Dave A. Chokshi, MD, MSc, FACP
Vice President and Chief Population Health Officer, NYC Health + Hospitals
“Health care is not enough,” declares Dave Chokshi. “We have to address social determinants alongside health care.”
Proactive care prevents avoidable suffering. That’s the simple credo Dr. Chokshi uses to guide his team at NYC Health + Hospitals. It sounds like a simple approach, but NYC Health + Hospitals is the nation’s largest public health system. Given the number of patients and the complexities of their care, less confident health care leaders might have taken a step back.
Not Dr. Chokshi. This former Rhodes Scholar has served in many public health and medical roles to prepare. He was a White House Fellow at the Department of Veterans Affairs. President Obama appointed him to the Advisory Group on Prevention, Health Promotion, and Integrative Public Health. Tough jobs in their own right, but nowhere near as complex and challenging as what Chokshi faces now.
What’s in a name? For Alan Cohn, his company’s name is its goal. It aims to provide fully comprehensive, patient-centered primary care for every patient at its five health centers in Philadelphia, Baltimore and Atlanta.
But it’s not just what AbsoluteCARE offers its patients. It’s also who those patients are. The centers’ patients are the sickest of the sick. Many are also homeless. Some are not sure where they will get their next meal. So, they are most likely to avoid or delay regular care. They are most likely to visit the ER for care of chronic illnesses that could be managed better in primary care.
“Our patient-centered model has been life changing for so many people,” Cohn proudly boasts. Still in its youth, AbsoluteCARE’s approach has remarkably improved patients access to care and reduced unnecessary hospital visits. Look at these numbers in a Baltimore center: Six months after enrollment, patient hospital admissions dropped 42%. ER visits fell 39%
The Absolute secret? Each center combines primary care, prevention and wellness, nutritional counseling, social and behavioral programs, a pharmacy, x-ray and lab services, all under one roof. AbsoluteCARE also limits each doctor (and support team) to 300 patients (instead of the usual 1,000+ that crowd the appointment book of a typical doctor). That means more time and attention devoted to meeting patient needs, even beyond traditional care. We’d say that’s quality improvement. Absolutely.
Joia Adele Crear-Perry, MD, FACOG
Founder and President, National Birth Equity Collaborative
Black mamas matter. Joia Crear-Perry, MD, repeats that wherever she can, whenever she can, to whoever will listen. She especially presses policymakers with her prescription for improving maternal health. (Hint: It includes quality measurement.) “Ultimately, what Black women in the U.S. need is accountability,” she says. “We need to know that our lives are valued.”
But Black American women die within a year of giving birth at three to four times the rate of White women. Add to that glaring disparity that we are the only developed country on the planet where maternal mortality rates are on the rise.
Dr. Crear-Perry is founder and president of the National Birth Equity Collaborative. Her numerous honors include the Congressional Black Caucus Healthcare Hero’s award. She sums up her own story like this: “Her love is her family; health equity is her passion; maternal and child health are her callings.”
Shreya Kangovi, MD, MSHP
Associate Professor of Medicine, Hospital of the University of Pennsylvania & Leading Designer of IMPaCT
The great divide: There’s often one between high-quality health care and at-risk communities. Dr. Shreya Kangovi knows just how to close that gap, and she knows who might be right for the job. One of your neighbors, perhaps.
Dr. Kangovi strongly prescribes community health workers—trusted laypeople from patients’ community—to close the care gap. She led the design team for IMPaCT, a scalable model for community health worker programs that’s spreading across the country. Health care organizations in 15 states have adopted her model. Among its benefits are that it improves access to care and reduces hospital admissions.
She now leads the Penn Center for Community Health Workers. It aims to smooth access to high-quality care, and you might guess how it works to do that: It conducts research and develops best practices for community health workers. Dr. Kangovi’s remedy, right next door.
Creator, Do-It-Yourself Pancreas System
“The diabetes disruptor”—that’s a pretty good description for Dana Lewis. As a person with diabetes, Dana had a glucose monitor to gauge her blood sugar and another gadget to administer insulin. Both required her time and attention. At best, this could be inconvenient, but for Lewis, it was unbearable.
So she designed an open source artificial pancreas system, or as she calls it, OpenAPS. She reprogrammed her separate tools to work together—automatically—with very little time and attention on her part.
But Lewis isn’t finished. She wanted to share her hack. She started a movement. That movement, #OpenAPS, pushes to make the hack available to everyone. She also leads the online discussion about it using the hashtag #hcsm (healthcare communications and social media). Posters use the tag to elevate the role of everyday people—patients—in the care conversation. Another hashtag, #WeAreNotWaiting, is a battle flag encouraging patients to be proactive, to hack health care when the system falls short. Diabetes disruptor? You bet. And a lot more.
Robert Pearl, MD
Clinical Professor, Plastic Surgery, Stanford University School of Medicine
“The biggest problem in American health care is us.” That’s how Dr. Robert Pearl, the longtime head of Kaiser Permanente, sums it up. “As patients, we wrongly assume the best care is dependent mainly on the newest medications, the most complex treatments, and the smartest doctors.” But why not build a better system, instead? And why not build it around the concept of prevention?
Dr. Pearl knows the current system’s failures all too well, professionally and personally: He lost his father from what he says was poor patient-clinician communication and subpar treatment plans. So, it should be no surprise he makes a passionate plea for shaking it all up in his best-selling book, Mistreated. In it, he explains why flawed perceptions are so common and how changes in structure, technology, financing and leadership could significantly lift quality outcomes.
In his latest incarnation as a Stanford professor, Pearl hopes to inspire students who will turn it all around. His pupils… and then payers, providers… and maybe us.
Travis N. Rieder, PhD
Bioethicist & Author of In Pain
The motorcycle accident was serious. Dr. Travis Rieder needed six surgeries to recover from it. But it was the opioids, prescribed for pain, that threatened his life and livelihood. The Johns Hopkins bioethics professor became dependent.
When he stopped taking the meds, the unexpected withdrawal symptoms proved almost unbearable, so much so that Rieder’s own doctors advised him to go back on the pills and try to quit later. He rejected that advice, went cold turkey and weathered the withdrawal symptoms. Now, his experience gives him unique insight as a health care leader who found himself addicted.
Some doctors see treating pain as a balance. Others might call it a tightrope: Do I prescribe medication and risk the patient’s addiction, or withhold and let the patient suffer?
Dr. Rieder would say that’s overly simplified. His new book, In Pain, explores the opioid epidemic, why it’s so pervasive and how some doctors make very big mistakes. He also travels the country to expose what he calls the “dark secrets” of pain management and the health care system. It brings new meaning to the phrase, “What doesn’t kill you…”