Live from HIMSS with Geoffrey Roche

Jonathan Wilk (00:00:30):
Geoffrey, thanks for coming. You've been over at the Interoperability Showcase I think today, you've been at HIMSS. We were just both talking about how exhausting of a conference this is. It's my eighth. What number of HIMSS is it for you?

Geoffrey Roche:
This is my second HIMMS.

Jonathan Wilk:
Yeah, they get worse. They don't get better. I agree. I think it's neat. They're getting bigger and bigger. We're talking through just everything here. You've done a lot of work in the health equity space. We're going to talk about that today with FinThrive, and I want to hear about this role and actually the company a little bit. It's a cool name, Core Education PVC, like what's that and what have you been up to there?

Geoffrey Roche (00:01:00):
Yeah. Core Education PVC is essentially an operating partner to colleges and universities around the country. We're really working on their healthcare programs, really supporting workforce needs, really around the SDOHN making sure the workforce is a major part of what the college or university does.

Jonathan Wilk:
Cool. That's very cool. You're passionate about something called empathetic leadership, but I'll be honest, I consider myself a pretty smart guy, and I have not heard that. I've heard of Health IQ and EQ and those types of things, but talk to me about empathetic leadership.

Geoffrey Roche (00:01:30):
Yeah, I mean, so what you just said is kind of all connected. I mean, empathetic leadership is really the idea that as a leader, you're going to have empathy in everything that you do. And so regardless of the situation or the condition, you're going to demonstrate that to each and every person regardless of position.

Jonathan Wilk:
That's cool. That's very cool. You helped publish a report on disparities in the grand state of Pennsylvania. We are talking about Harrisburg. If you haven't been there, it's a wonderful town to go visit. It's very Norman Rockwell, I would call it. What was that report about? You partnered with a ARP I believe and did some work there. Let's walk us through that a little bit.

Geoffrey Roche (00:02:00):
Yeah, so that was during the pandemic, and actually we did a little bit of an update actually during it as well. That was a report actually that Drexel University with ARP, as well as several of us in the state that were leaders within the health equity space came together to really look at disrupting disparities. And actually we did a full release of that actually last fall where we looked at some of the urban, rural, suburban challenges. And obviously Pennsylvania is a state that had a lot of redlining, and so if you look at the redlining that happened, you can see the inequities are still in place today.

Jonathan Wilk (00:02:30):
Awesome. You discussed new competencies for the healthcare workforce to be culturally competent. You hear about cultural competencies at my hospital, we learned about that and being respectful to everyone's culture, just not your culture. And I think it's a sensitive topic. It's getting more and more with the DEI stuff and everything else, more I guess streamlined or mainstream, if you use that word. But what does cultural competency mean to you and what are you done to promote it in your travels?

Geoffrey Roche (00:03:00):
Yeah. So I mean, look, at the end of the day, to me, it really means that we're going to show respect, value, and appreciation for each and every person regardless of where they come from, what their culture is, their ethnicity. We are there to truly engage with them in a meaningful relationship. And so we really have to train on that because it's very different. And in our healthcare system, which has some systemic issues, we haven't really moved the needle in these areas, frankly.

Jonathan Wilk (00:03:30):
Awesome. What are opportunities and data with this? FinThrive is a data software company. We pride ourselves on having very, very rich data sets. I just talked to Alex Wendling at University of Virginia and his work that he did with Utica about using data sets to understand disparities in care be of these social vulnerabilities or neighborhood risk scores. Where do you see the role in data in a lot of the work you do?

Geoffrey Roche (00:04:00):
Yeah. I mean, data's huge as you know. And I think in health equity lens, I know in Pennsylvania, and obviously Dr. Rachel Levine was our Secretary of Health and obviously now is the Assistant Secretary of Health. And when Dr. Levine led our pandemic response, I served on her leadership team for that response. And one of the things we noticed, we didn't really have rich data to truly understand. Our hospitals were doing incredible work, but when it came down to it, we still didn't know what was the impact on the LGBTQ plus community versus another community. And so we have to really leverage data through every aspect of our healthcare system.

Jonathan Wilk:
Totally. Can you give me some examples of that data application? What types of things do you think are valuable from data inputs to drive a different output?

Geoffrey Roche (00:04:30)
Yeah. So if you look at an Epic or Cerner, just from the very foundation. You have SOGI, for example, as you know well. During the pandemic, we should have been able to leverage SOGI to really get a sense of how did individuals disproportionately are impacted just because of who they are. But we didn't have that opportunity because we weren't leveraging the data in our interoperability manner.

Jonathan Wilk (00:05:00Yeah. I was in a session a couple days ago and they talked about the Prepara template, which I hadn't heard about, and it's spelled with an A not an E by the way. And it measures these risk assessments. And I was talking with Alex in the podcast prior about... It sounds funny, but you don't ask someone that comes into a hospital, "Hey, you single." It's like something you hear in a bar, not at a hospital, but it totally makes sense, right? Do you live alone? Do you have a support structure? Do you own a vehicle? Those are pretty personal questions and you have to have a third party data set to help understand the whole picture and socioeconomic status and barriers to make sure that care is delivered equitably. Do you have a thought on that or-

Geoffrey Roche (00:05:30):
No. Yeah, I do. I mean, I think ultimately you're right. We've got to have that, and I also call that a connection between the social determinants and also the political determinants.

Jonathan Wilk:
Totally. Yeah, right.

Geoffrey Roche:
Because some places of housing are truly political. Some matters of zoning are truly political. And so I always talk about the political determinants as a connection today.

Jonathan Wilk (00:06:00):
Yeah. You're not going to sucker me in, I'm not going to talk politics with you today, but we'll certainly keep going here. What are some other opportunities and data to better understand health equity? You talked a little bit about, so SOGI and some of those measurement principles, but specifically have you seen in your ARP report or others, what were some specific things that actually changed behavior based off the data input?

Geoffrey Roche:
Yeah, so I'm sure at FinThrive, you're familiar with the health equity tracker out of the Morehouse School of Medicine.
Jonathan Wilk:
Yep, totally. Yeah.

Geoffrey Roche (00:06:30):
So that was a CDC funded Google project that I actually served as an advisor on, and one of the things that we learned in that project is you should be leveraging that across our country because you have country, you have nation, state, and you can even go down to the locality. Now, the natural opportunity is that we're not pulling all that in and actually putting together innovative plans to address health equity. That's the next step of this phase is really to leverage all that collectible data and actually put plans together to address it.

Jonathan Wilk (00:07:00):
Yeah, I was listening yesterday. There's a hospital in Texas in the Parkland area that is looking at something called NETS, Non-Emergency Transport Services. And they're not like 911 calls, which you can track, but these are people that need a ride to the hospital, either through an Uber or Lyft or even a medical ambulance that doesn't need an EMS person on it. And they're tracking how much it's used and the car densities in those areas to ensure that people get to care that they need. And they're actually talking to transport agencies, some of even the rural or urban transport infrastructure to say, "Hey, you might want to put a bus station there," or, "We need to talk about rail and making another stop," or, "We don't have enough vehicles to get folks where we're at." It really is a community type outreach, which I found fascinating. I think it's great. Where do you see policy or market forces hindering this? What's in our way? How do we get out of our own way without equity?

Geoffrey Roche:
Well, I mean, I think Congress is a great opportunity. I mean, I think if you look at it, we've made a lot of strides at CMS. We make a lot of strides at all these agencies. But then you have a change in administration and then you take steps back. And so at all levels of government, we've got to understand that health equity is about people. It's not about politics. It's not about what you identify. It's truly about people. And so we've got to move it in that way.

Jonathan Wilk (00:08:00):
Yeah, I think it's about wellness and healthcare. I think one of the things you'll hear me say is it's a sick care system right now, it's very episodic, it's very revolving door. It's like people don't really actively go to get well in the majority. It's kind of the exception, not the rule. And the system's not set up that way. It's very coin operated, for lack of a better way of putting it. And it's paid that way too. It's incentivized to perpetuate that door moving around, and we need to remove the door and make it more of a open lobby to where people can come in and out as they need to.

Geoffrey Roche (00:08:30):
And a great example of that is maternal mortality. I mean, to sit in 2023 and still have a true crisis in maternal mortality is a perfect example where we have not moved the needle.

Jonathan Wilk:
And life expectancy's gone down for the two years in a row, which is really scary. I was joking around with some of my colleagues at FinThrive. We got to reevaluate our 401k, and maybe we need to draw from that a little bit because it's calculated on a timetable that's a lot longer. How do you define health equity? Define it for me.

Geoffrey Roche (00:09:00):
Yeah, so I mean, obviously you probably have seen the iconic image. And to me, health equity, it really means that regardless of where you come from, from a culture, ethnicity, and you have an opportunity that you're going to have your needs met for who you are. And really from a healthcare perspective, obviously we know that there are some communities that are going to be disproportionately impacted just because it's systemically how they were raised, where they grew up, where they lived. And we've got to be able to create a system where they have a chance to be just as healthy as I do just because of who I am.

Jonathan Wilk (00:09:30):
Nice. That's awesome. That's awesome. You're over at the interoperability. It's hard to say. You're over at the interoperability showcase today. You're a HIMSS ambassador, you're doing it with a buddy. What's going on over there? What's that interoperability showcase doing? What are you guys doing?

Geoffrey Roche (00:10:00):
Yeah, there's some really neat projects. I mean, one, for example, you were talking about EMS. There's one over there that UMass did I, which actually was leveraging Fitbit and actually Apple Watch data and actually using it to leverage integration. And they were actually seeing the opportunity to leverage technology to improve one's health and actually have an individual literally get a call or a visit from a paramedic just on that data alone. So there's some really innovative technology, interoperability work occurring there and some stuff dealing with health equity.

Jonathan Wilk (00:10:30):
Nice. Very cool. Geoffrey's all over the place. You can tell he is passionate. He's a dad. He's got little kids that keep him busy. I don't know where you find your energy. It's awesome. Go check him out at the interoperability showcase today. Look him up, LinkedIn with him, figure out, keep doing what you're doing, man. I really appreciate the time that you've spent with us, and hopefully we'll get those folks in Washington to start supporting some of this stuff a little bit better, and we'll start seeing it as a benefit in all the health plans.

Geoffrey Roche:
Absolutely. Thanks for having me.

Jonathan Wilk:
Thanks for your time.

Geoffrey Roche:
Yep.