Healthcare Rethink - Episode 27
As health disparities come under the spotlight, the urgency to achieve health equity in the healthcare sector...
Brian Urban: [00:00:22]
Welcome to the Healthcare Rethink. I'm your host, Brian Urban, and I am extremely excited to have, I'll say, my mentor, long term friend and leader in the broader space of health, John Lovelace. Today we're going to be discussing health. As a journey, not just a finish line. So here we go. John, thanks for being the first guests on this podcast.
John Lovelace: [00:00:56]
A pleasure to be with you.
Brian Urban: [00:00:58]
So we've known each other for quite a while. And to all of our listeners out there wanting to get them to know you a little bit more as well, I thought we'd start with kind of a fun fact here. If you Google John Lovelace, if you Google him and you find the right guy, the first thing that you're going to notice is a bow tie. Many, many bow ties. I think it's a marker or identifier of who you are. And I've always thought it's really interesting, aside from all the amazing things you've done. Tell me about the bow tie. Why has it been with you for such a long time?
John Lovelace: [00:01:35]
You know, honestly, I've never Googled myself. I never thought about it. Yeah. I get my familiar thing, I suppose. My grandfather traumatized. My father wore bow ties sometimes. I've always wanted a little bit when I last probably 20 years or so, I just gave up on long ties. You. You don't just feel soup on your bow tie. It's very hard to do, actually.
Brian Urban: [00:01:59]
I love it. I wanted to know a little bit about that personally, too. So that was a bit of a bonus for me. But. Well, John, you are the president for UPMC for you. The Medicaid and the Medicare arm. And you've you've been there for a while. So how long have you been not only in your position but in the culture and in the being of UPMC, the health plan?
John Lovelace: [00:02:24]
I've been at UPMC since 1996, so this is 26 years, I think my 25th anniversary last year. Upmc for you is one of the many arms of licensed arms of UPMC Health Plan. It's a 500 1c3 nonprofit corporation. It actually we don't do Medicare except for snip. So we have a medicaid product called Health Choices. We have a MLS's product called Community Health Choices, which are both state contracts, and we have a dual eligible SNIP plan for Medicare Advantage. So the three lines of business in UPMC for you, it's one of the nine license insurance companies that are part of UPMC.
Brian Urban: [00:03:03]
Wow. So that that gives, I think, our our audience a good depiction of where you sit and where you land and what you've been doing for such a long time. So I think at this point in your life, you're really a native Pittsburgher, I would say. But that's not necessarily where your academic career and some of your early parts of your career started. So what what took you from New York Buffalo into into Pittsburgh and with UPMC?
John Lovelace: [00:03:34]
The short answer Well, of course, if you're if you're from Pittsburgh, you're never a native unless you were born here. So I will never be a native. But I have been here for 50 years, so it seems like pretty native enough. I came from Buffalo because my wife got a job offer at Pitt actually, and it was she had finished her PhD at the University of Buffalo and it was a good job offer and we had a baby, so it didn't really matter to the baby where we lived and it seemed a good time to move. I was I went to college near near Pittsburgh and Washington, PA, which is not too far, about an hour or a half hour south of here. So I knew something of the of the culture. It's not very far. It's about 200 miles to Buffalo. So it's not not a stretch to get here. And it's a very familiar climate. So I then I worked at mental health. Actually, the first half of my career is all in public mental health. So I'd been in I've been running a mental health center out of Buffalo and I got a job at a mental health center in Pittsburgh. We commuted for nine months from January of 1980 till August 1st. She came in January and had a room and I had the house in the baby till May, and then we sold the house. And the rule was whoever had the whoever had the house had the baby.
Brian Urban: [00:04:45]
That's a good.
John Lovelace: [00:04:45]
Rule. So when we sold the house, I moved in with a friend and the baby came out of her mother. And then I in August, I started my new started my new job in September, actually, right after Labor Day.
Brian Urban: [00:04:58]
Wow. So that's the journey that's taking you here and here. You've been over 50 years, so it's definitely had an impact on who you are and definitely the region for what you do. So I wanted to really get into the social impact center and I think a lot of crossroads now for the culture of the region are really being highlighted in terms of how people need to be helped and how we need to work together. So I really admire the social impact center, so I wanted to get deeper into that. So can you help define what that is and what you're doing right now?
John Lovelace: [00:05:36]
For the short story. This is the founder of the Center for Social Impact in December of 2020. So before the before the pandemic, 19. So it's two and a half years old. It was really initially an effort to sort of pull together our collective thoughts about how we impact social factors that affect health. Upmc is a fairly big charitable arm of money we fund with nonprofits. We do tax credit investing, we have business arrangements with nonprofits, and we thought it'd be useful to try to organize this into a more coherent framework around what we're doing, other than a lot of one offs. The height of that is you've probably heard this before from other people, but there are various versions of this story. But basically it is if 80% of the outcomes of health care are not related to the health care yet, it's related to everything else your lifestyle, your lifestyle choices, your genetics, your environment, the decisions you make, the is not not the health care itself. So as we think about how to influence health care and certainly health care is you can't be healthy without it probably. But the opportunity to think about how how do you impact? How does housing impact health care? How does food security impact health care? How does how does having enough money to live? How does poverty impact health care? Those are much bigger questions that if you don't think about them in an organized way, you are just sort of spending money on health care without really getting much of as much of an outcome as you could be getting.
John Lovelace: [00:07:08]
So for us, it's a matter of trying to rethink how we broaden our scope with understanding. We can't solve the problems of the world, we can't house. Everybody needs to be housed, but we have limitations on how much money we have and how we can spend it. But we can really develop some skills, I think, at intersecting with other other sources of funding, writing, creating opportunities to create a more robust sort of synergistic sense where the whole is greater than the sum of the parts. And that's really our approach to social investing. So we have a really nice it was two people when it started the center of social impact, and we had a team meeting this morning. There were, I think, 12 people on the call who are either directly or indirectly affiliated with the center and just some, I think, remarkable work in two and a half years.
Brian Urban: [00:07:55]
That's amazing to hear the growth to internally. So when you talk about the sum and all the parts that you're pulling together in terms of maybe community players, community based organizations and other strategic partnerships, has that been core to the development that you've seen over the last two years?
John Lovelace: [00:08:17]
I think it is. There are many things we can't we can't we're not well positioned to do many things like interact with people in their homes. We have we have many health workers. We have outreach workers. The we have a large you know, Medicaid is a big program in Pennsylvania as it is, affects lots and lots of people. But we don't have all the tools that we need to do this. And people have relationships with all kinds of external people outside themselves, either churches, their religious, their synagogues, their mosques, their job, their grocery store, their cleaners, the babysitters, all kinds of people they have relationships with. And they have different qualities to them. So for us, it's really trying to build new relations with the people we don't have relationships with. We think about how could you engage with someone with whom who people do trust? They already have a relationship rather than trying to build another one. I think back to my it's true in health care as well, but certainly in mental health case management or care coordination or care management, lots of terms for it is a hallmark of trying to help people navigate systems. And it's imagine the frustration of knowing people of seven or eight or nine care managers in their lives for every social service they have, they have a care manager, and that each one is trying to do a great job.
John Lovelace: [00:09:33]
It's not that people aren't well intended, but it results in having eight people to talk to when you need something. And at which point, what's the what's the one's going to help you with this? So we're trying to think of how to make this more human, if you will, and more impactful than not, have eight care managers or at least have the care managers know who each other are so they can coordinate their efforts together. And that's been a hallmark of this. Our success is in building relationships, is the there are a lot of nonprofits that are we're a very large organ, we're a nonprofit, we're a very large organization. Many organizations that do good work are much, much smaller than we are, ranging from like $1,000,000 a year to 20 or 100. But that's still much smaller than we are in terms of the Medicaid business. The be able to engage is mutually beneficial. Actually. It teaches us things about people that we don't know. And it provides resources to smaller nonprofits who know different things than we do and have different, again, have different relationships. And rather than starting over again, we can really build on what they generally build on what already exists.
Brian Urban: [00:10:41]
I love this subject. We could probably talk another hour and a half about social drivers, social determinants of health, all the variable forces impacting someone's life. So I just love to hear you kind of say that you're casting out this huge web of support, a safety net, and what makes up that safety net to help not only identify people in need but actually connect services. So I'm just thrilled that this is still so young, only 20, 20, but it's plenty of room to grow, which is really cool. So I want to talk about data. So from a health care data perspective, that's where we are within Thrive. Data is definitely a telling direction, evidence based direction of how we make decisions in health care, a lot of things. So in terms of data, are you seeing any promising results that's leading you into future development with the social impact center, or is data a big driver for you in all things that you do for identifying people in need and building out other partnerships?
John Lovelace: [00:11:45]
What I did is a big part of what we do all the time. We have a large analytics team that we have teams of analytics, people in lines of business as well as centrally. It helps us to make more informed decisions about what what we need to do for people and how it can be helpful. The we've been very lucky in Allegheny County, which where Pittsburgh is in Pennsylvania, has a very robust data warehouse that Human service department runs. And we've been able to develop a data sharing agreement, a HIPAA compliant data sharing agreement with the county data Human service department that allows us to know much more about our members than we would normally know. We know their health status. We know what kind of claims we pay. We know kind of drugs. People take the legal ones anyway. We know what you know when we provide housing, people we know kind of housing, but we don't know things like who's in jail and who. And I don't mean we go fishing around looking for things. It just we find common areas of interest. Who's using which services, who's who's truant from school, who is on probation, who's on parole? Things that help you make smarter health care conversations with with consumers around what's important to them and how to help them be more healthy.
John Lovelace: [00:13:00]
We started this, our first initiative that you probably remember this from probably 14, 15, 14 years ago is a supported housing program for people who are homeless and had a lot of unplanned health care spending about really the care management people here said there are people who are really unable to impact their health care spending. And one of the things those people had in common was they didn't have anywhere to live. They might be under a bridge, they might be at a shelter, they might be couch surfing. They didn't have a permanent, decent place to have a normal place to live. We approached the local folks who run the HUD programs and proposed to do a joint venture of funding care management with housing subsidies to what used to be called Shelter Plus Care and HUD program. And it was not only a successful my my favorite tagline about this program is going on for all this time. Actually, it's one of the few things I've ever done that did just what I thought it was going to do and the way I thought I was going to because I was going to do it. I think most of the things are, you know, you start to do something as half of it's right and half of it's wrong and the half is wrong.
John Lovelace: [00:14:08]
You can fix it and you get half of that right and eventually it comes out to a workable place. And this this started off really to be what it's been all along. It's been very successful. The people from was intended, that is people that unstable housing who have who are disabled, who have a a history of a long, fairly long history of unavailable health care, unavailable meaning repeated air visits, repeated hospital admissions, detoxes crisis services, things that you if things are going well, you wouldn't need them more than once, once or twice. You don't need every month. The and this is this has saved consistently it saved us over the years. Enough money per person that we can afford to pay for the care management and care supports for these people. Our savings in health care are offset by spending on drugs, but that's a good thing because people take. They all have chronic conditions. All these people have at least one disabling condition. Most people have more than one. They're mostly forties and fifties, sixties. And their terms, their age, Everybody has a substance use problem or a mental health problem or both. We didn't set out to find those things, but that's what we've found the as well as our medical conditions.
John Lovelace: [00:15:18]
And much like the 80% think I started with if you could address their diabetes or their congestive heart failure. But if you don't take care of their nutrition, then they don't have a place to live. It doesn't really it doesn't really make much impact. You can't go to the doctor and take your medicine. If you're living under a bridge, you can. But it's very difficult when you're wondering where your next meal is coming from or where you're going to put your head. So this has been continued access for for a number of years. It's we've grown it through branch and other kinds of supportive housing with by partnering. We don't Medicaid programs aren't allowed to spend money on housing and rental assistance. There are some things we can pay for, but rental assistance is one of them. But we've made very successful partnerships with housing authorities who have Section eight vouchers for size, people who are willing to partner with us around high need members. And it's Deborah's advantage. They find they find a house and a decent place to live and they get their health care stabilized. And it's been a really great story, I have to say.
Brian Urban: [00:16:19]
And with that, we conclude our very first episode of this podcast, The Healthcare Rethink. A special thank you goes out to president of UPMC for you, John Lovelace. Also a special thank you goes out to UPMC Health Plan. And for all of our listeners out there, if you want to join our show or simply see insights in great excerpts from all of our conversations, please go to finthrive.com. My name is Brian Urban. I have been your host and I'm excited to continue this journey with you all.
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