Health Equity is Science with a Moral Compass!

Brian Urban:

Yes, this is the Healthcare Rethink Podcast. I'm your host, Brian Urban, and today we are very fortunate to be having on our show, one of the leading chief medical officers across the health care ecosystem, SVP and Chief Medical Officer of BlueCross BlueShield Tennessee, Dr. Andrea Willis. Dr. Willis, thank you for joining our show here today.

Dr. Andrea Will:

Thank you so much for having me.

Brian Urban:

This is going to be a ton of fun. We've gotten to know each other a little bit before the show, but we're really going to take a deep dive into getting to know Andrea Willis. There's no better way to start a episode here on our show than to get to know you before the MD. You have amazing background. Georgetown University. You've been at BlueCross BlueShield Tennessee for over 15 years now. A lot of great projects you've been on, but take us back before all of that, before the title, before your work in the medicine field. Who is Andrea Willis? Let's start there.

Dr. Andrea Will:

Well, thank you so much for the opportunity for that because when I tell my story, I usually do start off with where I came from and that's Athens, Alabama. It was in Athens, Alabama that I helped my grandfather raise pigs growing up. He had had a stroke, so his grandchildren had to truly do the heavy lifting.

But the moment that I decided I wanted to become a doctor was when I heard this horrendous noise in a shack behind my grandparents' house. I didn't know what it was, but I went and looked and it was a mama cat who was in labor, and she was having a hard time. I didn't know what I was supposed to do. I'm like seven years old. So I ran into my grandfather's house, and I got dish washing gloves on and a pair of scissors. I don't know what I had planned to do, but I went back out there. The mama kitten was laying there. I started to massage the belly a little bit and out popped the kitten, and she only had one. I named that kitten Fluffy. That was my first patient, and I knew from there on I would absolutely be a doctor, so that's when my career started.

Brian Urban:

Wow. That is the roots of a personal story and a chief medical officer in the making if I've ever heard it, Andrea. That is beautiful. I can assimilate with the family roots there. Have a little farm now myself. We don't have any pigs. We do have cats roaming around so if I could pull from your experience in any way, I definitely will in the future.

But it's fascinating. I think what else is so fascinating about your story, fast forwarding a little bit here, is that you're not just a physician that has a great strong background in medical sciences and as a practitioner, you also have a public health background. When I see that, I connect with it immediately with my work and our work at FinThrive, but for you it's had to have shaped the way that you see individuals that BlueCross BlueShield Tennessee serves, and then also some of your strategies that you're building out with your programs too. I'm curious, Dr. Willis, how has your background in public health shaped some of those things I was mentioning and how you see the lives you serve today?

Dr. Andrea Will:

Well, thank you for asking that because I believe at BlueCross BlueShield of Tennessee that we have to see ourselves as a part of public health. We really are. I mean, because we have unique data that others out there don't have, and we want to be at the table. We really want to make a difference. Even with the training that I did at Johns Hopkins for my Masters of Public Health, Hopkins is embedded in a community that didn't always trust it because of research and things that have been done in the past. They talk about that as part of your experience there. I'm glad that that was rooted into me and then it makes me look all the way back to my upbringing in Alabama and the disparities that I saw there. Back then, I didn't know they were disparities, but as I've gotten training and education, I realize they were disparities.

Bringing that over into what I do now, I mean, I worked for the state before I came to BlueCross, and certainly we worked on a population health basis. When I walked in the door at BlueCross, I was always talking about we have to see ourselves as part of public health. We have a unique slice of data, a unique perspective that we should blend with the healthcare system, with the providers, with community-based organization. We all have a piece of the puzzle, and I've never lost that. I mean, there is something better than just science in my opinion. It's science with a moral compass. I think we have the opportunity to all be a part of what we can do for the greater good.

Brian Urban:

Man, I love that. Science with a moral compass. That's got to be the title of this episode here, Dr. Willis. Beautifully said, and BlueCross BlueShield Tennessee being a licensee of BlueCross BlueShield, it automatically makes me feel you're in the community. You're about community health first, the households and families that you serve above a lot of other big health plans that we talk to on our podcast. It comes off in a very authentic and natural way, and I think that's having a nice ripple effect across other health plans in the US as well.

It seems really that you embody advancing health equity from your background, not only academically but personally and then professionally and BlueCross BlueShield Tennessee as well in terms of some really cool projects you've had for a while now. One of them, I love this one, called The Power of We. It's a health equity focused scholarship program that I think you've had stood up since about 2013. This has impacted many lives, and I'm really curious what this has meant for you being a part of the program and the broader population of Tennessee in particular.

Dr. Andrea Will:

When we think about health equity, we really want to see representation in medicine. We want to see people that not only know the experiences but are willing to give back to the community and to address health disparities. I think it comes from a very powerful place, not only when you learn about it, but when you live through it. That's what's so important about these scholarships.

We've tweaked it a little bit this year. In previous years it was specifically for minority students going into healthcare. This year it's going to be for undergraduate and graduate students that have the mindset to influence health equity. It's very inclusive, and we love that because we love that it is focused on a mission.

I can tell you it is probably one of the better days of the entire year for the company. You love going to that presentation. You love to see the hope and the hunger of the students that are getting those scholarships, $10,000 each to those students. They can be a sophomore in undergrad or on up through graduate school, like I said, but they are truly, truly on fire for the mission of trying to give back to the community. We've had some to come back and tell us what all that they've done. They stay within Tennessee, but some of them even do mission work across the globe and come back and apply that experience in Tennessee. It is so powerful. It's hard to leave there with a dry eye, but knowing that you were just a little bit of that, that you made that investment that is paying back in dividends, it's a powerful day.

Brian Urban:

Wow. I love how you said that it's a day that everyone looks forward to in the calendar in a given year. I couldn't imagine the feeling and the power that has for someone to be a part of receiving a scholarship, but then also the support that you give. I would imagine a lot of great relationships have spurred out of these scholarships that you've been giving since 2013. A lot of these students at the time have graduated or gone on to maybe additional education or started to make an impact in the field so there's probably great relationships that I'm sure you've seen unfold through the years. It's almost like just growing a next generation of impact makers so that's probably a beautiful thing to see as well.

Dr. Andrea Will:

It really is. I can tell you I am humbled honestly, when they come back and they talk about what they've done because I think everybody has their own journey. Even though I'm all about population health, the way they envision that and apply that, it's just amazing to me. I am truly humbled to hear the stories.

Brian Urban:

Man, I love that. You are literally family by family, person by person, changing the next generation of people that'll hopefully contribute greatly back to population health, community health, healthcare in and of itself. That's just such a cool direct play that you're having, your team is having as well, Dr. Willis.

In speaking about advancing health equity, obviously BlueCross BlueShield Tennessee walks the walk and talks the talk. You connect those dots very well. In February of this year, you came out with your Health Equity Report. I thought this was a fascinating well-published report. I think a lot of other organizations across the region really admire the work put into this and the insights that have come out of it. A couple things struck me. One is the access to quality of care in terms of maternal health and then also childhood immunizations. Those are kind of the big drivers of a lot of downstream complexity in terms of healthcare, healthcare costs, utilization, trust with healthcare among certain populations. I'm curious of what you found interesting from that report that you can share with our audience here as well.

Dr. Andrea Will:

One of the things that we show in our Health Equity Report, we show some public data, so basically how Tennessean is faring in general. We get that from publicly available sources: the Tennessee Department of Health, the Sycamore Institute, other institutions like that. Then we look at our data, which shows of the population eligible for services if people are actually accessing the services. It's really interesting because sometimes you feel like, well, there's not that much difference between some of the demographics. We break it down by Black, white, Asian and Hispanic in our report. Sometimes you don't see a lot of differences between the populations, but then when you take that step back and look at the overall picture for Tennessee, the outcomes are very disparate. We're asking ourselves, "What's happening?"

Sometimes we do want to see people access more services. Prenatal immunizations is not high for any population. That was one thing. But when it comes to timeliness of prenatal care, then you start seeing there's a bigger gap between the white population and minority populations. We have to ask ourselves, "Why is that?" A lot of times we feel like, well, the providers are out there. Well, in some rural communities, not always, not as close as we would hope. But then even in more urban settings sometimes you still don't see people going into the doctor's office. Why is that? Is there a breakdown in the care that's being offered?

Access is not about just distance. It's about what can the people actually be involved in, a two-way street, a relationship with a provider where they feel like they're respected and they're heard. If they don't feel like that's happening, that's not access either. We're trying to make sure we do our part to promote culturally competent care and to make sure people do have really meaningful access. That's a big part of what we're trying to do as we partner with providers.

Brian Urban:

Really interesting that you called out the cultural competent piece, and then also barriers to accessing care could simply be something that we take for granted in our everyday lives of how we communicate with one another: tone, pitch, word choice, and how respect is found within general communications. That in and of itself could be a barrier to accessing care in terms of trust and also likelihood of seeking out help when necessary. That's fascinating.

I love the insights come from the report. I think a lot of our audience listeners here would find great value in accessing that report. I believe it's made public on your site, so I highly suggest everyone goes out there and looks through it.

Dr. Willis, I'm really curious of your time as a Tennessean, if I have it right ... You've been there and worked there and lived there for a long time. I've been to Tennessee many times, all corners of the lovely state. I think about the cultural diversity in terms of health literacy, relationship to food, activity, education. It's so vastly different across the state, Chattanooga to Memphis, Knoxville, Johnson City, Nashville, Franklin, it's all so different, not too, too far away from each other. I'm curious of what you felt and what you've observed with the lives you've served at your time at BlueCross BlueShield Tennessee, and how you're seeing the culture of Tennessee so unique and is that informing some of your strategies in the future? I'm really curious of your observations being in Tennessee and how some of those observations are turning into, I guess, helpful insights for strategies you're developing.

Dr. Andrea Will:

Well, obviously you have been to Tennessee because you nail so much even in that lead-up to this because people in Tennessee would tell you Tennessee is three separate states within one state, meaning the east is not like the middle and the middle's not like the west. There is so much difference there. For example, in West Tennessee really the maternal mortality and preterm births, those pop up big time. There was a time that West Tennessee, we had so much of that that it was likened to Third World countries. It was just that bad. In Middle Tennessee, that's where we're seeing a whole lot of innovation. But it doesn't mean the right people always get to the innovation. That's something that we have to watch there. Then in East Tennessee, I mean, we've struggled there sometimes trying to get home health services to people that need them. It is very different across the state.

I think one of the lessons that I've learned through doing this work, and even before this at my time with the state, is sometimes you can try to craft the best solutions possible and where you miss is when you go out to deploy, the community is saying, "Hey, you're not for us without us," meaning, "You need to hear our voices in this." Data definitely points you to what the problems are. But when you're trying the solution, you've got to definitely listen to the voices in the community to make sure that the solutions that are put together resonate with the folks that you're trying to help. That's been a big lesson learned, and I think they will definitely clue you into the culture that you need to respect to help the populations you're trying to serve.

Brian Urban:

That is as good ... It seems like it's a very intimate relationship that you have with those three different states within the State of Tennessee. You've found that the sentiment that you shared there, you're not for us without us. Having that two-way relationship that you're not only listening to your data, but you're listening to the individuals, communities, families, I think that goes beyond what a lot of BlueCross BlueShield entities across the US have done. Now we're starting to realize that you have to go deeper in the community, and you have to go beyond some of the services that you've had for many years.

Speaking of that, Dr. Willis, on the show here we face a lot of healthcare technologists, researchers, innovators, that are trying to help health plans across different lines of business, Medicare Advantage, Medicaid, commercial, everything in between, D-SNP, et cetera. What I hear all the time is there's a lot of great solutions, a platform for this, a data algorithm and model for this to point you into what interventions should be needed for what populations, et cetera. It's so many companies right now that are trying to help health plans. I'm curious of what advice you would give for any healthcare technologist or healthcare tech company or startup that's trying to help a health plan. What advice would you give them, and what challenges would you say a health plan across the US in general needs help with in terms of advancing health equity?

Dr. Andrea Will:

That is a great question. Honestly, yeah, we're hit up by innovators every day. Every day. It can be overwhelming so I'm always looking for what is the differentiator of the innovator coming to us, and what is the problem they're trying to solve. Sometimes I feel like I'm being told a solution to a problem I don't have. What is the problem that I'm trying to solve? We've put some data out there to help point to the problems. But I mean, they can always ask, "What is the problem you're trying to solve," instead of selling a solution that does not seek to solve the problems that we're actually facing or the community is facing more importantly.

The other thing is because we have disparate populations, I'm always wondering if their solution is tailored to help the disparate because if you help the most vulnerable, then you're really helping everybody. If they haven't looked at that, then I do actually have an issue with that.

Then the other thing that I really look at, are they ready to deploy? A great idea is great, but if you don't know how to connect and interact with the entities you want to partner with, that's a problem. For me, sometimes I'll hear a great idea, and then if we start talking about, "Well, how do we do the connectivity?" I have to bring the IT folks in from my side when we're trying to establish the connectivity. Sometimes I get like, "Um. Yeah, well, I don't know." Well, it's a great idea that sits up here on an island, but if I have to then ask my IT folks to do the heavy lift, then I'm not going to see the return on investment. I can assure you, my finance people will be looking on that if we're partnering with somebody.

I'd rather have somebody come that's done the homework of how do we actually connect if we decide to partner together versus we're going to have to build the connection because that's going to take at least a year in some cases before we ever get to the program that's being promised. Be ready to deploy. Do the homework on that.

Let's see. Niche solutions. Sometimes you need a niche solution for some things, but there are so many broad issues. If you're only helping me with one sliver of it, then it means I end up having to carve that sliver out, and I've still got the broad problems sitting over here. What is the applicability to the broader issues that we're facing? The other part about niche solutions, and sometimes you need them, I'm not knocking that, but what I don't want to do is fragment care. We really, really want comprehensive approaches when we can get them.

Brian Urban:

That is extremely helpful. A lot to take in. I think to break down a few things you had mentioned, one, make sure your solution is addressing a problem that actually exists that can be applied for us. Two, your solution, product, service model, platform, et cetera, better be addressing the needs of high-need populations, vulnerable populations because if you're not there, then it's not going to make sense for a lot of other populations it could be serving. Then also, how ready are you to deploy? If it's niche, how niche? Is it cutting things out and just replacing things that maybe are the same. How technically challenging is it for connectivity with your IT team as well to actually get it set up?

There's a lot to take in there. So do your homework healthcare, technologists, innovators, startups, and make sure you're prepared. I think that advice is so critical. Thank you for breaking that down. To take a look at what your work at BlueCross BlueShield Tennessee, and your team's work there will contribute over the next five plus years, I see so much contribution not only to Tennessee and the lives you serve there, but beyond. Can you give us some predictions of what your work and your team's work or even teasers perhaps will contribute over the next five plus years at BlueCross BlueShield Tennessee?

Dr. Andrea Will:

Well, we are looking for ways to institutionalize the things that we're talking about today. How can we build health equity into value-based contracts? That certainly, certainly lasts out there, and we want to see it last. How do you start building health equity more into the benefits that are offered? We definitely want to do that. We're working with a lot of community-based partners right now, so we're trying to make sure that they're in the fabric of what we do as well because we know we can't do everything, so we want to make sure we do that also.

Then I think there's some things coming down, some of it from the federal level that I think will help move some of us along in the same direction, and that's interoperability, making sure that all the patients have data right in their hands. Now, putting the data out there without the right education and context around it, we know there's some work to be done there. But since we know that's coming, we're already trying to shore up and make sure that we're ready to help walk people through that. I mean, that'll be a great thing to have. But again, that still is a learning curve, and we want to be there for that.

Brian Urban:

I love that. It's realistic, it's measurable, it's something that can be achieved and shared across the market as well. I am beyond thrilled to have had you on our show here, Dr. Andrea Willis. This has been so much fun. I feel a follow-up coming on, perhaps when you have some upcoming announcements and some big achievements you're ready to share. But until then, I'm so thankful that you were able to join our little show here today.

Dr. Andrea Will:

Oh, I think it's a big show because certainly the purpose is great. We appreciate the opportunity, you just don't know. Any platform where we can talk about this is great.

Brian Urban:

I love it. Thank you again so much. SVP and Chief Medical Officer of BlueCross BlueShield Tennessee, Dr. Andrea Willis. This has been fantastic. For more exciting insights and excerpts, please visit us at finthrive.com.