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      Invest in Health Equity or Healthcare Will Fail

      Healthcare Rethink - Episode 15

      Dr. Omar Lateef, President and CEO at Rush University Medical Center, Dr. David Ansell, Senior VP for Community Health Equity at Rush University Medical Center, and Dr. David Nash, Founding Dean Emeritus, Jefferson College of Population Health, discuss how health equity is becoming a focus for effective healthcare delivery and what investments Rush is making in education, research, workforce development, and community-based clinical practice.

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      Healthcare Rethink: Hear From Leading Changemakers

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      Brian Urban (00:21):
      Yes, this is the Healthcare Rethink Podcast. I am your host, Brian Urban, and today we have our very first, I'll say panel of experts, joining the show, all medical doctors. This is a first time for our little program, so this is quite a treat for our audience.

      Let me introduce you right off the bat to Dr. Omar Lateef, CEO of Rush Medical Center in Chicago, and Dr. David Ansell, who, man, you've done so much there, you're now leading all of community health initiatives and we're going to get into your work deeper. And of course, Dr. David Nash, we've had you on the show before. So glad we were able to wrangle you back on another episode here. So welcome to the show, gentlemen. Thank you for giving me some time today.

      Dr. Omar Lateef (01:09):
      Great to be here.

      Dr. David Ansell (01:10):
      Thank you.

      Dr. David Nash (01:11):

      Brian Urban (01:13):
      Excellent. So with a conversation today, having all of you at the table, I really wanted to get into how health equity is becoming the new center of healthcare delivery across the US. And for many leaders that's true, but for those that haven't yet caught up to designing that type of model of care, they're falling behind a little bit.

      But you all in Rush Medical Center, Dr. Ansell, Dr. Lateef, you have led some great initiatives and I wanted to first get into a little bit about who you are and then we're going to talk about your Health Equity Institute with the BMO group, which is just so exciting. Want to get the updates and where you're going there. And Dr. Nash, want to get your perspective on how the landscape has even changed just in the last six months as well.

      But hey, let's get to know Dr. Lateef and Dr. Ansell a little bit more. So Omar, you've been serving here for more than a year as the CEO of Rush Medical Center, previously as president. You touched a lot of things. You're a young guy. Can you tell us a little bit about yourself and how you've come to be the leader, CEO of Rush Medical Center?

      Dr. Omar Lateef (02:22):
      Sure. I'm a pulmonary critical care physician by training. I grew up here at Rush. I came here to do my fellowship in 2002. I had a phenomenal experience with my mentor, a gentleman named Dr. David Ansell was the Chief Medical Officer. Our field of interest and our alignment was under quality and how to deliver the best care that you could possibly provide. And we work closely together and that care is expanded to, you can't provide great quality care unless you've provided to all people. So our work, Rush has been really built around taking care of larger populations and fighting against injustice in healthcare. And so I did that under Dr. Ansell's guidance and counsel. And in that experience of being a chief medical officer, and then after being chief medical officer, I became the president and CEO of the Medical Center, Rush University Medical Center.

      And more recently, in July, became the CEO of the Rush System for Health, where I'm currently serving now. So it's an honor to be here. I'll turn it over to you, Dr. Ansell.

      Dr. David Ansell (03:24):
      Yeah, it's been an evolution. Of course, I came to Rush back in 2005 as the inaugural Chief Medical Officer at a time when there were no quality metrics. Quality was the important, but there weren't measurements and introduced the idea if you wanted to improve quality, you needed to actually measure it and brought some of the first measurements to the board. And so through that quality improvement lens, of course, then you moved into the safety movement, the idea that you could provide top quality and yet people would be harmed in your medical center in many way, the safety movement, the zero harm movement, is very much aligned with, I think this... It's an old idea that's newly risen, not to supersede quality and safety, but to be important as the equity movement. No inequities.

      So the quality, safety, inequity movements are actually co-linear movements, all of them based on the premise that if you want to improve something, you have to measure it and then you got to focus on what's wrong to make it better. So that's been kind of my evolution and Omar's evolution. We co-evolved together. I'm just a lot older than he is. I'm now devolving, but he's continuing to evolve.

      Brian Urban (04:55):
      I love the torch gets passed on Obi-Wan Kenobi style. I love that. And Dr. Nash, father of population health, need no intro here, but wanted to get an update on you. And actually, congratulations, you've got an extended family. Your daughter recently had some nuptials overseas, actually.

      Dr. David Nash (05:16):
      Overseas, yes, yes. So first of all, great to be the program again and wonderful with my colleagues, Omar Lateef and David Ansell. So just very quickly, we're back from Mumbai, India where I met 150 members of our extended family, and it was really fantastic. It's my third time in India, second time in Mumbai. So outstanding opportunity, yes, it was.

      Brian Urban (05:44):
      I expected those. I didn't get any. So we'll connect on those.

      Dr. David Nash (05:49):
      Indeed, indeed. But great to have David Ansell, and Omar and I are both in the David Ansell fan club. I think it's important for your listeners, of course, David Ansell's, the 2017 book, The Death Gap, featuring what happens on our great city of Chicago, could be a roadmap for where we are in the post COVID world. Meaning all of a sudden it seems to folks like Ansell and Nash that the world is finally understanding how important it is to have equitable access to care, access to procedures, access to primary care doctors, access to safe water, food, all the rest. And the amazing impact that all of these factors have on health.

      And the work being done at Rush and their recent New England Journal of Medicine article, the one of many, many about West Side United, I think is reigniting a national movement to pay attention to these issues. So I'm just basking in there reflected glory about the work that they've done. And it sets a truly a model for what other academic medical centers in our opinion have to do moving forward.

      Brian Urban (07:14):
      And I could not [inaudible 00:07:16] basking in glory as well be because I think Dr. Lateef and Dr. Ansell, you really applied zip code analysis, and you can take that a few steps further. And what you'd mentioned Dr. Nash, in terms of the death gap, the life expectancy gap, and focusing on the difference between Chicago neighborhoods and specifically West Chicago, that west side has more than half a million residents in 10 neighborhoods, it's greater than the size of Atlanta. And when you think about that and the change in life expectancy being around 70 versus 82, if you go east on the blue line in Chicago, that's incredible. And it's also tragic, and it's actually embarrassing in our country that this has happened. But you all have stepped forward and you've done the research. There's no more evidence that needs to be put forth. It's a fact here.

      And I want to get into the Rush BMO Institute for Health Equity. Dr. Lateef, you announced this in May of 21, so it's been a couple years. It was, I believe, about a $10 million investment into four big pillars that we're going to get into, which is education, workforce development, community-based clinical practice, and health equity research. I want to get an idea of what it was back in 2021 to have this partnership and to launch that. And I want to get some updates too, but can you take me back to May of '21, Dr. Lateef and Dr. Ansell, and tell me how much that meant and how you guys started to kick that off for?

      Dr. Omar Lateef (08:53):
      Yeah, so I'd love to get started on this because I think it's such an important subject. And you alluded to some of it, and then I'll turn over the BMO Institute specifics to Dr. Ansell. We spend a lot of time in this country proving data and making academic arguments. And you can get pretty famous just writing articles over and over again about inequity. And you can show it and you could take your turns picking different diseases in different cities and then even get funded. Very famous institutions are funding large projects to show or to answer the question is, will you get a different outcome if you have a different color? I think [inaudible 00:09:29], and as a world, we have to stop doing those studies and transition that effort into solving the problem.

      That was a conversation that was led here at Rush in not just the BMO Institute, but in our overarching pillars for our hospital. We put equity as one of the pillars of our overarching strategic plan. How we solve that has to shift from words to action. Dr. Ansell led the team that created actionable plans, dashboards of which you could follow in different environments to create the ability to change things like the death gap. And so like anything else in science, you have to call out a problem. But we spent too much time, I believe as a field, continuing to call out the problem and far less time trying to solve it. So what West Side United was, what the BMO Institute are, are shifting away from actions into these are salvageable plans with spreadsheets that show us what's working, what's not working, where we can adjust as we go on. So David, why don't you talk to the specifics of BMO.

      Dr. David Ansell (10:37):
      Yeah. We began to put this strategy together back in 2013, 2014. Launched it in 2016. Then decided that if we were going to have an impact, so think about it, quality meant measuring things within your four walls. Safety meant measuring things within your four walls. We got pretty good about it and then Omar took over and we got even better at it. And Rush is top ranked hospital world in terms of quality, in terms of safety. Vizient ranked one or two in most years and US News as a honor roll hospital. So if you think about that, we could keep doing that, keep getting better. We've can [inaudible 00:11:23], and yet not solve the problems of life expectancy gaps. And that required us to think about population health and community health and the geographic nature of it.

      So our work has been like, well, how do we think about going to solve for these complex problems that now have you have to go outside your doors to do that? It requires partnerships, it requires relationships, and it requires you really to focus on those drivers that are going to help you move the dial, move the needle on things as complex of life expectancy. So that became our challenge. The death gap, we named it not just quality and safety, but life expectancy gap is the problem to solve. To do so, we needed to name the root causes, just like you do a root cause analysis when something goes wrong in the hospital. Not because there's one root cause, there's obviously many root causes when something goes wrong. And the same in the community. But among the root causes we had to name, were structural, racism, economic deprivation, housing and these other things.

      And then saying, go around, go about now finding solutions in which we could only be a partner in. We don't believe that we alone can solve these problems, but we think we can help set the table to solve those problems. To do that work and to advance ourselves, we said we need to build this institute. And this institute can't sit within the university and it can't just sit within the health system. It's got to go across our system, but also then to be sort of the catalyst for doing this work in the neighborhood. So we created the generous donation from BMO Financial created this health equity institute, that's not only about solving the problem, but training the next generation of healthcare leaders who will help solve the problem as wealth.

      Dr. Omar Lateef (13:24):
      And Dr. Ansell, you hit on something so amazing there at the end is training the next generation of physicians in a medical humanity lens. And I think that's where we've been gapped in our country, and I think that's where we're measuring things inside four walls. And Dr. Nash, you're shaping young minds as not only the father of population health, but the founding dean there at the Population Health School in Thomas Jefferson. How are you seeing this being adopted and being understood for the next generation physicians in the US?

      Dr. David Nash (13:56):
      Yeah, it's a great question. It's not just doctors. Of course, nurses, pharmacists, social workers, because everything we do is a team sport. But you've hit on a very important issue for the future, which is for folks like Dr. Ansell and me, we're on the other side of the mountain. What we have to do as leaders is help train the leaders of tomorrow. So the Jefferson College of Population Health is the first such school opened in 2009, the year before Obamacare. I was lucky to be dean for 11 years.

      But the mission of the school is to continue to build a different type of leader for the future where the issues that Dr. Ansell and Dr. Lateef described about the social determinants of health, racial discrimination, putting these issues deeper into the medical curriculum, nursing curriculum and pharmacy curriculum. And we do that in all kinds of ways, online, master's degrees, the first such kinds of degrees in the country, relationships with many other schools, research in this area, our scholarly peer reviewed journal, our annual conference, my book, How Covid Crashed the System. I mean, this is a generational issue which we're not going to fix tomorrow, but we now have more than a decade of helping to create a different kind of leader for whom these issues are core part of their training.

      Sadly, however, medical education still is way behind and that's going to take additional work to get this into standard undergraduate and graduate medical education. But lots of schools of population health, departments of population health and incredible growth in our field, especially in the last decade.

      Brian Urban (15:58):
      Yeah, it's definitely changing for the better and I'm seeing that in my neck of the woods, and New England as well. And you can feel the change because it's needed and what's been highlighted from the COVID-19 pandemic. So let me shift back to Dr. Lateef and Dr. Ansell here. I want to throw out a stat and a question at the same time here. There was a report from McKinsey that went out in 2019. They found from their research that about 45% of individuals across various healthcare coverage types experienced at least one unmet basic need. Do you think that is going to change over the next decade? And do you think the Health Equity Institute that BMO is partnering with you all on, are you going to close that as a part of addressing the death gap, the unmet basic needs?

      Dr. David Ansell (16:51):
      There's been growing wealth inequality in the United States and certainly extremes between the top and the bottom. And the best literature suggests that when you fall between below median income, the social stresses on you and your family increase. And so the approaches to solving have to be comprehensive. I can tell you about some of the work that we are doing here in Rush. And so we have a university and it's got four colleges. And I just want to go back to the education piece. So we're integrating equity and training and how to address these kind of social needs into the curriculum across all of our colleges. The educators who put it together are calling them sensibilities, not just competencies. But how do you develop the skills to not only know how to ask patients about their needs, but how do you go about solving for them.

      The kind of social needs that people have, we must identify, and there is now a growing movement with Medicare, with CMS, and the Joint Commission and others, and insurance companies, that we should be screening for these nays. But closing the gaps are going to require different solutions. And some of the work that we're doing here is to adopt an anchor mission, which is to go beyond just the healthcare delivery aspect of our work, but really addressing those community determinants of health, those structural determinants of health that lead to social needs. We know that many of our patients have more than one social need. But if we can't begin to address those community conditions, and so we adopted an anchor mission. And that simply means that a hospital or health system, by its definition is a big employer. Multinational companies, they don't roll out of the neighborhood when the economic conditions change, but an engine for economic growth and wealth building.

      And so we have this a very attentional approach to our neighborhoods to hire locally and create career pathways into wealth, to purchase locally and support local businesses in their growth, particularly off of our supply chain. In the case of Rush, we're partnered with West Side United with five other health systems doing that simultaneous investing locally into interventions. Oftentimes, these are bringing capital resources to communities that lead to jobs and wealth creation while addressing health and healthcare needs. So we look at that as being sort of a simultaneous approach, and an approach that really all healthcare systems can take to improve the conditions in the neighborhood. Yes, we have to identify them at the level of the individual patient, do our best to solve them. But if we're going to close them, it's going to be sort of how can we as big companies improve the health of communities leveraging our business units for equity.

      Dr. Omar Lateef (20:11):
      The other thing I would add to that, Bryan, is that the reality is your question was, is it getting better? To simplify your question, is it going to get better in the next 10 years? One thing COVID did was called out a problem that all of healthcare and science knew existed for years. There were studies that showed an African American woman with breast cancer would have a much higher mortality than a Caucasian. We knew that. Was it front and center. Instead, we kept doing studies to see if it counted in other diseases. When the pandemic started, it showed the entire world in front of you in real time, and it showed Seattle, it showed New York, it showed Chicago, a mortality of a disease three times higher in the same city based on color. The question is this going to get better? If it doesn't, then we should all be ashamed because we saw the data in front of us in real time and we were able in real time to affect change by opening access.

      But the reality is the solutions have to come from more than a handful of health centers that believe that this is going to be important. It has to come from the totality of healthcare. And the totality of healthcare is beyond treating hypertension in an ICU. The totality of healthcare is ensure you have a stable job, a safe home, a place to work. We talk about new initiatives that rely on the internet. Not everybody has the internet. We talk about new initiatives that require cell phones. So the broader brush that we paint the future of healthcare has to include more than just hospitals. And the challenge that we have and what we've done at Rush was include those external partners to say, "Let's all be a part of this." So the way this changes in the next 10 years is if you stop leveraging the battered up post pandemic group of heroes, which are your frontline providers in every single healthcare system in America who can't by themselves solve inequity. You need an entire village to solve this problem.

      Dr. David Ansell (22:10):
      I think that's fundamental. I think there are, I must say, a handful of hospitals and health systems around the country that have led the way in understanding this, that the social and structurally terms of health are not going to get solved by just more healthcare, but a doctor on every corner. It's not going to happen. On the other hand, the belief the hospitals could do it alone without sort of a uniform response across both the private and the public sector is foolish. And so to an answer to your question though, it's not going to narrow unless we fundamentally double down. Hospitals have done heroic work to lead the way, but there's no way that we're going to sort of address the conditions which at that heart of these inequities are racial, historic racial injustices and gaps, but tied to poverty or not even just poverty, the difficulty it is to get above median income.

      And this is not just for black and brown populations. There are large pockets of white people in this country who have been suffering. The United States is the only developed country that hasn't seen life expectancy bounce back after 2020. In Europe with all the problems have in Europe and life expectancy bounced back, and is largely driven through social and structural conditions for which health and [inaudible 00:23:53] can contribute to the solutions, but alone can't solve for them.

      Brian Urban (23:57):
      And you bring up these amazing visions and it does take a collective effort and a matrix partnership. More healthcare isn't going to be the answer. That's going to lead to more challenges and burden for those that are on the front lines. And those are even at the strategic levels like you all now, trying to be able to fill gaps and create those new partnerships. So it seems as if we have no other direction, but to invest into a broad brush to be able to cover a lot of challenges that are seeing at the community level.

      And one thing that you touched on, Dr. Ansell, I want to get a little bit deeper and get some updates on the Health Equity Institute and your relationship with BMO, the workforce and development. So I've known only one other really rich well-working model, and that's with UPMC in the state that Dr. Nash and I share, even though he's in Florida right now. But when he is in Pennsylvania, they have a Pathways to Work programs similar to what Rush has done. And that's an example of one of many that need to be instituted, the health, the economics of a society. Because when there's downturns, those populations don't move out. They are stuck with those situations in trying to either get out of their situation or shift service to labor type jobs. So I wanted to get an update maybe on those pillars. And starting with Dr. Ansell, how is the workforce development program going or how's the community engagement program, any of the pillars that your Health Equity Institute touches, wanted to get the update in the last two years here?

      Dr. David Ansell (25:28):
      Well, it's predates two years ago. One of the first things we realized, we have the communities outside our doors, which one can look at the health outcomes and all of those details, leveraging epidemiologic data. We get quality data for the hospitals. But we actually have the community that's inside our doors. Our workers, many of whom come from these neighborhoods. And all we needed to do was ask them. And we named our internal community, our employees, as our first community. And we did listening tours of them as we did outside. And what people really wanted were pathways to growth. And you have an industry right now that's starving for workers, the healthcare industry, a lot of shortages, and there's going to be continued shortages.

      And historically, what you needed to do was get at a degree or advanced degree, it used to be when I started, you could get a nursing degree, certainly by going to a three-year school. So we're going back to this idea of stackable certificates and creating pathways that lead into wealth for not only incumbent workers, but for people from the community. This is such an important idea at Rush built into our work of the institute that every week we stand in front of a whiteboard and ask the question, what was the percent of local hires that we hired last week and is central to the work? And then we also measure ourselves against the local living wage, prevailing wage, to see how well are we doing as an organization on that. So we really take seriously the idea that as a big employer, our low lower wage employees need to have pathways to get into other careers.

      It's slow moving, it doesn't move as fast as we would like it. But we've had a great deal of success and it's a big focus of our work is this idea of healthcare jobs and pathways into wealth solving the problems for us, but also solving the problems for our first community and their family members.

      Brian Urban (27:47):
      And that's amazing because it shows how deep your roots are. You're invested and you see that turnover into valuing not only your community locally, but also your health system as well. It's just a beautiful cycle. And I'm interested, Dr. Nash, and then Dr. Lateef, I have a kind of compelling look into the future question for you. But Dr. Nash, let's talk about the influence of Rush Medical for moment. Who else has started to really adopt this type of playbook? And you're all over the coast. You're in California, just last month in Chicago and now you're in Florida and you do so many different conferences and talks. Who else is picking up this type of playbook across the US healthcare economy?

      Dr. David Nash (28:31):
      Yeah. Well, sadly it's a short answer, Brian. I think Rush sets a fantastic high bar example, but let's listen carefully to what Dr. Ansell ane Dr. Lateef have said. This is a 10-year journey or more that they have been on with multiple community-based organizations. So I think there are at least three challenges that I see. One, committed long-term leadership, people like Dr. Ansell working in the community. Two, collaboration with community-based organizations who in many cities, are fearful or worse as it relates to the hospitals. And then three, a sense of collaboration with other delivery systems. So the timeline, the collaboration both in the community and with other providers, this is a tough trio of characteristics to find in many other cities. It's a polite way of my saying, frankly, as it relates to the 150 academic medical centers in the United States, I have a hard time coming up with more than a handful that have achieved the kinds of results that West Side United has.

      Now, the good news that Dr. Ansell sort of alluded to, and I want to reinforce, soon, this won't be a voluntary activity, it'll be mandatory. Meaning these kinds of measures are going to be deeply baked into joint commission accreditation, evaluation measures, CMS measures, managed care measures. So we are headed to a world where hopefully, in our remaining lifetime here, it's going to be no outcome, no income. And included in those outcome measures will be the kinds of the leading equity-based measures that you're hearing in West Side United. So short answer, a handful of organizations with this level of commitment to the community. Better long-term answer, we won't have a choice.

      I think there's one other comment I'd like to make which is, look, places like Jefferson and Rush and all the other amazing academic medical centers that are the envy of the world, at this moment, every one of these places is hemorrhaging money. So in the post COVID era, what are we going to do with these places? What's the new model? And I guess for me, selfishly, personally speaking, what's our true North. If our true North is to improve the health of the population, well, I think you could argue based on the evidence that we have not done such a great job. So it's going to take leadership from the board down to chief executives to chief medical officers, and many other folks to say, "What's our true North?" We're going to look in the mirror and ask a very difficult question, especially in light of the financial pressures.

      So as we talk about in How Covid Crashed the System, we have to have different kinds of incentives so that when you ask a question three years from now, name many other places that are doing this, I'll be able to name them off the top of my head.

      Brian Urban (31:58):
      And I hope that vision comes true, and I share that with you as well, Dr. Nash. And even to what you're saying is if you're not prepared as a healthcare system or health plan up here at this time, you better get prepared because it's going to be a part of HAIs measures, it's going to be a part of value-based contracting, it's going to be a part of member satisfaction, it's going to be woven into cap surveys, and Medicare star ratings, everything across the board.

      So in thinking about that, I want to wrap our wonderful, well-rounded conversation with Dr. Lateef. I normally, Dr. Lateef ask our amazing guests to take a look in their crystal ball down four years the road here, five years plus. But it seems like really, if we're going to make a difference, it has to be incremental, year by year, 24 months at a time. So in a shorter span, what do you think the biggest impacts of the Health Equity Institute at Rush Medical Center are going to be for your staff, your patients, and your community? What do you think's really going to highlight the good work you're doing that's going to influence other healthcare systems to follow that path?

      Dr. Omar Lateef (33:10):
      Brian, I don't think there's a single program in any institution that's going to be the trigger for institutions to change. Either you're in or you've turned your head and you're missing out on everything that's there. The very fact that an institution has an institute around healthcare equity is the motivation for every institution in the country to do it. But what David said, which can't be understated, is that we're asking, challenge healthcare institutions right now that are literally over 80% of the hospitals in this country right now are losing money, we're asking those healthcare systems to build equity institutes that will net lose more. So it's the strategic decision and the wherewithal to say, we are going to take this fight that will lead to the change that we're going to have in the next five years.

      It's not any one program within it. It's the fact that we've developed programs and called it out, lifted it up to the level of the entire organization and said, this is what we're going to invest in. Anybody can invest in these challenges during amazing times in our economy. I think healthcare now has to show the grit over the next five years to continue investing in them, and one of the most important inflection points of healthcare in our nation's history. And so where I'm optimistic is we are living in a country with incredible innovation and spirit and one where grit has never been on the short end. But this is a time to pivot how we're taking care of patients, open up access and provide care for all people and treat healthcare as a human right. If we do that, it doesn't matter what program is in the institute, it's the themes of not just our institute, the Institute of Jefferson, and in every other organization in the country. You got to have the themes.

      Dr. David Ansell (35:04):
      [inaudible 00:35:04] did this. And I think Omar and I subscribed to this, is we signed up for this because we wanted to be be part of healing companies, companies that heal. The work of healthcare is to heal individuals, families, populations. To anyone believed that the way we're doing it now or have been done historically is the right way, I think that's where the innovation comes in. We know it's costly. We know we're getting the worst outcomes. We know the really stiff economic headwinds. We chose to do this as an organization and as, we say part of our DNA. But navigating from now to the future requires us to really rethink everything that we've made assumptions about, the nature of delivery and the nature of reimbursement. Because what we've seen is growing in this country is expansion of healthcare, largely Medicaid, the aging of the population, people like David and me who are going to live for a long time and be customers of these services.

      We have to really think back to the innovation. We have to just sort of say that the island we've been on may not be the island of the future, and it's going to be those leaders who do not give up their values, given these headwinds, but move into sort of the rethink, the way the delivery system has worked to serve the needs of everyone in the population that's going to make the difference. What does that look like? I can't tell you. I just know it can't be more of the same. That's all I know. And hopefully there's enough of us around this country, as Omar said, grit, innovation, determination, the ability to solve problems, that we can move ahead with this.

      We've seen examples of this in our work. There was a giant gap in breast cancer mortality in Chicago, and we decided to take it on simply by getting people around the region to begin to look at the quality of the care they were providing and then redesigning it. And redesigning, including multiple partners. And we saw the black breast cancer mortality drop. We think there are ways to eliminate or reduce the death gap, but it's going to require real forward thinking and not business as usual.

      Brian Urban (37:36):
      I love those final. So it takes a collective effort. It takes more than healthcare. It takes grit now more than ever for healthcare institutions to invest in health equity. But calling out large national health plans to be able to partner here, large pharmacy in the retail setting, pharmaceutical manufacturing, health tech, data suppliers, everyone can contribute to this space.

      And while we're at Dr. Lateef, Dr. Ansell, thank you for the final words. Dr. Nash, can you bring us home, give us some final words here and close us out?

      Dr. David Nash (38:13):
      Sure. I can't predict. There's no future in predicting the future. But imagine a world where The Death Gap and How Covid Crashed the System are required reading in every medical school, nursing school, and pharmacy school. Then I'll know that we have made some progress.

      Brian Urban (38:32):
      I love that. You could not end this conversation in a better way. I'm so thankful to Dr. Lateef. Dr. Ansell, and good friend, Dr. Nash, for coming on the Healthcare Rethink Podcast. And for more insights and excerpts from our show, please go to

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