my own biases and concerns has been a really important way to sort of unlock those conversations.
Kimberly Noel: I'd like to transition a little bit into into your experience, Dr. Li, because you've had quite an extensive work experience working in different Asian communities and now in New York with you know, PanAsian communities. What is it about understanding the community that is so important to health equity, and particularly for the Asian American communities that have suffered increased racism violence during the pandemic and resurgence of covid concerns.
Like how, how are you framing health equity in that context?
Shu Li: So in our community, as you see, I, I still wear a mask to most places I go. So fortunately, most our patients are very, health conscious, I would say. And then also they're very vigilant about COVID. So that helped protect most of our patients during the first year or first few months.
Render was really formed in 2020, and so since then, every year we've had a theme for some kind of transformation projects or unifying projects that we had to do. So 2020 was. Just getting the company together to build hr, finance credentialing it. 2021 was really defined by two projects. One was the first quarter, especially first quarter of the year, the covid vaccination projects, and then later on quality, especially HEDIS related projects.
So for Covid vaccination I think it, it was January 1st, 2021 that our c e o, so Dr. Richard Park, who was also the founder of C D M. Who, who led also the forming and operations of render. So he got a call from New York City that said, you know, do you guys wanna be one of the first community medical groups to give vaccination?
So we said we would. And that just kicked off a frenzy of just getting ready for the vaccine. I, I don't know if you guys are familiar with how community clinics usually operate, but you , if you want to standardize and be really rigorous about the. Of storage and handling. It's actually a lot of work.
So we just had to get mobilized very quickly to say, okay, do we have all the equipment we needed? Do we have all the protocols we needed? How do we actually roll out the protocols the, the SOPs to all our staff members who probably have not really been hearing much about SOPs in the past? And so in that process we also try to open up first access or to this vaccine in our.
We thought, okay, well we don't have a unified or integrated emr. So we, most of our clinics actually use something called MD Land. You may not have heard of it but it is a medical record system that is used actually quite widely in the, in the Asian American, I guess, medical. System community in New York, but outside of New York, you would not see a lot of it.
So we don't have an enterprise version of it. It's not integrated. We cannot easily use it to organize the, the whole render group. So we thought that okay, we would. Be respectful of the reality on the ground and let each clinic, each legacy practice by that we were calling them back then handle their own patient calls, but we said we would also open up a hotline for people to call, but on day one we got like 4,000 calls.
So we had to turn off the hotline on that date. So, so we, we just really had to have a combination. Phone calls emails, web contacting contact points and just walk-ins for people to get access. But in that first year, I think we gave 70,000 doses of Covid vaccine, so protected our community pre pretty well.
And then later on in the year when we could move on to say, what kind of standard workflows can we develop to get better? Preventive screening. We also encountered hurdles. So the two most difficult things or the metrics that we had to tackle were breast cancer screening and colorectal cancer screening.
And I think for reasons that are probably shared in multiple communities are patients find these to be uncomfortable and sometimes painful. And also the access to screening or first imaging is, So they cannot get spots. A mammogram would be scheduled, say, two months from now. So what do we do?
One, we had to rely on the reality that our PCBs were the most trusted health providers and advisors to our patients. And one example of anecdote I would give is when I first joined render, I visited sites and how often see, Bubble tea or pastries on in the break room. Mm-hmm. . So I said, oh, who is so nice to bring these?
They said, patients , like, what patients would bring you this? I've never brought my doctor any coffee. I've, it never crossed my mind even to do so, but such as the relationship in the community between our patients and the physician. So, so our doctors are highly trusted. They will tell the patients why it is important for them to get the mammogram for them to do F O B T or colon.
So that's step one. But then we also had to partner with community imaging centers in each of the boroughs that we operate in and say, can you give us guaranteed slots so that we can schedule our patients? Because we realized that the only way to get the patients to go is that when they leave their P C P visit their office, we could schedule them right there.
If we, if we say, here's the number, go call them and they'll schedule you. No, that, that's lost. That opportunity is lost. So we really had to use low tech waves, shared Excel sheets, basically to coordinate with the imaging centers to say, here are the 20 slots. For that day or those two days that we need us to schedule the patients in.
So with that, actually we accomplished a lot in year one. I think we did so well on Take United Medicare for example, that we got a 4.76 star on that one. So it's really a lot of data because we so I actually have a colleague here, so who leads the data team. So it is the data that we. Pulled together from EMRs and payer sources.
And then it is also the centralized services that we built at render outside of or in addition to our clinics that can do outbound outreach calls. We get the patients into the clinic and then we just make sure that we also have automated, basically patient info sheets we call the pre-visit checklist.
Lists all the care gaps. The patient has suspect conditions to be assessed and what the physicians needed to do, or the MAs needed to do that day. So when the patient's actually come into the office, we hope that everything, every box can be checked for that visit to ensure that the care is actually delivered.
So these are really some of the things we do, but it is really I. I said earlier, fact-based. For evidence-based, it comes from the reality in respect of the patient's, say preferences, all the patient educational materials. For example, we, some of our doctors recorded YouTube videos telling patients how to do a self covid swab or how to do an F O B T use a kit.
And we made sure that there is captioning in Chinese, and we made sure that the spoken language of the tutorial is conducted in the most frequently used. Dialect, our language that our patients prefer or there are different language reasons. And then also whatever education or protocol materials that we sent our staff members.
We are also mindful that some of them may not be super fluent in English, so we made it bilingual as well in Chinese so that they know first of all, they underst. what they needed to do. And two, they have the language that they can communicate to the patients in otherwise people may not know what bladder control is in Chinese, you know?
Yeah. So, yeah,
Kimberly Noel: I think that's great. We, we learned that you know, having the data and being able to identify a gap of, of care is, is one aspect. Partnering with the right clinicians, understanding the role of that clinician in the community, and then empowering access through using all these tools with something else.
And then now you have the opportunity to help perhaps people from those communities or leaders who get the problem to make new solutions, to address problems. A lot of the challenges are shared amongst the healthcare, other healthcare systems on improving cancer screening rates and, and literacy and, and translation.
But what are you seeing in terms of the innovation? of solutions that are addressing health equity that are not only about enhancing access to the way the care is given now, but kind of pushing the needle as to how care can be delivered differently in a health equitable way.
Pothik Chatterjee: Yeah, that's a great question.
I also just wanted to touch on the maternal mortality question that you asked earlier about concrete ways that health systems and innovation groups are trying to tackle that issue. So at LifeBridge Health we invested in a startup called Baby Life Advice out of California. That's an online telemedicine platform that offers coaching and classes to new mothers, new couples.
And we found that to be really helpful in extending our staffing capabilities because they can offer around the clock online help for. families or new parents, and we found that that was helpful in gathering more data and that 91%. of the mothers that participated were from the black community, and we tripled the amount of students in those classes compared to the vendor that we had before because baby Live advice was able to offer a better digital platform, more user friendly.
So that was a, a really great example of being able to partner with a technology from the market to try to address the maternal and our leadership from our OB department really championed the use of this platform as well in terms of what we are seeing in the innovation space about really innovative approaches that go beyond access.
I would say one area that comes to mind is leveraging value-based care contracts to really incentivize health systems and pairs to address gaps in. , particularly around chronic conditions. So an example I'll provide is a startup from Washington DC called Rise Health. R Y S E that focuses on type two diabetes patients, and they use a hybrid approach.
So the patient will start off with an in-person visit with their PCP and then with an endocrinologist, but after that they will be enrolled in a mobile app that coaches them around their diet, nutrition, exercise, medication. and that hybrid approach has been able to, they've been able to perform an improvement in reduction in clinical and A1C levels for those type two diabetic patients.
So now the work that we're doing with Rise Health and 1501 Health is figuring out how do we pay for the use of this new online coaching solution? because we can't just keep adding these bells and whistles into the employee health plan. For example, LifeBridge Health has 13,000 employees. If we wanted to authorize health to our employee patient population, we have to figure out a way to fund this.
So what we're exploring is looking at our value-based care. In Maryland and seeing that if Rise Health is able to meet some of our performance targets in our contracts, then it's a win-win because then we get savings and then we can use that to fund the, the use of this technology and this innovation.
Another example of innovation. that I think is really exciting is around the use of virtual reality. And there's a company called Slowly that has come up with a VR headset that creates a relaxing, calming environment for patients with anxiety and also patients that have opioid dependence. to help them reduce that dependence.
So the VR headset will track the biometrics of the patient or the customer and the environment that they view will change depending on the heart rate and the other metrics picked up by the sensors. I think that these types of solutions can have an impact on health equity depending on what patient populations they focus.
and the founder of this company, Celine Tian, is from the Asian American community in California. So I think as leaders involved in health systems or incubators, it's really important to invest in founders and entrepreneurs that have that health equity mindset as they're designing the solutions.
Kimberly Noel: I think that's well said and I, I think.
I'm gonna push a little bit back on that aspect as well, because there are health systems. You know, we have seen an interesting moment in our economy, right? The health systems have been completely burdened, almost to the point of collapse, financially addressing covid needs and then the rise of big tech.
And now, potentially you know, we'll see what happens with tech. A lot of the solutions that are built in tech are solutions to problems that we don. , but they sound really good. And most doctors would probably wanna try some of these things. But the question is, if in a value-based system you're having to share those funds with the core functionalities of the health, what, what is currently being operated?
It's not new funds, it's better management of those funds. So how do we one is perhaps representation of the founders who understand the problem better, but from your perspectives, how are we addressing the underlying causes of health equity and not just creating solutions, you know, maybe data driven models or new task committees, or whatever it may be, but things that aren't getting to the heart of equity.
Komal Bajaj: I really appreciate that question. , this is blinky. And I think that there's a, a few sort of, comments, comments that I'll make. the first is be willing to pilot small in general, right? It, it's, it's when you hear these sort of jazzy solutions, you're like, and we're gonna implement it everywhere.
And so, you know, be willing to be strategic on. You know, sort of, partnering with a specific either population or type of clinic that might be more likely to adopt this, get that feedback and then iterate accordingly. I think the other thing that as healthcare we need to do better on is talk about failures.
Yeah, right. Because you know, for all of the successful examples that we can share, there's so many more that failed and oftentimes understanding why they failed and sort of some of the both, you know, sort of structural and, and process reasons why they failed, I think are really important to discuss.
And so, we've tried to create spaces for that locally within our sort of health system, but it's definitely something we need to do sort of on a larger.
Kimberly Noel: There is something unique that I, I wanted to resurface from what you had said before that I thought was pretty profound, which was that a lot of the interventions of your system, you were able to identify populations left behind.
And I think that's an example of a type of leadership in which an equity lens is being manifested into an outcome. Mm-hmm. , can you guys comment as well in terms of how do we move past, prefix solution based approaches to health equity and really get to the underlying.
Shu Li: Maybe I'll take a stab at that.
First, not only health equity, I think in general problem statement, we tend to have the issue when people want to accomplish great things of, of stating or identifying problems that are not real problems, and also trusting in toolkits or solutions. That don't apply outside of this original use case. And so I think at render, at least that's what we try to do.
Cuz I shared with you earlier how the majority of our patients are Medicaid and Medicare. And so we are moving toward a more risk-based, value-based care model. And in that case, everything we do would have to have a proven. Proposition, value proposition, it has to address something that is big. We could have a list of a lot of things that are worth doing, but there must be five that are more worth doing than others.
And then the, the next thing is, what do we do to actually solve that? An example I can give, which might be. A rather complex one is, you know, how caps has become an increasingly important piece of overall quality and also payment for Medicare. And so with so many Medicare patients, we are also challenged to say, how do we in improve continuously access to care?
Shorten wait time. In increase or improve coordination of care, improve provider patient communication, et cetera. In fact, we do extremely well on most of these things for the reasons that I explained earlier. But wait time is really something that we cannot tackle in the high volume.
Environment that we face, sometimes a PCP a day would see 50, 60, or 70 patients. And we also allow a lot of walk-ins because again, that is considering the patient needs in our community. One patients may not have the habit of making appointments two. They, they would want to come when they have an acute episode of something, right?
And that is usually beyond scheduling. And then three, they may be working in jobs that don't allow them to schedule ahead of time. They don't know when they'll be available. So we do, our offices are usually open seven days a week, nine to five, for example. That takes care of a lot of the urgent care needs so our patients don't have to go to urgent care or uh, ERs or going to the hospital. So that's what we do. But then the flip side of that is the wait time. Okay. So, so I have been working with my colleagues to tackle wait time forever. How do we do it? Oh, okay. Well, if the daily volume for a PCP can be lower than 40, then maybe they have a better chance of keeping wait time under 15 minutes.
But then no, we can't control that and how do we do it? And so, so, so, Just as an example to that, I'm just thinking is wait time a real issue? Right? I, I know CMS says it is. A C Q A would say it is, and to patients, they would also reflect in their comments in our patient surveys that they don't like the wait time.
But at the same time, if the cost of that, or maybe if the flip side of that is access or if the flip side of that is patients complain about wait time all the time, but then they still remain tremendously loyal to the same pcp thinking this is the best person to take care of me. Would that actually justify the wait time?
I'm not saying it's justifiable, obviously, but I'm just saying that, which is a bigger issue here. So, so I think we are faced with this, this choice very often.
Kimberly Noel: I think it's interesting implying, I'm not sure if this is exactly correct, but, you know, feel free to correct me that there might be differences in different communities.
what the perceived priority is, and that access may be more important than wait time in some communities, and we have to be able to do that. Okay. Last and then I'll open up for questions. We have five minutes. I'm sure you've seen a lot of pitches, some good, some bad. What are the, the good ones that get to the core of health equity issue?
Pothik Chatterjee: Yeah. To answer your question about how to, how we get to those structural causes of health equity and improving. Outcomes. I think that innovation doesn't always have to involve complicated technology. It can also involve just a creative redesign of the approach. And one example that I can think of from the pandemic is where we started a mobile clinic program at LifeBridge Health to go out to apartment buildings in West Baltimore and deliver covid tests in the apartments or the common areas of different building.
because those residents may have had transportation barriers or mental health issues or addiction issues that made it very challenging that for them to do. Go to the drive through testing areas that we set up near our hospitals at LifeBridge Health, and that proved to be so popular, that mobile clinic approach with a nurse and a social worker armed with iPads that could do telemedicine if needed with another.
Now we continued that even in other use cases like providing pediatric vaccines for family members that had been delaying pediatric vaccines for the first year or so out of fear of going into a medical setting. So I'd like to mention that example as a low technology approach. That really got to the structural challenges of why these patients were fearful of getting the testing or and later the vaccines as well.
The second thing is, I completely agree with Comal that doing small pilots and gathering data in specific service lines with specific patients can be really powerful if you are able to publish that data and show that the use of digital tools led to a re reduction in readmissions in the ed. That can then have an impact on the wait times that you discussed.
That's really powerful as well. So it's about figuring out what the clinical pain points are and then going out to the market to say, okay, who's the best technology provider and how do we set up a six month to year long pilot? And then you have to publish and communicate the results. So it's not only staying within your health.
but sharing that with the rest of the country as well.
I like literally meeting the patient where they are physically, but I would love to continue the conversation. Thank you so much.